Most Women Are Satisfied ‘Going Flat’ After Mastectomy, But Surgeons May Not Be Supportive of Decision

More women are opting to “go flat” after mastectomy—that is, opt not to undergo breast reconstruction surgery—according to a survey. However, not all women feel supported by their surgeon in this decision.

“Undergoing a mastectomy with or without reconstruction is often a very personal choice,” said senior study author Deanna Attai, MD, assistant clinical professor of surgery at the David Geffen School of Medicine at UCLA, in a press release. “We found that for a subset of women, ‘going flat’ is a desired and intentional option, which should be supported by the treatment team and should not imply that women who forgo reconstruction are not concerned with their post-operative appearance.”

To examine more closely how women feel about going flat, 931 women filled out an online survey pertaining to their satisfaction with mastectomy outcome and surgeon support for the patient experience. All respondents had a history of uni- or bilateral mastectomy to treat breast cancer or increased breast cancer risk without current breast mound reconstruction. Five-level scaled scores were used to assess outcomes.

Three-quarters of respondents said mastectomy alone was their first choice (73.7%). When asked why they chose to go flat, the main reasons were for a speedier recovery and to avoid a foreign body placement. Using a five-point scale, the mean satisfaction score was 3.72.

The most significant predictor for a satisfaction score <3, according to multivariable analysis, was a low level of surgeon support for the woman’s decision to go flat (odds ratio [OR], 3.85; 95% confidence interval [CI], 2.59-5.72; P<0.001). Additional factors associated with dissatisfaction were body mass index ≥30 kg/m2 (OR, 2.74; 95% CI, 1.76-4.27; P<0.001) and unilateral surgery (OR, 1.99; 95% CI, 1.29-3.09; P=0.002). Women who were less likely to be dissatisfied were those who received adequate information about their surgery choices (OR, 0.48; 95% CI, 0.32-0.69; P<0.0001) and who had a surgeon with a specialized breast surgery practice (OR, 0.56; 95% CI, 0.38-0.81; P=0.002).

Notably, despite the high satisfaction rate, a little more than a quarter of patients were unhappy with the appearance of their chest wall. According to Dr. Attai, some women reported that their surgeons left excess skin behind on purpose in case the patient ever changed her mind and wanted to undergo reconstruction in the future, even though this wasn’t what they agreed upon preoperatively.

“We were surprised that some women had to struggle to receive the procedure that they desired,” she said.

The study was published in Annals of Surgical Oncology.

“We hope that the results of this study will serve to inform general and breast surgeons that going flat is a valid option for patients, and one that needs to be offered as an option,” said Dr. Attai. “We also hope the results may help inform patients that going flat is an option, and to empower them to seek out surgeons who offer this option and respect their decision.”