Bias Towards Breastedness & The Future of Breast Cancer Care

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One year ago today I had my breast implants removed, making today my “Flataversary”. This is the most comfortable I have felt in my body since my double mastectomy in 2014. I walk through this world as a flat woman, not concealing or disguising, because arriving here was hard fought after 5 years of breast implant complications and surviving cancer.

I want to tell you why I am a “Flatvocate”, and what is so important about choosing to live flat out proud. I am planting a seed for the day you, or someone in your life hears that difficult news, because the staggering truth is that 1 in 8 women will get breast cancer in their lifetime.

Did you know women are routinely denied the option of choosing to go flat after a mastectomy by mere omission? Most surgeon’s will only discuss the ways in which you will reconstruct, at the expense of rearranging muscles and tissues, or inserting an implant -a foreign object that is making many women sick. This is another factor of fierce institutional denial and deserving of its own post. Reconstruction may result in tissue failure or complications. It is often a path that requires multiple surgeries and may impinge mobility and strength and sacrifice comfort. And all for what? For breasts with scant sensation, that likely won’t have nipples, that will be hard and cold? So you can make other people feel more comfortable? So you conform to a beauty standard that you had no part in writing and half disbelieve anyway?

Until the standard of care INCLUDES FLAT AS AN OPTION from DAY 1 of the surgical consult, and fully discloses all possible reconstructive complications, women like me will continue to raise our Flatvocacy voices. Dear Doctors, please stop forcing a breasted bias on us women who are fighting for our lives. How can a cancer patient make an informed and fully resonant choice when you don’t include all the options, and stand before her in open rejection and contempt for her desire for flatness? We see this bias towards breastedness play out as “flat denial” embedded in med school and carried out through surgical teams and medical device manufacturers. Reconstruction is big money, and rarely a one and done operation. When will we put women’s health and autonomy before profit?

If you have not lived inside of this choice, you will be SHOCKED to know that many women have experienced gaslighting and bullying by their medical teams. Some are forced to meet with therapists before making this choice for themselves like GROWN ASS WOMEN. Some have been denied flat closure, left with extra skin flaps “in case they change their mind”. I was told I would feel disfigured, that I’m “too young for that,” and I wouldn’t be able to wear a dress or find a swimsuit. I was told these things in 2019 and had to find another surgeon who would help me remove my implants. It is long overdue that the “standard of care” is updated, and that we see flat closure normalized as a viable option. We want to be visually represented alongside other post-operative photos on your surgical websites.

I plan on writing a letter to my flat denying plastic surgeon. I want him to know that I am still a vibrant, healthy, and strong woman. If this open celebration of FLAT OUT SEXINESS makes you uncomfortable, too bad. I’m not doing this for your viewing pleasure or approval. This is my reclamation. My sovereignty. And those of you facing cancer should know that you can still be feminine and sexy and strong, even after cancer takes and takes. You are not defined or limited by your loses and your scars.

I write this from my hetero-cisgender perspective, but this notion translates in all ways people are othered for non-conforming bodies. Might we all be healthier and happier when we free each other from our narrow boxes of what a gender conforming body must look like?

Listen, I celebrate human bodies in all forms, but you should know that reconstruction after mastectomy is not the real thing. That said, I honor all the ways women get to be embodied and feel healthy and whole, and if having breast reconstruction does that for you, go for it. Still, it will not prevent you from feeling loss and having your heart break a little. Whatever you decide, healing takes time and support. Support groups and supportive people have been invaluable to me. Reach out if you need help.

I am simply calling for fully informed consent and unbiased data-based options rooted in what is truly healthy for women. Thank you for reading.