Risk Management & Treatment

Going flat

Choosing to go flat or to have reconstruction is a very personal decision. Some people choose not to reconstruct for the following reasons:

  • they want to avoid additional surgery.
  • they want to return to their normal routine as quickly as possible.
  • are comfortable with the idea of a flat chest.
  • are undecided about reconstruction at the time of your mastectomy.
  • have a health condition that precludes additional surgery.
  • need radiation after your mastectomy. (If you want to have reconstruction after radiation, your plastic surgeon can insert and inflate a tissue expander after your mastectomy to preserve your breast skin and shape for later reconstruction—this is called a “delayed-immediate” procedure).

If you choose to go flat, the breast tissue and most of the breast skin is removed, leaving the chest flat or slightly concave. The incision will typically run across the middle of the chest. It may be possible for you to have nipple sparing mastectomy, even if you choose not to reconstruct. Make sure to ask your surgeon for an "aesthetic flat closure" as defined by the National Cancer Institute so they understand you want a smooth, comfortable flat chest with no extra skin left behind.

You can change your mind about going flat and undergo delayed reconstruction with tissue or implants at any time in the future.


Using prostheses

Some women who go flat like to wear breast-shaped forms (prostheses) that are adhere to the chest or can be tucked into specially made bras, camisoles, lingerie and swimsuits to temporarily restore their natural shape and profile. Prostheses come in a variety of shapes, sizes, textures, weights and with or without nipples. Customized silicone prostheses are the most realistic and the most expensive. Prostheses can be especially helpful after unilateral mastectomy to better fit into clothing and restore balance. A qualified fitter can help you find the right prostheses that fits your chest properly.

find-support

People making decisions about going flat after mastectomy can find peer support through the following resources:

paying-for-service

The Women’s Health and Cancer Rights Act (1998) requires most employer and group health plans that pay for mastectomy to also pay for prostheses (with a doctor’s prescription). Most insurance companies follow Medicare coverage amounts, which includes:

  • As many mastectomy camisoles as are medically necessary, but not more than 3 per month.
  • 1 foam breast form (2 for bilateral mastectomy) every 6 months or 1 silicone breast form (2 for bilateral surgeries) every 2 years.
  • 4-6 mastectomy bras annually, or as many as are medically needed as indicated by your doctor. (Additional bras may be prescribed as a result of surgery and/or loss or gain of weight.)
Last updated September 28, 2020