I Never Thought I’d Be Able to Make the Decision to Go Flat  

I went from a DD size chest to nothing but two big scars. No breasts at all. I ultimately chose aesthetic flat closure after finding a lump in my left breast.

I was diagnosed with breast cancer when I was 36. I didn’t see it coming, as no one really does. It threw my world upside down and quite literally changed everything.

It changed how I feel about myself. How I look at life. How I physically look. How I feel. How others look at me. It has changed who I am more than anything else in my life (on par, maybe, with becoming a mother).

I get asked a lot why I chose aesthetic flat closure. Why would someone choose not to have reconstruction? Why would you choose to be flat at 36? Why not get a shiny new pair of breasts?!

To be completely honest, I was one of those people prior to my diagnosis and in the first few months going through this. I didn’t think I could ever be flat. I thought women who chose to be flat were the bravest people. “Good for them! I’d never have the guts to do that.” – Naive Mia

My mom showed me an article of an older woman on the beach with no top on, her two scars showcased proudly. I was in awe of her. Again: that could never be me. But wow that she can own her body the way she does. She’s so strong!

And now I am that woman. And it was the best decision I could have made for myself.

When I was first diagnosed, my treatment plan was surgery first. I wanted to have a double mastectomy with immediate reconstruction. One surgery (I assumed at the time) to have both breasts removed and some new ones in place. No scary scars to worry about. All done and back to my life. Wow, was I ever naive?

Self-portrait of Mia after her single mastectomy.
My surgeon didn’t think I should have both breasts removed. He thought I was being rash and dramatic (and actually said a lot of his patients have the exact same feeling as me and want both removed). I didn’t *need* both breasts removed. So instead, he recommended a lumpectomy in my cancerous breast. (In other words: just removing the lump and surrounding breast tissue, but leaving as much breast as possible.)

But I just wasn’t comfortable with a lumpectomy. I wanted the whole breast removed. I felt betrayed by my breast and it felt foreign to me. I didn’t want it on my body anymore.

I had two weeks to decide what surgery I wanted. Every moment was spent thinking about it, talking about it, researching my limited options for a surgery I didn’t want.

As I learned more, I understood that with a lumpectomy, it’s very common for radiation to follow. And radiation was something I wanted to avoid if I could. If there was even a small chance to not have to do radiation, I wanted it. And in my situation, I understood having a mastectomy gave me that chance.

So that did it, no lumpectomy. I was having my whole breast removed.

At this point, I still thought I would have reconstruction. Still thought I wouldn’t be able to handle being flat.

Would I feel like a woman? Would I look ok and feel confident in my clothes? Would my mental health take a hit I couldn’t come back from? Would my husband be attracted to me? Would I still be me without DD breasts?

In the end, I couldn’t have immediate reconstruction anyways. We wanted to have my surgery as quickly as possible, which meant I didn’t have time to meet with a plastic surgeon.

So I then thought: I’ll have a double mastectomy with reconstruction at a later date, when I was strong and after whatever other treatment I needed.

My husband and I decided we should see what I might look like after surgery. We wanted to be as prepared as possible. So we looked online at double mastectomy scars.

While my husband completely supported me in whatever decision I made, seeing those photos and what would soon be my new reality scared me so much. I had a panic attack.

The photos I saw were very cold and clinical. The women, who were all much older than me, looked miserable. Or maybe that’s how I saw the photos. Maybe I was projecting my feelings. It’s hard to know.

But I knew in that moment: I couldn’t do this. I couldn’t have both breasts removed. My mental health wouldn’t be able to handle it.

That was one of the worst parts. I truly felt like I couldn’t do this. I didn’t *want* to do this… but I had to. I had to have surgery, no matter how I felt about any of it.

And am I ever grateful for that surgery. It saved my life.

It ended up being the best outcome I could have. I had a single mastectomy: my cancerous left breast removed and stayed flat.

A few weeks later, I got the best call of my life. My oncologist was giddy on the phone. I was stage 1A (the lowest stage you can be) and I didn’t need chemotherapy or radiation. I could have done that treatment, but it would only give me a slight decrease (1-2%) in the chance of recurrence. And that was significantly outweighed by the long-term negative effects from chemo and radiation that someone my age would experience later in life.

I am beyond grateful for that first surgery and the outcome. So glad I followed my gut and had a mastectomy versus a lumpectomy.

I still thought I would want reconstruction, though, because I thought if I didn’t have breasts, I would be a monster, ugly, creepy, and I would lose this vital part of myself. I had fairly large breasts for my size. They were so attached to my identity. I felt beautiful with breasts and I thought that would go away. I wouldn’t feel beautiful ever again. I wouldn’t feel like myself ever again.

But I’ve really, truly realized and accepted that I’m more than my body. I’m more than the size of my chest. My worth is not based on my body shape or the scars I now bear.

That feeling of having both breasts removed never left me. Having one breast was fine, to be honest. I grew to love my scar and connected with women worldwide when I started sharing my story.

But I wanted symmetry and peace of mind. I didn’t want to ever find another lump. I had so much anxiety over my one breast. So I decided to have a prophylactic mastectomy. I removed my healthy, right breast.

Self-portrait of Mia after her aesthetic flat closure
And I chose to stay flat, having aesthetic flat closure. I opted against reconstruction.

Here’s why:

Breast implant illness, implant maintenance, the look of implants without breast tissue and a whole new set of anxieties.

I didn’t want anything foreign in my body. Didn’t I just go through surgery to get rid of something foreign? I didn’t want to put anything back in that might affect my health.

Some women use their own body tissue to form a breast, therefore, there’s nothing foreign. But I didn’t have enough tissue on other parts of my body to do that.

I didn’t want any more surgery. I learned it usually takes a few different surgeries to get the final result you envision. Plus, with implants, it is recommended to have them changed every 10 years at least. I was already so over having surgery.

And I felt like having reconstruction wouldn’t let me move on from my anxiety. I felt that I would still wonder if a lump was growing underneath my implant and it would be harder to find. (Yes, even with both breasts removed, I still have a chance of a recurrence. There is still breast tissue on my chest cavity they can’t remove. So technically, I could still find another lump. Although, that is drastically reduced having a double mastectomy.)

It wasn’t easy to get here, but I’m so glad I was given a choice and made this decision for myself. It’s what is right for me and my body.

Do I miss my breasts? You bet! Do I wish I wasn’t in this position? More than anything.

But cancer doesn’t care about that. About who we are. Our age. How we live our lives. None of that matters.

This decision was hard to come to. And it’s not the right decision for everyone. It’s a very personal choice and there are no wrong answers.

It’s your body and you have to live in it. It’s your home. So do what feels right for you. Don’t let anyone – even well-meaning doctors – pressure you into something that doesn’t feel right for you. Trust yourself. And above all, be kind to yourself.

This is all total shit and unfair. Making these decisions we never want to make.

But we can do hard things. We are all strong and more than our diagnosis. Whether we show our scars proudly like the woman on the beach; or share photos online, like I do.

We’re in this together.

We’re not alone.

And we’re not too young. — Mia Purdy