"Best for Me": Decision-Making and Medical System Interactions When Going Flat After Bilateral Mastectomy

A growing number of young breast cancer survivors are seeking information about surgical options after bilateral mastectomy. This study explores the factors influencing decision-making and interactions with the cancer care system among young breast cancer survivors who went "flat," or pursued aesthetic flat closure (AFC) post-bilateral mastectomy.

Eighteen breast cancer survivors in the United States diagnosed before the age of 45 who had aesthetic flat closure completed semi-structured interviews. Verbatim transcripts were analyzed using Interpretative Phenomenological Analysis.

Eighteen survivors (average age 39 years) completed interviews lasting between 54 and 88 min. Eight themes about factors that influenced decision-making were identified: centering self or romantic partners' perspectives; emphasizing body functionality, faster recovery, and fewer surgeries; viewing flat as the safest, healthiest, and most natural option; negatively experiencing breasts; questioning the purpose of breasts; benefiting from transgender liberation; serving as a role model; and treatment information gathering and self-advocacy. Regarding medical system interactions, the data revealed themes of assuming reconstruction; infantilizing survivors; dehumanizing survivors; gender-affirming surgeries advancing surgeons' skill sets; and supporting, communicating, and collaborating.

Young survivors, who opt to go flat, prioritized functionality, faster recovery, and freedom of bodily autonomy and gender expression over societal beauty standards when making post-mastectomy surgical decisions. Survivors frequently had to advocate for AFC as a treatment option. These findings highlight the need for providers to present a range of affirming and accessible post-mastectomy treatment options. To improve young survivors' cancer care, providers can promote bodily autonomy and include AFC when presenting treatment options.