“Best for Me”: Decision‐Making and Medical System Interactions When Going Flat After Bilateral Mastectomy

BACKGROUND: A growing number of young breast cancer survivors are seeking information about surgical options after bilateral mastectomy. This study explores the factors influencing decision-making and interactions with the cancer care system among young breast cancer survivors who went "flat," or pursued aesthetic flat closure (AFC) post-bilateral mastectomy. METHODS: Eighteen breast cancer survivors in the United States diagnosed before the age of 45 who had aesthetic flat closure completed semi-structured interviews. Verbatim transcripts were analyzed using Interpretative Phenomenological Analysis. RESULTS: Eighteen survivors (average age 39 years) completed interviews lasting between 54 and 88 min. Eight themes about factors that influenced decision-making were identified: centering self or romantic partners' perspectives; emphasizing body functionality, faster recovery, and fewer surgeries; viewing flat as the safest, healthiest, and most natural option; negatively experiencing breasts; questioning the purpose of breasts; benefiting from transgender liberation; serving as a role model; and treatment information gathering and self-advocacy. Regarding medical system interactions, the data revealed themes of assuming reconstruction; infantilizing survivors; dehumanizing survivors; gender-affirming surgeries advancing surgeons' skill sets; and supporting, communicating, and collaborating. CONCLUSIONS: Young survivors, who opt to go flat, prioritized functionality, faster recovery, and freedom of bodily autonomy and gender expression over societal beauty standards when making post-mastectomy surgical decisions. Survivors frequently had to advocate for AFC as a treatment option. These findings highlight the need for providers to present a range of affirming and accessible post-mastectomy treatment options. To improve young survivors' cancer care, providers can promote bodily autonomy and include AFC when presenting treatment options.