By Michelle Barry, Sacramento, California
It’s Thursday, 1:15pm. I grab my phone and debit card and tuck them into the back pocket of my scrub pants. Before I pull my locked office door closed behind me, I tap the badge reel with my keys attached, which is clipped to the shoulder seam of my scrub shirt, just to make sure I have them. My chest is numb, so I can’t feel them. I would be annoyed to accidentally lock myself out again and it’s time for café y chisme. There isn’t actually much chisme going on–more like 30 seconds or less of “How’s your day? How are the kids? Do you have any fun plans this weekend?” because the post-lunch coffee line at the kiosk downstairs will quickly form behind me. Honestly, it’s more of the ritual of going downstairs for me, because if I get to the coffee stand, and the warm, smiling barista I anticipate seeing isn’t there, I’ll happily walk past without getting coffee and pretend I was just getting my steps in. To be honest, the coffee I’d order is decaf anyway.
I’m in luck because Luz is here. She tilts her head just a bit to the side and, with a sing-song voice and a slight smile, says, “Hello, Meechelle.” But today her tone is a bit sullen. Upon the usual pleasantries, she adds with hands flat, overlapped against her chest, “My sister is having a surgery at 2:00 today. I’”ll go see her tomorrow.” I look at her concernedly, and while I mirror her flat-handed gesture, which unbeknownst to her is the universal sign for “flatties,” I say, “Oh…will she be flat like me?” Her eyes widen and she says with some hesitation, “I never knew you are…flat.” I rub my hands up and down over my shirt a few times just to reinforce to her that, yes, I am indeed…flat. She answers that for now, her sister is having a mastectomy with no reconstruction and will consider those options in the future. I wish her and her sister well and go back to my office, but I can’t focus long enough to start my work (I am a healthcare provider). I open my phone to find the exact names of websites or Facebook groups that could be a source of support for her sister and jot them down on a sticky note. The catch to my plan is that her sister only speaks Spanish. I hurry back downstairs to give her the list before she closes down the stand for the day at 2:00. While she makes coffee for the next customer, I crouch in close to her from the side of the bar, hand her the note, and share quietly that I think community will be important for her sister. I tell her it is easy to feel alone as a flattie when every woman you know is breasted.
When I get home that evening, I post in my local Facebook group for flatties that I am in search of a Spanish-speaker who can offer support to a new flattie. No luck out of 125 members. Then two days later, in a much larger flattie group I belong to for people around the U.S. and even the world, someone posted a similar query! No less than 7 flatties posted comments that they would be happy to speak to that person’s friend, so I commented that I hoped no one would mind if I reached out to them also. I now have a Spanish-speaking flattie in my back pocket. Maybe it’s just confirmation bias, but seeing that post felt more like divine intervention.
We in the flattie community, and there are tens of thousands of us, have arrived here by many means. Some are previvors, meaning they are at higher-than-average genetic risk to develop breast cancer, and so they removed their breasts prophylactically. Others had reconstruction with implants or autologous flaps, but there were complications that could not be overcome and flat became the only option. Others, like me, developed symptoms of Breast Implant Illness and chose to remove them. Finally, others just wanted the simplest course of treatment to either avoid side effects and complications they had read about or just wanted to get back to their usual level of daily activity as soon as possible.
Regardless of the path, choosing flat in a society that is breast-obsessed, is a bold and sometimes alienating choice. Despite research findings to the contrary, some women are faced with pushback from their surgeons, being told “you’re overweight, so it won’t look good” or “you won’t be happy.” Some patients have even been made to undergo psychological evaluations by their surgeons to make sure they are “in their right minds” to make a choice like that! Some patients who have expressed a desire to be flat to their surgeon, wake up from surgery to unexpectedly find residual, sagging skin or breast tissue remains, that the surgeon knowingly left behind because “you might change your mind,” and in which case reconstruction would be easier. We in the community call this “flat denial.” In worst cases it looks like mutilation, and it’s wrong! We deserve an aesthetically pleasing, smooth, flat surgical chest wall reconstruction for which we as a community have coined the term Aesthetic Flat Closure (AFC).
It’s stories like these that have been the impetus for groups to form, either virtually or in person, to offer informational and emotional support as well as advocacy and activism for informed consent, shared decision- making, and surgical rights. Many of us have become activists to normalize flat as a healthy, valid treatment choice.
While presenting as flat rather than wearing prosthetics in one’s daily life is not required, I have found, as many others have, that it is empowering. To buck societal norms by relinquishing the most obvious outward trappings of my female-ness while claiming my whole womanhood has been liberating.
We gather at mainstream breast cancer events, carrying signs and walking, often shirtless or with painted, tattooed or bedazzled flat chests, to become un-invisible. People will clamor to meet us, take pictures, listen to our stories, or thank us, often with tears, for being visible. One woman came up to us at a walk, and while clasping her hands against her chest, exclaimed, “That’s it! They’re coming off! I’ve been undecided about removing my implants, but now that I see how beautiful and joyful you all are, I know it’s what I want.” Another woman, a mother, came over to us and asked if she could introduce her children to us because we made visible/tangible the reason they’d come out to do this charity walk. Another woman stopped to ask if she could take our picture to send to her friend in another state who had never met another flattie.
These are just a few of my own personal stories, and there are hundreds, maybe thousands, of others just like these. While I am not aware of another single flattie I encounter in my day-to-day life, it sustains me to know that I am not alone having these virtual or physical groups at my disposal and in my corner. I want the same for Luz’s sister. I hope she will be ready soon to take me up on my offer to connect her with the flat community. And while I have no interest in forcing my flat joy on anyone, I will simply ask Luz again on Thursday at café y chisme, “How’s your sister?” just so she knows I’m here.
Resources
https://notputtingonashirt.org/ Not Putting on a Shirt (NPOAS)is a 501(c)(3) organization advocating for optimal surgical outcomes for women who choose to go flat after mastectomy. You’ll find information for both patients and surgeons on flat surgical options, including photo gallery and a “flat friendly” surgeon directory, You’ll find information designed for SGM and male patients as well.
https://standtallafc.org Stand Tall AFC (STAFC) is a flat visibility campaign. STAFC brings awareness about aesthetic flat closure to breast cancer events and conferences around the globe. Their annual visibility campaign to de-stigmatize the loss of one or both breasts to cancer presents aesthetic flat closure and promotes body positivity at public events including mainstream breast cancer events/walks. Also find a map with links to local peer-to-peer groups for meetups and support.
https://youngsurvival.org Young survival coalition is an organization devoted to information and support for breast cancer survivors 45-ish and younger. Find materials in English and Spanish
https://www.metavivor.org Metastatic Breast Cancer Awareness, Research and Support and Awareness
www.breastcancer.org Their mission is to help people make sense of the complex medical and personal information about breast health and breast cancer, so they can make the best decisions for their lives. Find information articles and community forums here.
