In an online survey, around 74% of people who opted not to have reconstructive surgery after breast removal to treat or prevent cancer reported that they were satisfied with the outcome.

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  • Some people who undergo a mastectomy to treat or prevent breast cancer choose to undergo reconstructive surgery afterward. In contrast, others opt not to; a decision sometimes referred to as “going flat.”
  • A new survey indicates that about 74% of respondents who opted for “going flat” after a mastectomy are happy with their decision.
  • The same survey shows that 22.2% of respondents who had a mastectomy experienced “flat denial,” meaning that their surgeons disregarded or discouraged their wish not to have reconstructive surgery.
  • The survey results may help medical professionals better understand an individual’s potential choices following a mastectomy.

In recent years, advocacy groups have campaigned to increase awareness and acceptance among surgeons and those requiring a mastectomy of “going flat” — opting not to have reconstructive surgery after a mastectomy.

However, some surveys suggest that individuals who choose to have a mastectomy without reconstruction experience a lower quality of life than those who choose either immediate breast reconstruction or breast-conserving surgery.

A team of researchers led by researchers at the University of California Los Angeles (UCLA) suspected that the validated survey tool that surgeons commonly use to assess outcomes after a mastectomy is biased towards reconstruction.

With input from advocacy groups, they designed a new survey tool to assess peoples’ reasons for going flat, their satisfaction with that decision, and the associated factors.

The researchers also designed their survey to uncover concerns unique to these individuals but which other types of surveys do not capture.

The study appears in the journal Annals of Surgical Oncology.

Through online “going flat” communities, the researchers recruited 931 individuals who had chosen this surgical option and were willing to complete the survey.

The survey revealed that about 74% of respondents were satisfied with the outcome of their surgery.

“We hope that the results of this study will serve to inform general and breast surgeons that ‘going flat’ is a valid option for [some people],” says Dr. Deanna Attai, an assistant clinical professor of surgery at the David Geffen School of Medicine at UCLA, and senior author of the study.

“We also hope the results may help inform [people] that ‘going flat’ is an option, and to empower them to seek out surgeons who offer this option and respect their decision.”

The survey also revealed that 22.2% of respondents had experienced “flat denial” from their surgeons. This means that the surgeon does not initially offer it as an option, does not support a person’s decision, or leaves surplus skin — against their wishes — to facilitate reconstruction if they change their mind.

Flat denial was the factor most strongly associated with dissatisfaction with the outcome.

Respondents with obesity and those who only had one of their breasts removed were also more likely to be dissatisfied with their surgery.

Conversely, the respondents reported high satisfaction levels when they received adequate information to inform their decision and had a surgeon who specialized in breast surgery.

The new survey invited respondents to say why they chose not to have reconstructive surgery. Among the most common reasons cited were:

  • avoiding a foreign object in their body
  • lower health risks
  • lower complication rate
  • shorter recovery time
  • unimportant for body image

The support organization state:

“The decision to reconstruct or not is very personal. There is no ‘right way’ to approach mastectomy and reconstruction (or lack of it). There is only the way that is best for you, your preferences, and your healing.”

However, it notes that some people who decide against reconstruction, especially those with large breasts, overweight, or obesity, may be left with pockets of fat under their arms.

In addition, it says going flat may result in a “tab” of skin or fat or both that forms a bulge at the end of the surgical scar or under the incision.

The authors of the new study report that their research had some limitations inherent to all surveys of anonymous, self-selected respondents on social media.

The scientists were unable to verify the respondents’ identity or the information they provided about their treatment, for example.

All the respondents were also active in online going flat communities, which may have biased the results.

Finally, the authors note that the study did not fully represent individuals who are less likely to have reconstructive surgery following a mastectomy.

These groups include racial or ethnic minorities, older people, and those without private medical insurance.