When Jill Claggett told me she is on the path she is meant to be and right where she is supposed to be in her life, I didn’t doubt her for one second. Jill has a clarity and a self-assuredness that I admire. She needed both when she was diagnosed with and treated for breast cancer.  Jill is a Flatty, a growing and fierce community of women that are working to de-stigmatize going flat after a mastectomy. They also are working to make sure women know it is a reconstruction option just as implants are and that health insurers cover it just as they do implants.

It is important to be clear about what going flat is. According to breastcancer.org, Aesthetic Flat Closure is when the surgeon “removes extra skin, pockets of fat, or excess tissue and tightens and smooths out the remaining tissue to create a flat chest wall contour.”

A malignant lump was discovered in Jill’s right breast through a mammogram. Her mom had gone through her own breast cancer journey two years earlier, and an MRI had been crucial to her diagnosis, so Jill requested an MRI to make sure there were no other cancer spots in her breast. But the surgeon she was meeting with refused to give her one, so she got a second opinion and an MRI, which revealed additional cancer spots. Jill decided to get a double mastectomy with expanders put in, so she could get breast implants in a follow-up surgery. 

At the time, Jill wanted to keep her nipples, which was the main reason she was getting breast implants. Looking “normal” was a big deal in the early stage of her journey. But the expanders were awful. Eventually, Jill developed an infection on her left side. The expander was making her sick.

All of this was happening around the time Jill’s oldest daughter was getting ready to graduate from high school. Jill was tired of feeling sick and decided to take control over what she could. She had researched reconstruction options since her double mastectomy.  Jill determined that implants were not a good option because of her experience with the expanders and the fact that a lot of women get sick from them. Also, Jill was told she was not a good candidate for harvesting fat that is used to fill in around implants. Instead, Jill determined going flat after the infection was the healthiest and best option for her.

The morning of her surgery, Jill was the one who told her surgeon she was going flat, which surprised him. He wasn’t at the final appointment before her surgery. The good news is her surgeon listened and adjusted and when Jill awoke from surgery, she was flat, just as she wanted. She said the recovery from her reconstruction surgery was a whole lot easier than her double mastectomy.

Jill said the decision to go flat was easy because family and friends supported her, especially her husband and two daughters. Also, her faith has given her strength, comfort and clarity during her cancer journey. Jill knows she made the right decision to go flat. While her body may have changed, she is still the same person she was when she had breasts. She realized that the most important thing is being healthy. Looking “normal” was not worth it, if it compromised her health.

Jill’s experience made her become an ambassador for Stand Tall AFC, a campaign working to de-stigmatize the loss of breasts to cancer treatments and normalize going flat. Stand Tall AFC ambassadors attend breast cancer awareness events to promote body positivity and going flat as a healthy option after a mastectomy.  Jill has received a lot of support when out in the community and been able to connect with other women who chose to go flat. 

Jill hopes that going flat will become normalized and that it will be presented to women as a reconstruction option just as implants are. There are signs that is happening. Women who have gone flat are becoming more visible, showing up on fashion runways and in ad campaigns. Even the Simpsons created a character who went flat. But given how hypersexualized breasts are, there is a long way to go.

Plastic surgeons are important to efforts to de-stigmatize going flat, because this is where breast cancer patients often learn what their reconstruction options are. I shared with Jill that I never got any information about going flat as an option from my plastic surgeon.

In a recent patient survey, Dr. Deanna Attai, a breast surgeon at University of California Los Angeles, found that, out of the 930 respondents, 22% of them were denied going flat.  They ended up with excess skin instead of the smooth chest they requested. This happens because plastic surgeons mistakenly believe their patients will change their minds about wanting implants, and the excess skin makes it easier to add them later. Many women who went flat report they were made to feel like something was really wrong with them for not wanting breasts any longer. To make matters worse, health insurers don’t always cover Aesthetic Flat Closure as a reconstruction option as they do implants.

I am inspired by and grateful for Jill and so many other women who are helping breast cancer patients understand all their reconstruction options. They are also showing all of us that they were never defined by their breasts and that they remain beautiful and vibrant without them.

Learn More

Please visit Stand Tall AFC to learn more about the campaign and Not Putting On A Shirt, a nonprofit that provides resources and support to breast cancer patients choosing to go flat. The Firefly Sisterhood provides support to women diagnosed with breast cancer.