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The Choice to Go Flat

By Erin Perkins

Read Erin’s TNBC diagnosis and treatment story: Walk Through The Hard Things And Keep Going

My best friend Maura holds all my memories. We met at age six when our second-grade teacher placed our name cards across from one another. The first thing I said to her was, “Your name is weird.” She then no doubt sassed me back, and we became fast friends—like sisters—now for 31 years.

Erin (right) with her friend Maura (left).

Maura and I spoke a few days before my bilateral mastectomy with aesthetic flat closure. We discussed her memory of when we began to develop breasts as young teens. She said, “You always hated them. It totally makes sense that you would not get implants.”

While I do not recall when my breasts came in, I can remember finding breasts annoying, like an added fatty component to my body that did not seem necessary to me. Though I did begin to understand their worth when my breasts became engorged with milk, so full that they felt like rocks, and I was able to nurse my two babies.

The last time Erin breastfed.

Also, there were elements of intimacy that made having nipples better than not having nipples. But as it came down to the impossible post-mastectomy decision to build new breasts likely without sensation or nipples, or just keep my chest flat without extra surgery or foreign objects in my body, I really had no personal reason left for building anything new out of what remained.

While this profound decision basically chose itself in my case, it was also not easy. I didn’t want to lose a part of me, or have to make this decision in the first place. I know I am not alone in that. Throughout this cancer adventure, I kept reminding myself to take a step back (and I want to remind you to do that now if you haven’t). Really take in the truth that what we go through with cancer is not okay. It can start to feel so normal—not always, but it can. You get into the groove of cancer life and you forget that you should not have to be in this situation, you should not have to be making the decision of whether to keep your breasts, receive radiation, and live with consistent scanxiety at every subsequent mammogram, or take one or both breasts off completely—an amputation—and then have to decide how and whether to rebuild them.

For me, I knew the aesthetic flat closure I expected to receive was not what I ended up getting the first time.

There were these pockets in the middle of my chest, at the end of each scar, that I have heard people call “booblets.” While that is a funny name, I knew I needed them gone to feel more like the self I was deciding to move forward, given the impossible choices I was facing because of my diagnosis. Erin’s original surgery results.

I had choices. You have choices. We deserve to love what we see when we look in the mirror, even after such loss. Also, I am happy to report that the scar revision was about a two-week recovery with a total of ZERO drains.

I wish I still had my breasts that grew in when I was a young teen. I wish they were saggy post-nursing, and that I had nipples and sensation. But those things were taken from me regardless of which surgery I chose, and now I am flat and nippleless. Even a year and a half in, it is still surreal to have a sensationless flat chest. However, I do still feel like myself, and because I advocated for a second surgery which my surgeon called a “mastectomy scar revision,” and because my good friend from college tattooed over my scars, I love what I see when I look in the mirror. Somehow, even in the pain of loss, I feel completely whole now; I feel authentically me, and full of so much gratitude.

Erin after her mastectomy scar revision. Her necklace was made with her breastmilk.

Whatever decision you end up making, friend, I want you to know that you have options to make the best you can out of an unfair situation. You can shop for surgeons, advocate for a plastic surgeon, and ask to see pictures of the closures your surgeon has done. You can request whatever feels most authentic to you, and decline whatever feels inauthentic.

If your surgery is first, before chemotherapy or radiation, you may not have a ton of time—but please know you still have choices. Don’t let your team pressure you into anything that isn’t right for you. If you do not feel whole post-surgery, see if there is anything that can be done, like my mastectomy scar revision surgery, or explanting, or fat grafting, or re-sensation, or tattooing, or nipple tattooing.

Erin’s chest tattoo, featuring lyrics from from the song “Cattail Down” by mewithoutYou. Along with the flower to represent each birth month, the lyric “you’re everyone else” is a reminder that we are each other. None of the suffering makes sense. All that makes sense is that we are connected.

Before surgery, I encourage you to take a picture, whether professional or not, of your body as it was before. I encourage you to check out the Treasured Chest Program by the Keep A Breast Foundation. They will send you materials to create a cast of your chest to keep as a memory. Mine was sent to me by a dear friend the night before my mastectomy, done by my husband and I, and painted by me and my beautiful artist friend Heather on a getaway months later. It’s on display in my living room. There’s something soothing about having it; about remembering who I was, and who I am still.

Thank you for sharing your story, Erin. SBC loves you!

Learn more:

Aesthetic Flat Closure and Flat Denial

Informed Decision Making About Going Flat

Flat and Sexy

Breast Cancer and Intimacy

Going Flat and Explant Surgery

3D Areola Tattoo: Everything You Need to Know

Walk Through The Hard Things And Keep Going Resources & Support:

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