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opinion

Ellyn Winters is the president of the marketing firm Ignition Communications and a breast-cancer patient.

On May 31, 2022, I underwent a double mastectomy for breast cancer, opting for something called an aesthetic flat closure. I do not plan on reconstruction.

In other words, this former D-cup is now as flat as a pancake.

Only officially adopted by the U.S. National Cancer Institute as a defined medical term in June of 2020, aesthetic flat closure is a single surgery option that leaves a woman postmastectomy with a perfectly flat chest. This is in contrast to a standard mastectomy, where extra skin, fat and remaining breast tissue are left in place, allowing breasts to be reconstructed in the future. In the opinion of this “flattie,” it is a reconstruction alternative deserving of more awareness, attention and acceptance by the medical community and society.

Breast cancer is the most common form of female cancer, affecting one in eight women. This year 28,600 women in Canada will be diagnosed with the disease. Six thousand of those will undergo some form of mastectomy. Approximately 12 per cent will undergo a double mastectomy, where both breasts are removed. Thirty per cent of women like myself, with cancer in a single breast, will choose to remove both.

When I first met with my surgeon, we discussed a variety of reconstruction options. Due to the size and distribution of the tumours in my left breast, a lumpectomy was quickly ruled out. But there was the possibility of an oncoplasty, where my surgeon would work hand-in-hand with a plastic surgeon to remove the cancer and remake me a pair of smaller boobs. If radiation was not required, a mastectomy with immediate reconstruction using implants was also on the table. Alas, a subsequent MRI revealed yet another tumour, and a mastectomy with deferred reconstruction was the only pathway forward.

So, in good Canadian fashion, I opted for a double-double.

I’ve fielded a lot of questions from friends and family over my decision to remain flat. While over the past decade, reconstruction options have greatly improved for women who undergo a single or double mastectomy, it is still a long and challenging journey, involving multiple surgeries. My surgeon explained that it was likely I would require radiation as part of my treatment protocol, so this meant any reconstructive surgery I might contemplate would be at least a year away to allow me to heal.

Women of a slender build like myself have additional reconstruction challenges.

The trend today is toward the use of natural tissue in breast reconstruction. It allows for a more natural feeling breast. But that tissue has to come from another part of the body. Not to brag, but I had no tummy to tuck or derriere to lift. So the only option would have been to use my latissimus dorsi (lat) muscle in my back. Even if I opted to use implants, the muscle tissue would still need to be used to “wrap” the implant and prevent rejection. Fitness is a big part of my life and essential for my mental wellness, so the choice between losing a key back muscle and my functional strength or my breasts was a no-brainer. After two years of life on hold because of a pandemic, and the better portion of this year contending with a cancer diagnosis, I had little appetite for spending the next two years trying to rebuild my lost breasts.

It is a small, but growing movement of women who opt for aesthetic flat closure. Approximately two thousand flat closures are performed each year in Ontario, and about one out of seven women in the province having breast-conserving surgery or mastectomy choose the procedure. U.S. research shows that nearly 75 per cent of women surveyed who opted for mastectomy without reconstruction were satisfied with the results, but almost 25 per cent said their decision to go flat was not supported by their surgeons.

I was introduced to the idea of going flat by a friend and fellow breast cancer survivor. She is currently considering going flat as her 12-year-old implants are now reaching the end of their lifespan, deteriorating and must be removed.

When I raised the idea of remaining flat to my surgeon, I was comforted to know he was familiar with the surgical procedure. He was receptive to my questions and did not oppose my desire to be “one-and-done” with surgeries. I count myself lucky he did not subscribe to “flat denial,” a situation where a surgeon overrules the patient’s desire and proceeds with a more traditional form of mastectomy, where the skin is preserved “just in case” the patient changes her mind.

He did a beautiful job of surgery. I have healed quickly and I’m very pleased with the outcome. In fact, I gave him a big hug in our last meeting together.

I’ve been less impressed, however, with the way society and the fashion world regards “flatties” who have opted to have one or both breasts removed and who do not pursue reconstruction. I have quickly learned the word mastectomy is heavily loaded with preconceived notions about female beauty and the role breasts play in shaping our feminine identity.

I’ve always been a clothes hound. I have a closet full of fashion. Winners and Nordstrom Rack love to see me coming. Before my surgery, I searched the internet for clues on how to dress postmastectomy. To my distress, much of the information that came back to me focused on concealment. I was told to wear patterns, avoid spaghetti straps and low necklines and hide my newly flat chest under scarves. Mastectomy bathing suits and bras all looked like something my granny would wear. And my granny is dead.

I have to admit and it sounds very shallow, but I grieved more about the thought of giving up my newly purchased summer 2021 bathing suits with their plunging necklines than I did the thought of losing my boobs.

I called my local lingerie store to see what my options might be. She thanked me for my patronage, but it was like a breakup call. I was referred to a boutique that specializes in mastectomy fittings.

I reached out directly to some of my favourite fashion brands for their recommendations. These are women-run companies espousing inclusivity and female empowerment. The suggestions that came back to me either assumed I’d be wearing foobs (breast cancer lingo for fake boobs) or that I would want to conceal my flat chest and its battle scars under high necklines, loose-fitting tops and ugly patterns. I sent an impassioned note to their chief executives pointing out the missed opportunity to embrace mastectomy survivors by offering feminine and more revealing options that celebrate rather than conceal our unique form of beauty. I’ve had no response.

Breast cancer is a cruel thief. It tries to steal a woman’s femininity. It can rob you of your breasts, your eyelashes, your eyebrows, your hair. Of all women, survivors of this disease and those who undergo a mastectomy deserve to be celebrated for their strength, courage and beauty. There is something wrong with society’s deeply misguided 1950s-like notion that women who have lost their breasts to cancer are less than and should be consigned to some boobless boneyard. I find it quite ironic that today’s fashion ideal – found in nearly every magazine campaign – is a slender flat-chested model. I guess only those born that way count.

I have had several heartbreaking conversations with women who have opted against reconstruction. Some are ashamed of their new body. They are frustrated by the lack of fashion and lingerie options. They hide their flat or single-breasted appearance under vests and loose-fitting tops. They are traumatized by their loss and societal expectations around the necessity of breasts provide little comfort.

The thing is, as a newly minted flattie, I feel no such shame. I feel sexier and more empowered now than I have in my entire life. I am living out my, and many women’s, worst nightmare and I’m not just getting by. I’m thriving. I’m strutting. And I’m making bolder and more daring fashion choices.

I want the world to know I am not going to hide my breastless body. I am going to wear my shirts buttoned low. Those bathing suits with plunging necklines look spectacular on my flat physique. I haven’t cast off a single article of clothing from my closet. And I’m on the hunt for lacy, sexy lingerie – if I can find it. And I will wear it all proudly as I brave the chemo and radiation that come next to save my life.

Of course, I would have preferred not to have developed breast cancer or lost my breasts at all, but remaining flat after my double mastectomy was my decision. I appreciate it is not the same for everyone. Breast cancer, surgery, treatment and reconstruction, I am learning, is a unique journey for every individual. I have respect and admiration for everyone who walks this road and the choices they make. But whatever their decision might be, women in the breast cancer community have been through enough. We shouldn’t have to live in shame or hide from our reality to conform to others’ expectations of what beauty should look like.

We are more than enough just as we are.

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