Women are sometimes offered a number of choices regarding breast surgery: breast conserving surgery (removal of the tumour), mastectomy with no reconstruction, mastectomy with reconstruction of the breast, or “going flat”. Going flat involves the removal of the other, healthy breast in a bilateral (both breasts) mastectomy, leaving a flat chest.
There are many reasons women may want to have a bilateral mastectomy, including:
- worry that the cancer might come back in the remaining breast
- not wanting to have ongoing mammograms on the remaining breast
- feeling anxious about doing a self-check or having a mammogram
- feeling lopsided with only one breast
- not wanting to wear a prosthesis
- preferring a flat-chested appearance.
The choice to go flat is an individual decision that should be discussed with your surgeon, who may want to talk through the following concerns with you:
- the likelihood of cancer returning or a new cancer developing
- possible complications from surgery to the healthy breast, resulting in delays to other treatments (e.g. chemotherapy).
- the surgery is complex and this may lead to delays in scheduling the surgery date.
- potentially regretting the choice of a bilateral mastectomy, especially when there is no cancer in the other breast.
Your surgeon may recommend that you have the initial surgery to remove the breast cancer, and then reassess your decision to go flat once you’ve had time to think through your options.
It is important to note that the risk of your cancer returning, or even a new cancer developing, is very small (unless you have significant family history), so this shouldn’t necessarily be the only reason to have the surgery. As with any surgery, there are risks involved, such as side effects or complications.
If you decide going flat is the right choice for you, your breast surgeon should respect and support your decision. They will want to have a thorough conversation about the procedure, to talk through any risks and make sure you have accurate information. If your hospital doesn’t offer this procedure, you can ask for a referral to a surgeon in another hospital.
It’s likely that the mastectomy will leave scars on the chest wall and these will thin and flatten over time. If you or the surgeon aren’t satisfied with the appearance of the chest wall, or if skin folds (commonly called “dog ears”) are an issue, then revision of the surgical site or scar can be carried out.
Webinar: A Tale of Two Reconstructions
Choosing what’s right for your reconstruction can be difficult, especially with the overwhelming choices, from implants to tissue transplants and immediate to delayed. Our webinar can help you figure out what’s best for you.
Watch: Considering reconstruction after breast cancer
Visiting French surgeon Krishna Clough discussed different surgical options in his talk at the 2016 Australasian Breast Congress Consumer Day.