There are many reasons to decide against breast reconstruction after a double mastectomy, a choice often called “going flat.” The medical term for this approach is aesthetic flat closure, which means the chest is surgically contoured to lie as flat as possible after breast tissue is removed.

Some people choose to go flat to avoid potential complications or additional health risks associated with breast reconstruction. Others may not want breast implants or additional procedures.

Going flat usually requires only one surgery, while breast reconstruction often involves two or more surgeries. Recovery time after aesthetic flat closure is typically several weeks to a month, though healing time can vary from person to person.

One survey found that nearly 75 percent of women who opted to go flat reported being satisfied with their results.

An important first step is finding a surgeon who respects and supports your decision. Some people have reported waking up from surgery and discovering that extra skin was left on the chest wall in case they later decided to pursue reconstruction, even though they didn’t want that option.

Before surgery, make sure you and your surgeon have clearly discussed your goals and expectations.

If you choose to go flat, it can help to prepare ahead of time. This may include:

• Learning about wound care
• Managing surgical drains
• Giving yourself time to heal
• Supporting your emotional well-being

Preparing for Surgery

Preparing your home before surgery may help reduce stress and make your recovery more comfortable and manageable. Setting up your space ahead of time can also help support your safety and healing after surgery.

Start by placing commonly used items within easy reach so you do not have to stretch your arms overhead or bend down to reach lower shelves or cabinets.

You may also want to buy, rent, or borrow a recliner or supportive chair for sleeping if you don’t already have one. Getting in and out of bed can be uncomfortable after surgery, especially for people who usually sleep on their side.

Here are some other items that may help during recovery:

• Loose-fitting tops that zip or button in the front
• Yoga pants or other soft, comfortable pants
• A pillow to place under your arm or between your chest and the seatbelt
• Slip-on shoes
• A drain apron, cardigan, or zip-up hoodie with pockets for surgical drains (small tubes that remove extra fluid and blood from the surgical area during healing)
• A pen and notebook to track medication schedules and questions for your doctor
• Dry shampoo
• Comfortable pajamas
• Medication to help relieve constipation

Keep extra pillows nearby while sitting or riding in a car. You can place a pillow between your chest and the seatbelt to make the ride more comfortable.

“Pillows under your arms will make you feel more relaxed, so definitely use them,” suggested one MyBCTeam member.

“Pillows under your arms will make you feel more relaxed, so definitely use them.”

— A MyBCTeam member

Other members shared that disposable body wipes helped them feel fresher while they avoided showering after surgery.

“I bought and used natural, organic body wipes,” said another member. “I did it every day, and I felt clean. But once those drains were out, my first shower was a long one!”

Drains and Wound Care After Going Flat

It’s important to closely follow your breast surgeon’s instructions for caring for your wounds and surgical drains, including when to remove dressings and when it is safe to shower.

What To Expect With Drains

Some people say that drains are the most uncomfortable part of postmastectomy recovery. You may have one or two drains per side. Ultimately, the number of drains depends on your surgery and your plastic surgeon’s recommendations.

Drains usually stay in place until the fluid collected drops below about 20 to 30 milliliters per day for two days in a row. For many people, this takes about two to three weeks.

While the drains are in place, you need to keep the skin clean and dry to avoid infection or skin irritation. You’ll also need to empty the drains several times per day.

Some people find that specially designed wedge pillows may help reduce discomfort while resting or sleeping.

One MyBCTeam member recommended a pouch that helped hold their drains. “Before I left the hospital, I asked the nurses to get me two telemetry pouches,” they said. “These pouches were perfect for putting the drains inside of them. I’m a registered nurse, so I already knew about these little tricks.”

“Before I left the hospital, I asked the nurses to get me two telemetry pouches. [They're] perfect for putting the drains inside of them.”

— A MyBCTeam member

Telemetry pouches are small fabric pouches designed to hold medical devices, such as heart monitors or surgical drains, while allowing people to move around more comfortably. They’re typically inexpensive and widely available online.

Caring for Your Wounds

It’s normal to feel nervous or emotional about seeing your chest after surgery. Scars and physical changes in the breast area can bring up many different feelings. However, it’s important not to avoid checking your surgical site or caring for your skin as instructed by your healthcare team.

Good wound care can help support healing and lower the risk of complications. You should also watch for signs of infection or other skin problems and let your doctor know if you notice concerning changes.

Some people develop mastectomy skin flap necrosis (when tissue doesn’t get enough blood flow and begins to die) after surgery. Studies suggest this complication affects about 5 percent to 30 percent of people after mastectomy. Although it is not very common, it is important to know the warning signs and contact your healthcare team if you have concerns.

Scars From Going Flat

Scars from breast surgery usually take about six to eight weeks to heal, although healing time can vary from person to person. Some people may also notice small folds of skin at the ends of their scars, sometimes called “dog ears.” If these areas bother you, your surgeon may be able to remove or revise them later.

Once your wounds have healed, your healthcare team may recommend emollient creams, scar oils, or other scar-care products to help keep the skin moisturized and soften scar tissue. Wearing loose-fitting clothing may also help prevent irritation while the area continues to heal. Tight shirts or blouses may irritate healing scar tissue.

Some people find that silicone gel sheets and silicone gel help moisturize scars and improve their appearance over time. These products may be available over the counter or through a prescription from your doctor or breast cancer care team.

These products can occasionally cause skin irritation or allergic reactions. If irritation develops, stop using the product and contact your healthcare team.

You can also ask your healthcare team about treatments that may help reduce scarring. These may include pressure therapy or steroid injections for hypertrophic or keloid scars, which are raised, thickened areas of scar tissue.

Ask for Help During Your Recovery

Recovering from surgery can make everyday tasks more difficult, especially during the first few weeks. You may need help with activities such as:

• Showering
• Getting dressed
• Preparing meals
• Doing household chores

You may also want to arrange help with grocery shopping, laundry, child care, pet care, or transportation before your surgery.

If you do not have a large support network nearby, it may help to prepare in advance by stocking up on groceries and other supplies or using grocery- and meal-delivery services.

Having the support you need during recovery can help you avoid overexertion and reduce the risk of injury while you heal.

Plan on Gentle Movement After Surgery

Once your mastectomy surgery is complete, your healthcare team will likely recommend some gentle exercises, light stretching, and deep breathing exercises as part of your recovery. These movements can help:

• Improve range of motion
• Reduce stiffness and tightness around mastectomy scars
• Support healing after surgery

Gentle exercises may also help lower the risk of complications such as:

• Lymphedema (swelling caused by a buildup of lymph fluid)
• Cording (tight, ropelike tissue that can form under the arm)
• Blood clots

Although rest is important after breast cancer surgery, it’s also important to move around a little each day as recommended by your care team. Light movement may support circulation, recovery, and overall well-being.

Talk with your care team about when it is safe to return to regular exercise, lifting, and other daily activities.

Take Care of Your Emotional Needs, Too

It’s normal to experience many different emotions after a double mastectomy without reconstructive surgery. Some people feel a sense of loss or grief about changes to their body and appearance.

Others feel relieved or empowered by their decision to live flat. As one MyBCTeam member wrote: “Today, I’m a happy girl being flat chested and wearing no bra. No more boob sweat or rashes. [And] praise God I’m still here.”

Many people experience a mix of emotions over time.

Whatever you’re feeling, your emotions are valid, and you don’t have to go through recovery alone. Friends, family members, mental health professionals, support groups, and online communities such as MyBCTeam can all provide support during this transition.

If you’re struggling with depression, anxiety, body image concerns, or changes in sexual intimacy or relationships, talking with a licensed therapist or counselor may help. Your healthcare team may also be able to connect you with additional support resources in your area.

Join the Conversation

On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

Did you decide to go flat after double mastectomy? Let others know in the comments below.