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Going Flat after Breast Cancer Surgery

Posted 11/8/2016

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  As is obvious, I am back. We actually arrived back in Boston yesterday afternoon, but the day was consumed by unpacking and picking up the dog and laundry and going through the mail. You know the drill.This morning I awakened with an intense pleasure that it is Election Day AND (please excuse my politics), I am voting for a woman to be President of the United States. The insanity of this long campaign has somehow forgotten this historic fact, but it is a big one. My suffragette grandmother would be thrilled. As am I. 

  And this seems like an excellent topic to consider on this day of women's empowerment. As you likely know, the rate of mastectomies (including bilateral ones) has been rising as has been the rate of reconstructions. In many hospitals, including, sadly, this one, the standard dialogue between a breast surgeon and a new patient goes something like this: "I am sorry that you need to have a mastectomy, but you can have reconstruction at the same time." Yes, it is wonderful that is an option. But it is one of the possible options, and the other one, to forgo reconstruction, is often not mentioned.

  Finally there is some push back as this terrific article from the New York Times describes. If you are interested, there is also an excellent website

Going Flat’ After Breast Cancer

Before Debbie Bowers had surgery for breast cancer, her doctor promised that insurance would pay for reconstruction, and said she could “even go up a cup size.” But Ms. Bowers did not want a silicone implant or bigger breasts.

“Having something foreign in my body after a cancer diagnosis is the last thing I wanted,” said Ms. Bowers, 45, of Bethlehem, Pa. “I just wanted to heal.”

While plastic surgeons and oncologists aggressively promote breast reconstruction as a way for women to “feel whole again,” some doctors say they are beginning to see resistance to the surgery. Patients like Ms. Bowers are choosing to defy medical advice and social convention and remain breastless after breast cancer. They even have a name for the decision to skip reconstruction: They call it “going flat.”

“Reconstruction is not a simple process,” said Dr. Deanna J. Attai, a breast surgeon in Burbank, Calif., and a past president of the American Society of Breast Surgeons, adding that more of her patients, especially those with smaller breasts before diagnosis, were opting out of reconstruction. “Some women just feel like it’s too much: It’s too involved, there are too many steps, it’s too long a process.”

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