After my breast cancer diagnosis, I wanted to go flat. My surgeon disagreed.

Guest post by Sonya McConnon

I was diagnosed with Stage 1 breast cancer just after my 40th birthday in August 2021 following my routine mammogram. From the moment of my diagnosis, I wanted to go flat. My surgeon, however, had different ideas.

As I had a family history of breast cancer, I was screened yearly from age 35 in Dublin including annual mammograms and consultations with the Breast Consultants. 

Three days after my routine mammogram, they called to say they had noticed changes in my right breast in comparison to the previous year’s mammogram. They asked me to come in the following week for a ‘more in-depth’ mammogram. 

I was assured it was nothing to worry about, so I went to that appointment thinking I would be half an hour. In and out. Four hours later, I was undergoing a triple assessment consisting of a mammogram, ultrasound of my lymph nodes and a breast biopsy. Two weeks later, I was told by the breast consultant that I had Stage 1 invasive carcinoma (IDC) behind my nipple. 

This led to surgery — a wide local excision of the nipple and sentinel node biopsy. It was a four-week wait for the results.  

Unfortunately, when the pathology came back, I was sad to learn the surgeon was unable to get clear margins. It was advised that I have a mastectomy as the IDC was multi-focal throughout my right breast and ER-positive. Looking back, in the year before my diagnosis I had noticed discharge from my nipple and had experienced a stabbing pain in my nipple which I put down to hormonal changes. I was very fit, running and racing for Ireland in mountain running, I ate healthily and didn’t drink or smoke. I had breastfed my three children and was feeling so well. So understandably, this diagnosis was a shock to the system. 

My single mastectomy took place in November 2021.  I was given the option of direct-to-implant reconstruction by the breast reconstructive surgeon. The literature I was given only contained information on reconstruction and delayed reconstruction with tissue expanders for women who require radiotherapy. 

I was never advised of the third option, aesthetic flat closure —  which was where my heart was telling me to go. I had grown up with my mother who hadn’t hidden her flat closure mastectomy from us as children. At the time of her breast cancer back in the 1970’s, reconstruction was an option, however her breast surgeon at the time advised her to avoid an implant as it was a new method. He felt that it could be risky to put a foreign object under the skin that could burst. Thankfully, my mother listened to his counsel, as many of these early implants were recalled. My mother wore her scar with pride. I think being de-sensitized to going flat helped me. 

Pushed to reconstruct

That didn’t stop my surgical team from pushing me into having reconstruction. My breast care nurse kindly advised that looking down at your chest and seeing nothing there is very traumatic for a lot of women. She told me if I had something there,  it would help with the mental recovery. 

So, with this urging, I went against my instincts and chose to try the implant. I regretted the decision the minute I looked down at the hard nipple-less mound of skin I had after the surgery. It was like somebody had stuck a hard tennis ball to my chest. It was tight and I could feel the implant’s edges under my skin. I  wanted it out as soon as possible. 

Because of my age and family history, I had genetic testing carried out which confirmed that I was carrying the ATM gene. So a year later I had a prophylactic mastectomy of the left breast. I told my male surgeon I did not want reconstruction on this side and I wanted the implant from the right side removed at the same time. He questioned my decision time and time again, telling me I would regret my decision. He said I was too young to do this to my body. Even on the day of the surgery, as I was just about to be put under general anaesthetic he came to my bedside and checked once again to ensure I was happy with my decision to go flat. He told me he had just operated on a 34-year-old girl and done a lovely reconstruction following a double mastectomy. I felt he believed that I would be less beautiful without reconstruction. 

Resolute to go flat

That said, I went into the operating theatre more resolute than ever. I knew I was making the right decision for me and that flat was what I wanted. It is just sad that I had to stand my ground on it and prove to him why I wanted to go flat. 

I woke up after surgery, looked down at my chest and sighed in relief knowing that the alien implant was gone and I was flat-chested. The consultant’s registrar visited me the next day to say the surgery had gone well, and that he was relieved that the implant was removed as the skin was very taut over it and it had the potential to burst in the future. I felt further vindicated in my reasoning to have it removed. 

However, all was not perfect. I was left after the surgery with sagging skin and the capsule that formed inside my breast around the implant on the right side was still intact. I called for my breast care nurse to visit me. She took photos and the next day my surgeon visited me, firmly telling me that the skin would tighten and that the capsule would be reabsorbed into the body. His parting comment to me was, “If I had my way, I wouldn’t have you going home looking like this.” His projection of the ideal woman was one with breasts.

Of course, he was wrong on both counts. The sagging skin never tightened. It bothered me terribly but as his patient, I had little recourse. Thankfully, when he left last year a wonderful female breast surgeon took his place. She reviewed me three months ago and was shocked at the level of sagging skin that was left on the right side and the lack of symmetry in the scars on both sides. She told me that I should not have been left like this and promised she was going to tidy things up. Just a few weeks ago, I had my final surgery, and thanks to her, I finally had the aesthetic flat closure — and the desired result I wanted — from the minute I was diagnosed. 

Fortunately, I did not need radiotherapy or chemotherapy. I am now on tamoxifen for three years now and menopausal with no periods for 2.5 years. 

I look forward to the day in Ireland when surgeons, hospitals and cancer organizations publish literature that includes aesthetic flat closures as a reconstruction option for women who require mastectomies. We deserve to have that choice, and our wishes should be respected. 

About the author

Sonya McConnon, 43, hails from Dublin Ireland. She’s a married mum of three children, and an athlete, running for Ireland in the European Mountain Running Championships and World Mountain Running Championships. Sonya loves mountain biking, hiking, sea swimming, and paddle boarding – anything that gets the adrenaline pumping! She has no regrets about opting to remain flat after her mastectomy and is a proud “flattie” who wears her scars with confidence and pride and loves sleeping on her tummy.