Going Flat

Discussions about whether women should have breast reconstruction after mastectomy are like politics: everyone has an opinion. Wander around the Internet and you’ll find blogs against reconstruction, arguing why women should stay flat after mastectomy. You’ll also find the polar opposite view: strongly-worded positions in favor of breast reconstruction.

We are all different

We all have our own goals, varying likes and dislikes, and personal opinions of what is right for each of us. Some feel the breast reconstruction journey is well worth the effort, and that is fine. Others consider it a risky waste of time and effort, and that is also fine, because what is right for one isn’t necessarily right for all.

Going flat

Like reconstruction, going flat is a personal choice. You may prefer to forego reconstruction if you:

  • want the simplest mastectomy and the quickest recovery.

  • don't want breasts that aren't "real" or don't have full sensation.

  • don't want implants or additional scarring.

  • don't consider a flat chest to be a significant change from your natural breasts.

  • fear potential complications or unsatisfactory results of reconstruction surgery.

  • want to try going flat before committing to reconstruction.

  • are unsure about having reconstruction at the time of
    your mastectomy.

  • have a health condition or pending treatment that precludes having reconstruction.

What to expect

If you don’t have immediate reconstruction (at the same time as your mastectomy), your surgeon will make an incision across your chest, remove the breast tissue and excess breast skin, usually including the nipple and areola, and any previous biopsy scars. The incision edges will then be pulled together and closed.

Going flat isn't something someone should talk you into or out of. Go with your gut, and do what you feel is best for you.

The Goldilocks Mastectomy

If you don't want reconstruction but also don't want to be completely flat after mastectomy, the Goldilocks mastectomy
might be just right for you. In this procedure, after the breast tissue is removed, the surgeon creates a small breast mound
with fat remaining under the breast skin.

Women with large breasts (and more fatty tissue) tend to have better results.

Not all general surgeons or breast surgeons perform this procedure, so be sure to ask about this during your consultation.

If you change your mind about reconstruction, your breasts
can be recreated at any time in the future. Although your mastectomy scar will remain on your new breast, it will
fade in time.

Either way, the choice is yours.

Aesthetic flat closure

Before your surgery, it’s important to speak with your surgeon about how your incision will be made and how your chest will look after your mastectomy. Request an aesthetic flat closure. This means that excess skin and fat in the chest will be removed during surgery, and the remaining tissue will be tightened, leaving a smooth, flat chest.

It's best not to assume you'll get an aesthetic flat closure without asking. Before your mastectomy, be very clear about what you want. Ask the surgeon:

  • about their specific experience performing aesthetic flat closures. How many have they performed?

  • to show you their patient photos of aesthetic flat closures.

  • what they do to prevent lumps of excess skin and "dog ears" (puckers of skin at the ends of an incision) and provide an even, smooth chest contour.

Some women report that even after requesting an aesthetic flat closure, they awoke from mastectomy to find their surgeon left uneven incisions, puckers, excess skin, and/or dog ears. This "flat denial" happens when a surgeon disregards a patient's explicit request for an aesthetic flat closure after a mastectomy, "just in case" the woman changes her mind about later reconstruction.

The goal of mastectomy is always to remove as much breast tissue as possible, whether you do or don't have reconstruction.

Breast prostheses

Breast prostheses are manufactured breast-shaped forms that temporarily restore shape and profile. Available in many shapes, materials, and sizes, they adhere to your chest or fit into the pockets of special bras, lingerie, swimsuits, and camisoles. If both of your breasts are removed, your new “breast” size is limited only by the prostheses you choose.

Unilateral mastectomy presents a more
practical problem. Because one breast is missing, you may feel unbalanced or lopsided and find it difficult to fit into clothes. When you’re dressed, one side of your chest will be flat; if you wear a bra, one cup will be empty.


You can balance your remaining breast and regain symmetry with a weighted prosthesis that will provide balance and help you to
maintain proper posture. (Weighted prostheses aren’t necessary after bilateral mastectomy because your chest, although flat, is balanced.) If you’re undecided about reconstruction or you need to delay it until you complete treatment, a prosthesis can also serve as a temporary breast during the in-between interval.

It’s a good idea to be measured by a certified fitter to ensure the prosthesis fits properly and isn’t too light or too heavy. Try different
styles to see which ones look and feel the best.