Going Flat: Choosing a surgeon

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CJB71
CJB71 Member Posts: 7
edited February 2019 in Living Without Reconstruction After a Mastectomy

I had A BIRADS 5 score on my Dx mammogram and US and am ready for a malignant outcome when my biopsy results come in. I have a very strong family hx of cancer and am not surprised to find myself in this situation. I’ve had years of preparing for this and I plan to go flat but am nervous about finding a surgeon that will give me the nice aesthetics of a flat smooth chest. I plan to request a plastic surgeon for the finishing touches and closing, but wondering how I best go about finding one with expertise in flat finishes? It’s not something they advertise.

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  • santabarbarian
    santabarbarian Member Posts: 3,085
    edited January 2019

    Maybe get a referral from someone who works w trans community? So he/she has experience doing an aesthetic job and leaving a nice looking chest after MX?

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  • CJB71
    CJB71 Member Posts: 7
    edited January 2019

    That’s a good idea! Thank you

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  • Luckynumber47
    Luckynumber47 Member Posts: 397
    edited January 2019

    Although I didn’t really have reconstruction I had a PS involved in my BMX. Instead of an incision straight across my chest I have one on each breast that looks like an anchor. The vertical part in the center has basically disappeared and the curved part doesn’t show because of some loose skin. I’m happy with how it looks.

    Now, having said that, I think my PS did a lousy job. She left lumps of tissue on each side and left me with all the “fat” that was sort of under my arms on the side of the breasts. I just assumed that if I had a PS I’d have a perfect job. So have that discussion with your PS. Be very, very clear what you want, even get it in writing if necessary. My BS recommended my PS but I think my PS wasn’t that interested in me because I was opting out of the big money reconstruction.

    If I wasn’t so anxious to get the surgery behind me I would have taken more time to find a PS I felt comfortable with. You’re really smart to be doing your homework now

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  • Jedrik
    Jedrik Member Posts: 51
    edited January 2019

    Have you had a look at "Flat Closure Now"?

    Among other things they are collecting resources that help people to get the flat result they want.

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  • Sactolady
    Sactolady Member Posts: 1
    edited January 2019

    I had a double mastectomy in August of 2018 and now belong to a Facebook support group called "Flat and Fabulous". Maybe you already belong to it. It is a closed group that you can join to help with surgery decisions, a list of surgeons, questions to ask, going through surgery, & post-surgery advice. The female-to-male surgery is different than a BMX and this has been discussed in the group, too. The ladies are very supportive of each other. I have the book "Flat" too, if you would like to read it. I can mail it free to you. Best wishes to you, Alison

    Smile

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  • CJB71
    CJB71 Member Posts: 7
    edited January 2019

    Thanks ladies these are good resources to check out. I haven’t joined Flat and Fabulous as my diagnosis is still pending biopsy results and I already feel I am getting ahead of myself. Still hoping to get results today yet but otherwise for sure Monday, this waiting is the worst! I just want to know what I’m dealing with. Your resources will give me something to pass the time while I wait.

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  • wallycat
    wallycat Member Posts: 3,227
    edited January 2019

    I'm hopeful you will find the biopsy b-9 and not have to deal with this at all. I have had several doctors compliment my outcome and I had a "regular" surgeon who did the bmx. I brought a pic in of a 10 year old boy and asked if he would honor my wish to make my chest look as close to that as possible. No fancy stuff and no interpretation of what he thinks I want. He agreed. He did a fabulous job. He had "D" cups to contend with on me, but if both of you are on the same page, it shouldn't require "specialists" in any field..that's my humble opinion.

    Best to you with results.

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  • CJB71
    CJB71 Member Posts: 7
    edited January 2019

    Thanks wallycat, that is reassuring to hear. I have read so many stories of women going into surgery feeling confident about their surgeon and expectations to find the surgeon has left extra skin and tissue when they woke up. To me that would be worse than being diagnosed with cancer!

    I got my initial biopsy results yesterday morning (bless my PCP, she made a point of checking for them on a Saturday morning and called me right away so I didn’t have to wait out the weekend), it is grade 2 ILC. Still waiting on markers and will hopefully get that info tomorrow. I will be getting a referral to a breast cancer tx center and moving forward with going flat due to my strong family hx of cancer and love/hate relationship with my breasts.

    I just turned 47 last month and have always had large, cystic, dense, heavy, and painful breasts and view bras as a nessary evil torture in life. If there is any positive I find in having BC it’s getting rid of my painful breasts and uncomfortable bras. I’m ready for the 10yo boy look and plan to burn my bras, get a cool chest tattoo, and run around outside topless!

    Thanks again to everyone for your comments. I wish you all good health!


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  • sherrmue
    sherrmue Member Posts: 25
    edited January 2019

    Hi!

    I think it’s great that you are thinking ahead. If it turns out you don’t need masts, nothing lost.

    Just a thought on totally flat and removing fat: comfort!

    I had double masts with 3rd level LN dissect. All the fat on my chest and axilla were removed. It was necessary to close my chest and remove as much disease as possible. There is no padding between skin and bone and I must say, is uncomfortable and sensitive even after almost 9 years. Having a nice even layer of fat over your ribs will keep you comfortable.

    Sherri


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  • Darnit_DDD
    Darnit_DDD Member Posts: 40
    edited February 2019

    Hi, I'm new to the site, thanks everyone for your willingness to share... I was diagnosed last week, this site is a great comfort.

    I am a 36DDD and want to go flat, but have aesthetic concerns about my size and the potential for dog ears or extra skin, has anyone had an issue with that?

    Thank you sisters!

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  • ksusan
    ksusan Member Posts: 4,505
    edited February 2019

    Put your desired outcome in writing and have the surgeon's office put it in your EHR after you've given a copy to your surgeon. This seems to decrease the risk of paternalistic decision-making that's not what you asked for, since it documents your wishes clearly in a way that could have legal consequences if ignored.

    I had no disagreement at all from my surgeon. My chest isn't the prettiest flat BMX I've seen, but it's flat and not bulgy. Call it a top 10% outcome.

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  • blah333
    blah333 Member Posts: 270
    edited February 2019

    Darnit_DDD from what I have seen, women with larger breasts can have a more difficult time going flat right off the bat. The more tissue/skin, the harder it is to make that area flat, BUT you can still get great results, it may just take a revision surgery later on. This seems especially common with large breasted women who are also overweight. I would join the flat and fabulous group and look at pictures. You should expect and strive for good results but know it may take some time. Even for me, I have good results but it didn't feel that way for the first 10 months, things need to settle down.


    The most important part is getting a surgeon who knows that flat is an aesthetic choice and that it can still look good. Avoid surgeons who emphasis helping women's "journeys to become whole again" or those with an attitude that fake breasts are needed/you'll regret not having reconstruction. I'd recommend gorging yourself on pictures as much as possible... I looked up the #mastectomy tag on instagram, though beware it's a mix of breast cancer/trans. You should be aware that there are multiple kinds of incisions that can be made. Talk to your doctor about your preference and if that could work for you (if you have large breasts). For some reason, I leaned towards having straight lines (they curve up slightly by the armpits). Other women like diagonal scars, they even have anchors etc.

    I was angry I had two people work on me (I go to an educational hospital) one side is perfect, the other more crude (breast fellow). I sent my (breast fellow) surgeon a very detailed email about what I wanted with pictures of flat women with my build, ie. feasible results for how I could look. I wish I had asked them to have the same person make both incisions though. Despite my complaints, I do think my results are better than 90%+ pictures I've seen. I was only a B though and also have a small torso. BUT --- anyone can get nice results. I think you can avoid a horror story (like a surgeon leaving extra skin "incase you change your mind") with communication. Know what you want and convey that.

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  • CJB71
    CJB71 Member Posts: 7
    edited February 2019

    I’m now two weeks post-op and it’s too soon to tell the final outcome aesthetic-wise, but from what I have learned is it isn’t uncommon to need a revision for the extra skin at the ends of the scars. My surgeon did a great job of giving me a smooth even chest, but I do currently have thickened areas that are raised on both ends of each scar. I was a large D and she explained with large breasts it’s difficult to avoid but often can be corrected with a revision. So as a fresh newbie in the process I would say stress what you’re ultimate goal aesthetically is and stress no extra tissue and a smooth even surface. I went into It wanting a one and done surgical outcome, I now realize there are limitations to what they can do whenever there is a lot of tissue. I’m very happy with the result and so far love being flat. I do wish they would put the time into perfecting a flat procedure as they have put into reconstruction.

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  • blah333
    blah333 Member Posts: 270
    edited February 2019

    If the end of the scar is thickened - don't worry. I kind of have amnesia about the first few months post-surgery. But I do remember having one scar (the bad/fellow/generalsurgeon side) be a raised tip nub at the end and feel like it was never going to "sit down" or flatten. I even had a huge pucker like crater on one side, it was incredibly depressing. They must have made a wonky incision because the flaps were not even, there was a little ridge too where the skin came together but my body even evened that out! So I really wouldn't make any judgements until 6months, unless you have big mounds of flesh in your armpits. Eventually my "pucker" popped out too and is mostly flat (around the underside of my chest muscle), except if I flex certain ways/in certain lighting.

    I would also recommend putting kinesio tape over the scars after you have your 1 month post op checkup. This helps scars heal flat as well as fade! You can get some on ebay for like $12. It also helps with keloid areas if you end up having them.

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  • Darnit_DDD
    Darnit_DDD Member Posts: 40
    edited February 2019

    Thank you all so much, I have a better understanding of expectations now, great advice and feedback. I've been digging through the boards and see this is a common challenge, I do have lot of tissue and should probably temper my expectations, but clearly define in writing what I'm hoping to achieve.

    Blessings and gratitude!

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  • CJB71
    CJB71 Member Posts: 7
    edited February 2019

    blah333 thank you for your comment as I meant to add that it takes months for things to heal and calm down. I’m not overly concerned with the thickened areas and feel hopeful things will smooth out. I already have the ok from my surgeon to start using the scar tape as things have healed on the surface really well. I hold out hope for not needing any revision, but have come to the realization it’s not the end of the world if I do 🙂 it’s encouraging to hear how well things can heal over time. Thank you

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  • Q4life
    Q4life Member Posts: 8
    edited February 2019

    Greetings,

    Request a surgeon that has done FTM (female to male) top surgery for transgendered females. You want no dog ears. That is extra skin they leave in case you change your mind. I went to MSK in NYC. I do not regret the decision. Ask to see their other patients’ fotos. Emphasize you do not want to be concave. That depends on the first surgeon and the extent of the cancer spread within the tissues and chest cavities. You will have a pot belly which you can reduce with leg lifts while lying down on your back. Do that for two months then do crunches for two months. I use resistance bands and bend forward at the waist. Do this for a set of 10 3x then work up to 6x. When you build the strength do free weights. After 6 months you will feel better about your body with exercise. Trust me.

    Tell the surgeon that with exercise you want to build your chest muscles. Recovery is faster with PT and you will have full range of motion. If you have a problem reach out to flat closure a community of flattoppers or women who went flat. Most surgeons want to give women implants but at least 45% of women opt for no reconstruction. Also reconstruction is not like a breast augmentation. You will have scars. One breast may be bigger than the other. Due to the implant being placed under your pec muscle it will affect your neck, shoulders and back. If you work out hard your pec can distort the implant.

    I hope this helped.

    Q

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