Choosing to be flat and fabulous after breast surgery

Darlene Hoyt of West Yarmouth had never heard of the “Flat and Fabulous” movement, but after deciding against breast reconstruction following her mastectomy six years ago, she says being flat has been fabulous for her.

“Interestingly, I only became comfortable with my body after I had the breasts removed at age 64,” Hoyt said, “because I finally let go of everybody’s expectations.”

She recalled Sarah Swain inviting her to a class she taught at Total Body Dance. Hoyt said, “I’m going to show up flat.” “Great!” Swain answered.

Hoyt said that was a defining moment for her because Swain, founder of the popular and innovative Cape Wellness Collaborative, has been her hero for a long time. Swain’s immediate acceptance and enthusiasm made a difference for Hoyt.

About 18 months after her mastectomy, Hoyt said she stopped wearing her breast forms. She felt no need for them anymore, having accepted herself and realizing she was now comfortable with her body and herself.

“I’d say I was uncomfortable with those breast forms when I became comfortable with myself,” she said.

Hoyt and her breast surgeon, Jill Oxley, MD, want women to know there are options and that breast reconstruction is a very personal choice.

Dr. Oxley, medical director of breast services for Cape Cod Healthcare, who practices at Cape Cod Healthcare Breast Surgery - Hyannis, helps educate patients about their options and supports their choices.

“I tell my patients it’s a personal choice to have reconstructive surgery or not. It’s not a good or bad thing from a cancer standpoint. Having reconstructive surgery does not affect the way your cancer is treated or affect a person’s chances of getting or not getting cancer again. Reconstruction is really a personal decision,” she said.

Lifestyle choices lead many women’s decisions. For instance, a patient who is an avid golfer may decide against reconstruction in order to get back to the course as soon as possible.

At Cape Cod Healthcare, most breast reconstructions are implant-based. After Dr. Oxley performs the mastectomy, a plastic surgeon comes into the operating room and places either a tissue expander or an implant. If the tissue expander is placed, the patient needs a second surgery to exchange that for a silicone or saline implant. There is usually a minimum of three months between surgeries.

Dr. Oxley said reconstructive surgery requires a longer recovery time; however, most women only stay one night in the hospital after a mastectomy, whether or not they are going to have reconstructive surgery.

Mastectomies have been on the rise since 1998 when the Women’s Health and Cancer Rights Act mandated that health insurance companies pay for breast reconstruction. More than 100,000 U.S. women undergo some form of mastectomy each year, according to Brigham and Women’s Hospital.

Dr. Oxley said that a recent study showed mastectomy alone was the first choice for 73.7 percent of respondents. The top two reasons for going flat were desire for a faster recovery and avoidance of having a foreign body placed inside them.

Over the past year, 50 percent of Dr. Oxley’s patients chose reconstruction and 50 percent opted not to undergo the procedure. Women have been electing to “go flat” for a long time, but the acceptance of it is increasing, along with the fact that women are talking about it, she said.

Talking about going flat

Hoyt did extensive research before making the decision to go flat. This included talking with her doctors, Jaclyn Flanigan, MD, a cancer specialist, and Molly Sullivan, MD, a radiation oncologist, at Davenport-Mugar Cancer Center at Cape Cod Hospital.

“I was a real nuisance, but my doctors took the time to answer all my questions,” she said. “They were great. And so were the cancer survivors I talked with. Ultimately, I thought of all the things I loved to do, and I thought none of them needed my breasts. So, I felt like this was the right decision for me.”

Hoyt wants to be a good example for her granddaughter and daughters. “I want them to know they don’t have to go through radiation and chemo if it isn’t necessary,” Hoyt said. “There are other options that people don’t often bring up because they think that’s like maiming someone, but realistically, breasts are just outside extensions of your body that don’t serve a purpose after your childbearing years.

“I want people to know that going flat is a real choice. I’m not saying it’s the right choice for everyone. Six years ago, you almost had to fight for it, but you shouldn’t have to fight for your choice—whatever that is—anymore.”