In the days before Davina Gantz-Needle's double mastectomy, the 52-year-old Maryland resident spent time mentally preparing for the outcome, which she was certain she'd loathe.
"I was afraid it was going to be a long adjustment period, and I was terrified I would hate my body," she tells Yahoo Life of the breast cancer-related procedure she went through nearly three years ago. "But I knew I had to do it."
Gantz-Needle, who was already two years out from her original cancer diagnosis, opted for the double mastectomy following a recurrence scare. And while she chose to stay flat, knowing she did not want the extra surgeries or long recovery of breast reconstruction, she was still nervous about how she'd look and feel. She practiced taking showers without glancing down and passing by mirrors without taking a peek.
But, to her surprise, she felt ready to embrace her flat chest within hours of having had the surgery — something she largely credits to the supportive "flattie" communities she had already connected with on Facebook.
Even more surprising, she recalls, was that the feeling lasted.
"It took me a while to realize: I don't miss them," she says.
Gantz-Needle, as it turns out, is not alone — despite the warnings often coming from oncologists and breast surgeons, not to mention society at large: that a life without breasts is one of disfigurement, bereft of one's womanhood.
"A male doctor said to me, 'You'll lose your identity as a woman'" without reconstruction, Gantz-Needle recalls. But that notion did not resonate with her, and she told the doctor, "Breasts don't make a woman any more than a penis makes a man."
Melanie Testa, of Brooklyn, who was open to having post-mastectomy reconstruction a decade ago but wound up forgoing it and has since become a flat advocate, running a robust Facebook group, has a theory about the disconnect. "I think medical bias interferes with societal expectations about how women express their femininity, and that there is a very narrow tunnel of bias that just leads to assumptions — that women will feel better if their bodies appear breasted," Testa (who can be seen doing a joyous flat dance, below) tells Yahoo Life. "And not all women relate to their breasts."
Many others, when speaking to Yahoo Life through breast cancer and "going flat" Facebook groups, as well as at Sunday's Making Strides Against Breast Cancer walk in New York City (one of many that took place across the country), echoed Gantz-Needle's experience. They were eager to speak about how little they missed their breasts — for reasons ranging from how large and restrictive they had been to never having connected to their breasts in the first place, to even a simple shift in priorities after having survived cancer.
"I don’t miss my breasts one bit," New Yorker Susan Derwin, 61, who opted to "go flat" rather than undergo breast reconstruction surgery, tells Yahoo Life. "I never was crazy about them, they did not have the greatest shape, and I was never dependent on them for my identity or the way I dressed," she says, adding that it was much more unsettling when she lost some of her hair due to chemo (though not all of it, because she used a cold-cap technique). "My identity is much more tied up with my hair."
Testa also does not pine for what's been lost, saying, "I have never really identified with my breasts, and I often felt like they held me back in situations where I felt uncomfortable — and I never really expressed my gender through enjoyment of them. So, I just looked forward to a breastless body."
Tuneshia Gallop, joining the Making Strides walk from New Jersey on Sunday, said that she did not miss them one bit. "I've always been a modest person — never showed a lot of cleavage, and always felt, doggonit, they're really heavy, I can't run how I want to run, I can't sleep the way I want to sleep," she tells Yahoo Life. "I had heavy breast tissue, and at one time thought about having breast-reduction surgery, because the bras were causing separating in my shoulders. So, after I went through [breast cancer] I was like, you know what? This is who I am."
Anne Sullivan, four years out of her mastectomy and going flat, feels similarly, noting, "I do not miss mine! I love the freedom — from breast pain, tenderness and swelling around hormonal changes…This speed bump on my bike ride to the park that I used to brace myself for because it caused painful jiggling… When I realized it no longer hurt to ride over it was this moment of freedom."
"I'm relieved to have no breasts. I was very large," Esther, 42, (who requested her last name not be used), just a few weeks out of her surgery and also opting for no reconstruction, tells Yahoo Life. Factors playing into her relief, she explains, include being a Hasidic Jewish woman for whom modesty (and not accentuating one's bodily assets) is important, having already breastfed her three children and the pain and discomfort that came with being so large breasted. "I felt like, 'good-bye, good riddance'... I always felt like something was wrong with my body because I'm way too large for people's comfort."
For Indianapolis comedian Lissa Sears, losing her breasts has made her "a better person," more empathetic to many of trans experience — and, compared to also dealing with a multiple sclerosis diagnosis, felt like a walk in the park. "I feel more in my body than I ever have, more confident," she tells Yahoo Life. "I go topless all the time, even onstage."
Some noted that their biggest regret was having a surgeon who did not respect their wishes to perform what's now officially called an "aesthetic flat closure," which the National Cancer Institute added its terminology last year — instead leaving unwanted "chunks" of flesh behind in case a patient wants to change her mind and pursue reconstruction in the future. That widespread problem known as "flat denial," as covered by journalist and memoirist Catherine Guthrie, is just part of an overall belief that no woman can possibly face life without breasts.
"I think a combination of holdover paternalism in medicine and just the assumption (based on societal expectations) that a woman would want to maintain her appearance is why physicians sometimes do not offer going flat," Dr. Deanna Attai, a breast surgeon and professor with the David Geffen School of Medicine at UCLA and UCLA Health Burbank Breast Care, tells Yahoo Life. "I have found that you simply cannot assume what a woman wants or what is important to her, based on age, marital / partner status, etc. — you have to ask! But too often those questions are not asked."
Last year, Attai published the results of her study, which looked at patient satisfaction outcomes post-mastectomy, in the Annals of Surgical Oncology. She found that 74 percent of patients who went flat were pleased with the outcome, despite more than a third not being offered the option at the outset; previous studies had found high complication rates for those who chose reconstruction, with one in three women facing such complications.
Still, Attai adds, there have been several past studies that have indeed found that women "who undergo reconstruction have higher satisfaction and better body image." Because of those findings, she believes "surgeons may truly feel that this is a better option for their patients, and also then may not take the time to learn some of the aesthetic flat closure techniques."
Opting for one of the myriad reconstruction options available or forgoing it altogether post-mastectomy is of course an intensely personal decision. And while reactions to any surgical outcome are as myriad as there are people going through them, losing one's breasts — whether you wind up perfectly OK in the end or continue to struggle — is always a big deal, stresses Wendy Myers, director of counseling at the Cancer Caring Center in Pittsburgh, Pa.
"It's like having an amputation — so no matter how you view your body, whether you really valued [your breasts] or thought, 'they're just a part of my body,' it's still a big deal. It is," Myers, whose practice is around 80 percent breast cancer patients or survivors, tells Yahoo Life.
Through her patients, she hears about the widespread assumption that women will want breasts at any cost. "I don’t hear about them getting any [non-reconstruction] options — it's like, 'here are the reconstruction options for you,' with no other option," she says. "I don't think most have any inkling that they can remain flat."
The therapist says she's made it her mission to provide support to those not only going through cancer but to those who, once the fast pace of diagnosis and treatment slow down, find they are oftentimes dealing with grief over the bodies they knew — even if they eventually reach acceptance.
"There are some women that do like having their breasts — not because society tells them they should have breasts, but because they just really love their breasts," she says. "So, I think you have to watch the language around getting the word out about the option of being flat. You don't want it to be a judgment call. It’s a fine line."
As far as who may be able to come out on the other side of a mastectomy and not miss their breasts, Myers says it's pretty impossible to predict. "I think it's individual,” she says. "But probably a lot of the women thought they were going to die from cancer, so it’s just a relief to not have to worry about it anymore."