The Choice to Go Flat Post-Mastectomy
Why Read This
What Makes This Article Worth Your Time
Summary
What This Article Is About
Anthropologist Arianna Huhn recounts her experience choosing aesthetic flat closure (AFC)—commonly called “going flat”—after a double mastectomy for breast cancer. Writing for SAPIENS, she details the institutional and social pressures that present breast reconstruction as the default, expected response to mastectomy, from surgeon assumptions to insurance frameworks shaped by the Women’s Health and Cancer Rights Act (WHCRA). Huhn’s surgeon initially misheard “flat” as “flap,” revealing how unfamiliar the choice remains in clinical settings, even as research shows that between 19 and 58 percent of women forego reconstruction.
Beyond her personal narrative, Huhn examines the cultural machinery driving reconstruction norms, including social stigma, flat denial by surgeons who refuse or are untrained to perform clean chest contouring, and billing ambiguities that until 2024 allowed some insurers to classify AFC as elective. Drawing on her anthropological lens, she argues that the routine prescription of reconstruction — replacing breasts with “stiff and senseless fabrications” — reflects a deeper patriarchal standard that equates a woman’s value with her body’s conformity to conventional femininity, and that genuine bodily autonomy demands room for women without breasts.
Key Points
Main Takeaways
Reconstruction Is Not the Only Choice
Aesthetic flat closure is a legitimate, covered post-mastectomy option, yet it remains unfamiliar to many surgeons and patients alike.
Reconstruction Carries Serious Risks
Nearly half of women who undergo reconstruction are disappointed; complications include capsular contracture, infection, loss of sensation, and repeated surgeries.
Flat Denial Is a Real Barrier
Some surgeons ignore patient wishes, lack training in flat closure techniques, or leave excess skin behind without consent — a practice advocates call “flat denial.”
Social Pressure Shapes Medical Decisions
Women choosing to go flat face questions about femininity, partnership, and desirability — cultural pressures that treat breastlessness as a personal failure rather than a valid outcome.
Policy Lags Behind Patient Needs
The absence of a standard billing code for AFC and insurance ambiguities meant AFC was classified as elective until revised WHCRA guidance was issued in 2024.
Reconstruction Norms Reflect Patriarchy
Huhn argues that treating reconstruction as the medical default reveals how a woman’s value is culturally tied to conforming to a conventionally gendered body.
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Article Analysis
Breaking Down the Elements
Main Idea
Going Flat Is a Cultural, Not Just Medical, Act
Huhn’s central argument is that choosing aesthetic flat closure after mastectomy is not merely a personal preference but a challenge to deeply embedded cultural norms. The medical system’s default assumption that women will pursue breast reconstruction reflects patriarchal values linking femininity to breast presence — and the choice to go flat exposes those assumptions by refusing to conform.
Purpose
To Advocate for Informed Bodily Autonomy
Huhn writes to expose the systemic and cultural pressures that constrain women’s post-mastectomy choices and to advocate for a healthcare landscape where flat closure is genuinely and equally available. She uses her personal experience to ground an anthropological argument, aiming to inform readers while pushing for institutional change and greater patient agency.
Structure
Personal Narrative → Critical Analysis → Advocacy
The article opens as a first-person narrative using dialogue headers to advance the story chronologically. It then widens into an analytical examination of medical, legal, and social systems, before concluding with an explicit advocacy argument. This Narrative → Analytical → Persuasive structure allows Huhn to build emotional credibility before mounting a broader cultural critique.
Tone
Candid, Analytical & Quietly Indignant
Huhn’s voice is direct and unsentimental despite deeply personal subject matter — she observes her own cancer journey with anthropological detachment while allowing flashes of dry wit and restrained anger. The tone is candid without being polemical, maintaining analytical credibility even as it builds toward an unmistakably critical stance on medical norms and patriarchal culture.
Key Terms
Vocabulary from the Article
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Tough Words
Challenging Vocabulary
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Derived from the patient’s own body; in breast reconstruction, refers to flap surgery that relocates the patient’s own skin, fat, and muscle to form a new breast mound.
“Flap surgery involves relocating skin, fat, and sometimes muscle from another part of the body to the chest. The method is touted as providing a more natural look and feel than ‘alloplastic’ reconstruction.”
Pertaining to the use of non-biological, synthetic materials — such as silicone gel implants — in reconstructive or cosmetic surgery, as opposed to using the patient’s own tissue.
“‘alloplastic’ reconstruction (using nonbiological materials, such as silicone gel implants).”
A complication of breast implant surgery in which scar tissue forms around the implant and tightens, causing hardness, distortion, and often significant pain.
“capsular contracture (scar tissue squeezing the implant), infection, and wound reopening.”
The death of living cells or tissue in the body, often caused by injury, infection, or inadequate blood supply; a recognized complication in breast reconstruction surgeries.
“Aesthetic concerns include asymmetry, prominent scarring, rippling, and tissue necrosis.”
The social environment or cultural setting in which a person lives or an event occurs; the surrounding conditions that shape attitudes and behavior.
“declining reconstruction in a social milieu where it is not the norm can be a difficult choice.”
A heightened susceptibility or likelihood of developing a disease or condition, often due to genetic factors inherited from one’s biological parents.
“Further testing indicated a genetic predisposition, and that had modified the risk analysis.”
Reading Comprehension
Test Your Understanding
5 questions covering different RC question types
1According to the article, the Women’s Health and Cancer Rights Act (WHCRA) has always explicitly covered aesthetic flat closure as a form of chest wall reconstruction since its enactment in 1998.
2When the author told her surgeon she had “decided to go flat,” what was his immediate response?
3Which sentence best captures the author’s core anthropological argument about why breast reconstruction has become a medical default?
4Evaluate the following statements about breast reconstruction as described in the article.
Nearly half of women who undergo breast reconstruction are disappointed with the results.
Reconstructed breasts typically retain full sensation comparable to natural breast tissue.
Studies cited in the article suggest that women who choose to go flat are generally satisfied with their decision.
Select True or False for all three statements, then click “Check Answers”
5The author’s surgeon remarked that most women are “more interested in talking about the free boob job than they are about the cancer.” What does this statement most strongly suggest about the medical culture surrounding mastectomy?
FAQ
Frequently Asked Questions
“Going flat,” or aesthetic flat closure (AFC), involves tightening and smoothing the chest wall after mastectomy without creating a breast mound. Breast reconstruction, by contrast, uses either implants (alloplastic) or the patient’s own tissue relocated from elsewhere in the body (autologous flap surgery) to restore a breast shape. AFC is a distinct, recognized medical option — not an absence of treatment — though it remains less familiar in clinical practice than reconstruction.
Flat denial, a term used by the nonprofit Not Putting on a Shirt, describes situations where a patient requests flat closure but does not receive it. This can result from surgeons who are untrained in clean contouring techniques, who deliberately leave excess skin behind in case the patient changes her mind, or who simply dismiss the preference. Billing ambiguities that historically classified AFC as elective also contributed to systemic barriers against the choice.
Huhn argues that the medical default of reconstruction reflects a broader cultural assumption that a woman’s value is tied to her body conforming to a conventionally feminine shape. This is evident in social pressures — friends and family asking “what will your husband think?” — and in the medical system’s framing of reconstruction as the obvious next step after mastectomy. She views this as an extension of objectification embedded in cultural norms rather than a purely clinical recommendation.
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This article is rated Intermediate. It uses some domain-specific medical and anthropological vocabulary — terms like autologous, capsular contracture, and alloplastic — but grounds them in accessible personal narrative. The argument requires readers to follow both a first-person story and an abstract cultural critique simultaneously, which demands inference and analytical reading skills beyond the beginner level but does not require specialist knowledge to engage meaningfully.
Arianna Huhn is a professor of anthropology at California State University, San Bernardino, and director of its Anthropology Museum. Trained at George Washington University and Boston University in museum studies, medical anthropology, and African studies, she brings a scholarly lens to her own cancer experience. Her dual position as patient and academic gives the article unusual authority — she can analyze systemic cultural patterns with professional rigor while grounding them in vivid personal testimony, making her argument both emotionally compelling and intellectually credible.
The Ultimate Reading Course covers 9 RC question types: Multiple Choice, True/False, Multi-Statement T/F, Text Highlight, Fill in the Blanks, Matching, Sequencing, Error Spotting, and Short Answer. This comprehensive coverage prepares you for any reading comprehension format you might encounter.
