Editor:  Not Putting on a Shirt believes that women shouldn’t have to take extraordinary measures to ensure that their choice to go flat is respected. Unfortunately, we live in a world where paternalism is still endemic. Sandee’s patients in Qatar are lucky to have someone knowledgeable and bold acting on their behalf to protect them, but so many women don’t have anyone in their corner when making their reconstructive decision.  That’s why we are here – working towards a future where the choice to go flat is treated with the same dignity and respect that is afforded to the choice to reconstruct. We have a long ways to go. In the meantime, it’s good to know that patient advocates like Sandee are speaking out to protect patients.  Patients facing mastectomy in the US can usually find a nurse navigator or oncology social worker to help them advocate for themselves, but they often have to actively seek them out.

“We all need advocates to help us speak our truths when we feel broken into bits. It can be hard to demand our rights when we are afraid and it can be hard to stick to what we want when we feel bullied by what others want. Surgeons have no right to tell us what to do based on their definition of beauty.” – Sandee

“Greetings from Doha (Qatar),

My experience as a patient advocate started because there aren’t really any support groups in Qatar for survivors yet. When I first arrived in Qatar 6 years ago, I was a two-year breast cancer survivor. I wanted to volunteer somehow but all I could do was staff a table at our college’s quilt ticket sales! It was frustrating. Then, the next year, a dragon boat was brought in to Qatar and although I wanted to start a team for breast cancer survivors, I couldn’t meet anyone! I decided to just paddle and leave the idea behind me.

Then I had a recurrence of breast cancer and everything fell into place. On November 14, 2014, I started a breast cancer dragon boat team. I also decided that since it was obvious that something had happened to me (going from a 34DDD to small implants), I might as well talk about it. I started writing articles, speaking at events and organized a survivors speakers panel. Then, my implants became a health hazard and caused a lot of infections and holes in my skin etc. so I finally had them removed. It was a hard decision for me because I had fought so hard to have the implants. Anyhow, I decided to go flat, gave myself three days to mourn the loss of my breasts and implants and got on with it.  I looked for an online support group. ‘Flat and Fabulous’ became my online home.

Not being one to remain silent, I started to advocate for women to be allowed to make their own choices… implants, no implants… do whatever. The local hospital started sending women my way who needed support or who were sad and in need of help. Two women I met wanted to go flat but had to fight their doctors or partners. The first woman was already small and didn’t want to bother. Her husband and her surgeon tried to convince her otherwise. I went to her home, chatted, showed her my scarred chest and said “do whatever will make YOU happy. It is your body.” She decided to go flat and never looked back.

The next woman had a surgeon I was unfamiliar with. This female doctor and her resident even made this woman wait another two weeks for surgery because they wanted her to contemplate her decision further! The nurse called me and asked me to speak to her… not sure what they thought I would say, given how many issues I had with implants, but I said, “go flat!”

I advised her to take a photo of my flat chest, sent her a picture and told her to get her surgeon to put in writing that she would agree to make her flat or she would go to a different hospital. I offered to go with her if she wanted an advocate or to practice what she would say. Like many of us, she didn’t want to disappoint or ‘backtalk’ her surgeon but she knew what she wanted! She wanted to go flat! And so, she went into her meeting, told them they must do what she asked for and then I sent her messages and pep talks until an hour before her surgery.

We all need advocates to help us speak our truths when we feel broken into bits. It can be hard to demand our rights when we are afraid and it can be hard to stick to what we want when we feel bullied by what others want. Surgeons have no right to tell us what to do based on their definition of beauty. They are not the ones who have to deal with cellulitis, discomfort, multiple surgeries etc. We need to be told all of our options… the pros and the cons. It was MY choice to go for implants and then it was my choice to have my implants removed. No one tried to convince me of anything. Occasionally my surgeon mentions some new prosthetic but he only gets one or two sentences in before I say “I’m not interested. I am flat and fine with it. I am not interested in putting my breasts in and out of my shirt every day.” He gets that… and he no longer suggests anything.

So, advice for women who want to go flat. Take photos of flat-chested women, bring them to your appointment and say “This is what I want.” Arm yourself with pictures of fabulously flat women and bring them to the appointment with whomever you are supporting and if the surgeon does not agree, find another! Sometimes easier said than done but it is better than having to go back in for revision surgery or to wake up with excess skin left behind because they didn’t believe you when you said “flat!”

And remember… Your body, your right to choose!

Love and light,

Sandee”

Editor: While every woman’s story is unique, the contrast between the post-operative experiences of women who choose to go flat whose decision was respected, versus those whose wishes were not respected, is stark. Going flat can feel freeing and empowering, but when a woman’s choice is stolen from her, she experiences it as a loss and grieves accordingly. The path to self-acceptance for these women is complicated, even confounded in some cases.  Rebecca chose to go flat and her surgeon honored her choice. Going flat for Rebecca was an extension of her sense of self as a woman, and she was able to retain a sense of power and ownership over her body despite the loss of her breasts.

There can be no allowance made for paternalism in medicine. Every woman deserves to be afforded the best chance she can have at navigating breast cancer treatment and coming through with her sense of self intact.

“For me, the real power comes from saying ‘I am enough JUST like this’ and believing it, living it, sharing it. I dress in ways to highlight how flat I am, to show my scars, to show the whole thing sometimes. And every time I do, I feel it is a statement, not just for me, but for every woman I pass.  We are okay JUST how we are.” – Rebecca

I do things a little odd for many.  I think the way I process is for sure off-beat most of the time. My journey of learning real body positivity started in like the strangest way most could imagine.  What inspired it was odd and unexpected even to me. The person who inspired it is also the least likely I could have imagined and hasn’t a clue and never will.  I was a teen, and like most teens girls in the USA, I was shaving all the parts I was “supposed to”. It was fall or winter (can’t recall) so I wasn’t making a point to make it daily or anything, but often enough to still count as shaving. A young man that I knew (and didn’t at all like on any level) made a comment after noticing stubble on the one inch of ankle skin exposed while I was seated. My face went hot for some reason. I was so irritated that he pointed it out. No doubt I said something sharp in reply, but even so, I felt embarrassed.

And this is where my thinking tends to diverge from others. I thought about it several times as the day progressed and the more I did, the angrier I became that he had any power to make me feel embarrassed. I kept dissecting the situation and thinking about how ridiculous it is that any person feels they have the right to make any issue out of my body hair.  How dare they. Then I thought more and thought “I can never shave again if I want to and it’s no one’s business”. Then I thought about not shaving at all and letting it show. And I realized how uncomfortable that idea was. The more uncomfortable it seemed to do it, the surer I was that I needed to do exactly that. I realized he didn’t embarrass me, I did. It dawned on me that somewhere along the way I have opted to buy into the idea that the body hair of adult women, all adult women, was something I was supposed to remove, that all women should. I realized I wasn’t loving me when I was so embarrassed about something totally normal, totally natural, totally healthy about my own body.

So I made myself a promise that day, that I would stop all shaving until no comment could make me uneasy. It was so hard. I met my husband during my personal shaving strike even. That didn’t make it easier. I decided that I would allow myself to shave if I wanted to, but only after I had ridden myself of any level of discomfort with it.  It took me three years. THREE. That is how ingrained it was in me. I never expected it to take that long, but it did. After that point, I’ve shaved as I wanted to, if I wanted to, and usually, I have no desire to.

I think this matters because, in order to ever gain anything in life, it takes effort and often discomfort.  There isn’t some simple way to accept yourself. At that time I took lots of flack, from women and men. I still do sometimes, but not from people that have tired long ago, only new ones.  But all along, and even now, people see this not shaving as “radical”. You might think in 27yrs that would have changed, but not much at all. As an homage to that word, plastered onto me so many times, I have developed for me what I called “radical self-love”. I stopped shaving as my first act of radical self-love. What was not a phrase back then was “body positivity”, but in its full version, this fits perfectly. My body grows hair as a grown woman, and I welcome it. I am not upset with my body, annoyed where hair grows, how fast it grows, etc. It is what it is, just as it’s designed to be. AND I can be feminine just as much as ever because shaving isn’t femininity. Our Western cultures like to try to tell us it is, but I get to define my views, not cultural norms.

Along the way, I have met new challenges. I’ve had several children, I’ve had thyroid issues that have caused me rapid weight gain and hard to manage weight loss. And every time a new issue arises, I have met it with the same determination I did to learn to love my body hair. I have delved into a radical attempt to love whatever it is. I work on kind talk to myself. If I say something bad to me about me, I cover it with three compliments. I look at myself naked all the time and say nice things to me when I do. I have had all the weird body things you get after babies, including the crazy tummy. I do not allow myself to avoid looking. Instead, I look MORE. I do not allow myself to hide these things from my husband. I have learned that for me, the more I push myself forward, out there, to just “own” my space and declare my own value, my own inherent right to love this package, however it looks today, the more it follows naturally that I do feel confident and good, however I showed up today.

And over the 25+ years since I was out of that daily environment, I have been challenged at various times and at various levels to learn what real self-love looks like.  I have been challenged to figure out what real body positivity is. The challenges were always a head issue, not a body one. I believe that is really always the key in the end. No one else can give it to you. You cannot wait to have the perfect body to have it, or it’s never going to happen.  And you have to have a lens that is loving supportive and positive to other people’s bodies to get it.  You can’t be harsh in how you see others and kind when you look at yourself. It just cannot coexist.  So I’ve also endeavored all along to speak positively to others about their bodies as well.

So when it came time to face mastectomy in my own life, the decision to be flat was relatively easy for me to choose.  It wasn’t easy to do, but easy to know that is what I would have to do. Any other choice would be a departure of what I worked so hard for, radical self-acceptance.  I live my truth, whatever it is today, openly, graciously, with pride, with love for me and love for you. I recognized early on as well, that being openly and proudly flat was not only a gift to me, and to my family, but to others whose paths I cross.  I allow women to see they are absolutely all they ever were with or without breasts. I am still feminine, with my new body. I often do dress what many consider very sexy, and I still get just as many compliments on it, maybe more.

I also knew I had to do this for my kids.  I try to teach them all I have learned about radical self-love as young as possible.  For my thinking, and the way I live, that meant I’d have to be openly flat or I’d be sending a really mixed message.  I teach that cultural ideals are nothing to aim for. They should not be celebrated, embraced, or sought either in yourself nor in a partner.  What we need to find real happiness, is a real acceptance of the variety that beauty comes in.  We need to learn to live our most authentic versions of ourselves.  We need to seek to be open and honest as often as we can be. In that, one of my many truths is that I had my breasts removed.  THAT is the truth of me. I cannot seek to find some way to lessen the impact of that on myself or others that see me.

I am not interested in seeking to get anything back from what I lost, because to my way of thinking you cannot give me back what I lost.  I had breasts I really loved. I loved their shape and size. I loved the way they had changed over time, over babies, over decades. I liked the idea of them aging along with the rest of me.   I loved my breasts.

The options aren’t at all like what I had.  They just are not. There is no type of reconstruction that gives you breasts.

They do rebuild the area to appear as if you have breasts, but we all know deep down they aren’t breasts, no matter what culture names them.  When all of your actual breast tissue is removed, the lobules, the ducts, the fat, it’s gone, forever. That is truth. It’s a painful truth and one we might all like to ignore, but it’s true for all of us, the ones with recon and those without.  None of us have breasts. They can move things around on your body if you are a candidate. They can manipulate my chest muscles and give me some implants, but what they cannot give me is breasts. They can give me special bras with breast forms of any size I like.  They can offer options. And I am well aware that they are meant to empower women, and perhaps they do for some.

For me, the real power comes from saying “I am enough JUST like this” and believing it, living it, sharing it.  I dress in ways to highlight how flat I am, to show my scars, to show the whole thing sometimes. And every time I do, I feel it is a statement, not just for me, but for every woman I pass.  We are okay JUST how we are. We do not have to accept any pressure to be anything else.  We don’t need larger busts (or smaller ones), we do not need a specific body type or waistline, we don’t need a larger butt or thinner thighs or to be free of cellulite or any other nonsense.

YOU are enough for me. You are just who you are supposed to be, and you are beautiful to me just the way you are.  When I make the statement that I am enough, in my heart every time I am saying WE ARE ENOUGH. ♥”

Editor: We at Not Putting on a Shirt are grateful to Rebecca for her wise words of affirmation and hope.