One in eight Australian women will be diagnosed with breast cancer in their lifetime. For around 40%, treatment will involve a mastectomy — the surgical removal of one or both breasts. For some, reconstruction follows. Others, however, choose not to rebuild. They “go flat.”
A growing number of women are choosing to forgo breast reconstruction after mastectomy — opting instead to live flat-chested. Yet until recently, their experiences remained largely underrepresented.
That’s changing, thanks to new research from Flinders University that lifts the voices of 460 Australian women who chose “flat closure”, either unilaterally or bilaterally.
The study found 92% of respondents were happy with their decision to “go flat”. But many also reported feeling pressured by medical professionals to reconstruct, with one in four saying they were second-guessed — even after surgery. A third felt their healthcare team was biased towards reconstruction.
“Thousands of Australian women undergo a mastectomy in Australia each year but there has been very little research into the experiences of those who choose to go flat,” says Dr Fiona Crawford-Williams from the Cancer Survivorship Program, who led the survey.
“By hearing from those who have had to make this decision, I hope we can help bring about change, working together with breast care nurses, surgeons, and other healthcare professionals. A well-informed person can’t make the wrong decision.”
Robyn Smith, co-researcher and co-founder of Flat Life Australia, says the data indicates that healthcare providers and support services must “do better” by their patients in providing unbiased information.
“During our research, we discovered many flat women are routinely asked at follow-up consultations whether they’ve changed their mind about reconstructing their breasts, despite being satisfied with their choice to go flat,” says Smith.
“This research data shows the Australian healthcare system needs to better support women so they can make informed decisions about their mastectomy and outcome. This is one of the most personal decisions a woman can make, so let’s give women access to unbiased and informative resources.”
Co-researcher, breast cancer survivor and flat advocate Melanie Law said she was disappointed that women are not being supported to make their own informed choices about their bodies.
“Healthcare professionals come into our lives at a vulnerable time, when we need their skills, knowledge and expertise; however, we live in our bodies beyond those discussions and need to make the right long-term decisions,” says Law.
Perhaps most disturbing are accounts shared by women in the study who were denied flat closure unless they passed a psychological assessment — a practice co-researcher Joanna Atzori says is deeply inappropriate.
“As advocates and researchers, we question why any other person or healthcare provider – male or female – would feel they have the right to interrogate patients and question their psychological and mental state of mind when requesting flat reconstruction,” says Atzori.
“If the patient is clearly stating how they want their body to look, feel and function after mastectomy, nobody else has the right to comment or put forth their personal biases or social beliefs about that patient’s wishes.”
The study’s findings are a clarion call for change. At the heart of it is a plea not just for choice, but for respect — and for women’s decisions about their own bodies to be met with dignity.
“Our research shows going flat was the right decision for most women who chose that path and therefore it should be equally presented and supported for those going through this life-changing decision,” says Dr Crawford-Williams. “Patients deserve to have their voices heard when asking for flat closure surgery, not asked to explain themselves or defend their decision.”
These findings are published with Flinders University.