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Kate Thies proudly goes flat.

Voices / Viewpoint

A fight to go flat

Surgeons talked less about removing the cancer and more about risky surgery to emplace breast implants. No one offered the option of foregoing reconstructive surgery altogether.

Kate Thies, a Brattleboro expatriate, works in human resources at the University of Albany. Amid her journey as a cancer survivor, she is raising her kids and is running marathons.

Albany, N.Y.

If you don’t like reading about boobs, you should move on, because this post is about boobs (or lack thereof). It is October, after all — the month of pink ribbons and catchy breast cancer slogans: Save the Tatas. Save Second Base. Big or Small, Save Them All.

I get it. They’re funny. I chuckled a little. But can you imagine how these slogans would read if they were for prostate cancer? Save the Nuts? Swing for the Balls? Big or Small, Save them All? (That last one works both ways, doesn’t it?)

OK, I chuckled at those, too.

But notably missing from all of these slogans are the actual humans battling the disease. We live in such a boob-obsessed culture that saving our breasts is more important than saving women’s lives.

I experienced this obsession firsthand this spring, right after my breast cancer diagnosis.

* * *

Immediately after learning that my diagnosis and treatment required a mastectomy, I was ushered into a series of appointments meant to help me decide what kind of reconstruction I would have.

First, I was offered reconstruction with implants. The surgeon would place expanders under my pectoral muscles and fill them once a week for several months, until eventually the muscles stretch enough to fit the implants. In about six months, I would return for more surgery to exchange the expanders with implants.

The plastic surgeon was up-front about the risks and potential complications. In fact, he told me one in three women have complications that require additional surgery, sometimes several surgeries. And implants have a shelf life, guaranteeing another surgery in about 15 years.

Another surgeon offered me autologous reconstruction. This, mind you, was the only alternative I was offered.

For this option, he would take flesh and muscle from my abdomen and transplant it to my chest. I would lose some core muscle, but I’d be getting a tummy tuck in the process, so no big deal, right?

The surgery would take about 10 hours and would require up to four days in the intensive care unit. It’s a micro-surgery, where tiny blood vessels have to be reattached, requiring constant monitoring in case the transplant dies.

The surgeon was very confident that he could perform the surgery without any complications. As he manhandled my breasts (the 11th stranger to do so in a matter of weeks), he said that he could make me bigger and more symmetrical.

* * *

During the weeks that it took to have these appointments, I was absolutely consumed with worry and fear over the cancer still growing in my body. Meanwhile, surgeons talked more about cosmetic results and sexual function, and less about removing the cancer.

I’m a very active person between running and raising two young boys, and the thought of a lengthy recovery was also overwhelming. I was exhausted.

No one offered me the option of no reconstructive surgery altogether — going flat. I had to put it out there.

I still agonized over the decision before I finally told my breast surgeon that I wanted the cancer out — no reconstruction, and I wanted the surgery as soon as possible. Surgery was six days later, but in the end, it took place exactly two months from the date of diagnosis.

* * *

I realize that this is an intensely personal choice, and I respect the choices other women have made. But I worry that too many women make a choice without options or a full understanding of the long-term side effects — or, even worse, under the pressure of a surgeon looking to make bank.

By law, reconstruction for breast cancer surgery is covered by health insurance, so a procedure guaranteeing follow-up surgeries could be a windfall. (I am not suggesting that any of the surgeons I met fall into this category, but it is a reality for others.)

Unbelievably, some women who confidently come to the same decision that I reached are met with the requirement of counseling — because women apparently can’t be trusted to make decisions about their own bodies.

Even worse, some surgeons refuse to make their patients flat, because either they lack the skill to do it successfully, or they don’t trust their patients’ decisions. So, against their patients’ wishes, they leave a deforming amount of excess skin (which fails to provide the best odds against recurrence), to preserve the option for reconstruction.

* * *

Not a day goes by that I regret my decision to go flat. I’m fortunate that my surgeon was both highly skilled and respectful of my decision, giving me the best possible outcome. She did hand me a prescription for prostheses, delivering me options for “grocery-store boobs” and “going-out boobs.”

I have yet to fill the script, and I’m not sure I ever will. I can’t bring myself to wear a bra I don’t need, to hold a piece of foam I can’t feel, just to give me the silhouette people expect to see.

I’m not completely healed — I still lack some range of motion and I have some lingering nerve pain — but as I go through the debilitating side effects of chemo, I can’t imagine adding the pain and discomfort I’d still be having if I chose reconstruction.

On this road, I’ve come to know so many other women who unfortunately have suffered through breast implant illness (it’s a very real thing), recalled implants(!), multiple surgeries, poor surgical results and, in some cases, recurrences of breast cancer masked by implants.

So many of these women wish they had been presented with the flat option first. Instead, they’re left deformed and sick.

It’s maddening.

* * *

It’s no help to the cause that absent in all the public awareness campaigns are images of real bald and flat women. That’s why, in the spirit of awareness, I’m putting my personal story out here this year, on Oct. 7, when we marked the first International Flat Day.

This is a breast cancer problem that needs way more attention than it gets.

And hopefully that will change as more women make the flat choice and share their stories.

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Originally published in The Commons issue #531 (Wednesday, October 9, 2019). This story appeared on page F1.

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