Breast cancer survivor decides to ‘go flat’ following double mastectomy

Devorah with her radiation oncology team at BIDMC: Ingrid Itta, Kimberly Halloran, Melissa Coombs, Brittany Branco and Susie Topp.

Devorah Vester Borenstein received her first breast cancer diagnosis in February 2018: ductal carcinoma in situ in the left breast.

She underwent a lumpectomy and 21 days of radiation therapy. Then, more than a year later, she learned of a recurrence after an MRI-guided biopsy. This time, it was Stage 1 in her right breast.

“At that point, I knew my breasts had turned against me,” said Devorah.

There are many different treatment options to consider after a breast cancer diagnosis, and surgery is the most common. Depending on the type of cancer, options range from removing the tumor within the breast – what’s known as a lumpectomy – to removing one or both breasts – a mastectomy or double mastectomy.

Devorah spent a week researching all of her options. She asked herself where she wanted to be several years from now – a question that guided her towards the decision to have a simple mastectomy, without reconstructing her breasts. She did not feel like she could live with asymmetry, therefore ruling out the option of a single mastectomy. She wanted the greatest possible reduction in recurrence overall.

“I just wanted to be me – beautiful simplicity. I didn’t want anything foreign in my body, and I knew I didn’t need artificial breasts to feel like a woman.”

Devorah then met with Ted James MD, Chief of Breast Surgery and Co-Director of the BreastCare Center at BIDMC, to discuss her surgical options.

“When I work with patients, I provide a full 360 degree view of their options,” said Dr. James. “My recommendation is that patients have an open discussion with their physicians, so that they can make an informed decision. We want our patients to feel empowered and supported to make the choice that is right for them.”

After meeting with Dr. James, Devorah felt well-informed about her range of options and confirmed that a simple mastectomy with only the reconstruction of the natural contours of her chest wall was her chosen path forward.

Devorah is part of and an advocate for a growing community of women called “The Flat Movement” – women who choose not to have breast reconstruction after a double mastectomy, but decide to “go flat.” There are websites, social media groups and online blogs that raise awareness around this option and offer support for women with breast cancer who are weighing the alternatives. Devorah has also become involved with a nonprofit advocating for optimal surgical outcomes for women who choose to go flat after mastectomy.

Devorah at her home following her double mastectomy.

“I knew I wanted the greatest possible risk reduction, and I wanted the greatest peace of mind,” said Devorah. “I want to be healthy. I want to be happy. And not having breasts isn’t going to change that.” Devorah noted that while ultimately this was her own personal choice, she does not think there is a single ‘right’ answer. She encourages women in similar situations to make the decision that’s right for them. “What might be the best option for one woman may not be the best for another,” she says.

“More and more, patients are asking me about ‘going flat,’ ” said Dr. James. “Breast reconstruction is not a requirement – it’s a personal decision. We support our patients whatever their choice, and we give them all of the information they may need to make a decision that’s right for them.”

“I want women to know that by going flat I did not have to sacrifice femininity for health; less is truly more,” said Devorah. “It is all a question of the relationship that each woman has with herself, independent of the cancer. Quite possibly, my true blessing is my healthy self-image which has accompanied me throughout my breast cancer journey. That’s why it’s so important to stress that the biggest part of autonomous decision-making in women’s health care issues, such as post-mastectomy options, is to really know who you are and what your personal needs are.”

Dr. James says a woman always has the option to have reconstructive surgery even years after deciding to go flat, should they change their mind.

To learn more about Devorah’s story from WCVB Channel 5, click here.

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