Living Flat or Asymmetrical (No Reconstruction)

Why People Choose to Live Flat or Asymmetrical

Choosing to live flat or asymmetrical after breast surgery is a deeply personal decision and it’s just as valid as choosing reconstruction. People make this choice for many reasons, including:

• Personal comfort and confidence: You may simply feel more at ease and empowered living flat

• Reconstruction isn’t a priority: It may not feel important to your identity or recovery
• Avoiding more surgery: Some want to skip the extra pain, recovery time, and potential complications
• Health conditions: If you have conditions like diabetes or heart disease, additional surgery might carry more risk
• Avoiding implants or grafts: You may not want implants or to use tissue from another part of your body
• Concerns about the final result: Reconstructed breasts might not feel or look natural, and the results may not align with your expectations
• Prosthetic discomfort or cost: Breast forms can be uncomfortable or costly, and not all insurance plans provide coverage (though support programs exist)

Some people who choose to live flat or asymmetrical still want the appearance of a nipple without undergoing reconstructive surgery. One option is 3D nipple tattooing, which can create a realistic look without additional surgery. You can learn more about this option in our blog on 3D nipple tattooing.

Others may choose mastectomy tattoos, which are decorative tattoos designed to cover scars, boost confidence or create something meaningful to mark their journey. You can learn more about this option in our blog on mastectomy tattoos.

It’s also helpful to know that reconstruction or prosthetics are not medically required. Many people feel confident and complete without them. If you are unsure about your decision, speaking with your healthcare team or connecting with others who have made similar choices can help you feel more informed and supported.

Day-to-Day Considerations

Living flat or asymmetrical can impact intimacy, clothing, and self-image. Here are some things to consider:

• Sensation Loss: Loss of feeling in your nipple(s) may lead to increased sensitivity in other areas
• Intimacy: Intimacy may require adapting to new ways of connecting. Open communication with your partner can help
• Breast Forms (prostheses): These are optional, and you can wear what makes you feel most comfortable and confident. There are versions of lingerie that can be worn with breast forms, but you do not have to wear them if you are not comfortable.
• Clothing Tips: If you want to draw attention away from your chest area, the website BreastFree offers helpful tips:
  • Busy or irregular patterns
  • Dark colors, especially black
  • Crisp shirts with strategically placed pockets
  • Asymmetrical closures and features
  • Layering with overshirts, jackets, or sweaters
  • Scarves and shawls for chest coverage
  • Accessories like earrings and hair ornaments to draw attention upward

Living flat or asymmetrical does not mean sacrificing confidence or expression. Instead, it is about embracing what feels right for you in your day-to-day life.

Aesthetic Flat Closure (AFC)

AFC, or post-mastectomy chest wall reconstruction, is a type of reconstructive surgery that creates a smooth, flat chest after mastectomy. It can be performed immediately or delayed. The procedure removes excess skin and tissue and may involve fat grafting or tissue transfer for a more even contour. In some cases, a second procedure is needed to refine the result.

Considerations:

• Surgeon: Breast or plastic surgeons may perform the procedure, especially if more complex techniques are needed.
• Candidates: Those with higher BMI, larger breast size, or radiation damage may benefit most.

Click here to see before and after photos of real people. (Content warning)

Questions to Ask Your Surgeon

If you’re considering (or have decided) not to have reconstruction, it is important to talk openly about this with your surgical team. Here are some helpful questions to ask during your consultation:

• How will the contour of my chest look after mastectomy? Can an uneven contour be corrected with fat grafting?
• Will my chest wall have a generally equal appearance?
• Where will my surgical scars be? Will they lay flat?
• How many mastectomies without reconstruction have you performed?
• What kind of results can I expect? Do you have pictures?
• Will I retain any sensation in my chest area?
• Are there any health considerations with living asymmetrical if I have larger breasts?

Options After No Reconstruction

Choosing not to have breast reconstruction does not mean you are without options. There are several ways to adapt and personalize your appearance, if or when you choose to:

• Breast prostheses: can be worn regularly, occasionally, or not at all
• Decorative tattoos: to reclaim your chest and express your style
• Silicone nipples: removable options that offer a more natural look

Resources
If you are considering going flat, online groups and advocacy organizations like BreastFree, Not Putting On A Shirt, and Flat Closure NOW offer helpful resources, including photo galleries and videos.

Medical Reviews by Mark Basik, MD, FRCSC, December 2025