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A happy choice for some women: 'going flat' after mastectomy

Women are embracing mastectomy without reconstruction surgery, otherwise known as “going flat.” And most patients who only undergo mastectomy are pleased with their results, according to new research published in Annals of Surgical Oncology.

The finding is in stark contrast to previous studies showing lower quality of life for women who forego breast reconstruction surgery after mastectomy and blows the lid off bias around reconstruction surgery.

“We found that for a subset of women, 'going flat' is a desired and intentional option, which should be supported by the treatment team and should not imply that women who forgo reconstruction are not concerned with their postoperative appearance,” senior author Deanna Attai, MD, assistant clinical professor of surgery at the David Geffen School of Medicine at the University of California, Los Angeles, said in a statement.

To better understand motivators for foregoing reconstruction surgery, Attai and colleagues surveyed 931 women who underwent a mastectomy in one or both breasts after a breast cancer diagnosis or for preventative measures. Researchers also sought to gauge if the respondent’s surgeon provided sufficient information about “going flat” or if the surgeon was supportive of the decision to opt out of reconstruction surgery.

A whopping 74% of survey respondents chose to have a mastectomy with no reconstruction, and were satisfied with their outcomes and generally happy with their appearance. The top reasons for “going flat” were:

  • Avoidance of a foreign object in the body

  • Lower health risks

  • Lower complication rate

  • Shorter recovery times

Cost was not a major factor among most respondents. Only 14% of patients reported direct or indirect costs as a reason or one of the reasons to go flat.

Strikingly, 22% of respondents were subject to “flat denial,” where surgeons either advised against going flat or outright refrained from offering no reconstruction; their surgeon was not supportive of the decision to go flat; or the surgeon intentionally left additional skin post mastectomy in case the patient changed their mind.

"We were surprised that some women had to struggle to receive the procedure that they desired,” Attai said.

Patients were more likely to be dissatisfied with their surgical outcomes when faced with flat denial. Surgeons should be aware of the negative impact of the lack of communication about going flat.

"We hope that the results of this study will serve to inform general and breast surgeons that going flat is a valid option for patients, and one that needs to be offered as an option," Attai said. "We also hope the results may help inform patients that going flat is an option, and to empower them to seek out surgeons who offer this option and respect their decision."

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