Sexual and gender minority breast cancer patients choosing bilateral mastectomy without reconstruction: “I now have a body that fits me”

Abstract

Sexual and gender minority (SGM) breast cancer patients have begun embracing the choice to "go flat" or opt out of reconstruction after bilateral mastectomy, though little is known about this population. SGM breast cancer survivors were identified through purposive and referral sampling and invited to participate in a web-based survey containing both closed- and open-ended items. Of the sixty-eight SGM breast cancer survivors aged 18-75 years who completed the survey between May 2015 and January 2016, 25 percent reported "going flat" (flattoppers®). Bivariate analyses revealed that flattoppers® were significantly more likely to have been diagnosed in the past five years, to identify as genderqueer, to have disclosed their sexual orientation or gender identity (SOGI) to providers, and to report participating in lesbian, gay, bisexual, or transgender cancer support groups, compared to other participants. More flattoppers® believed that SOGI mattered in terms of getting the support they needed regarding their cancer; this difference was not statistically significant. Thematic analysis of qualitative comments from flattoppers® revealed themes related to reasons for making this treatment choice, interactions with health-care providers around treatment choice, and physical and emotional outcomes of treatment choice. Providers would benefit from training about SOGI as they relate to treatment choices.

Patient satisfaction and quality of life in breast reconstruction: assessment of outcomes of immediate, delayed, and nonreconstruction

“…The present research was a cross-sectional study and therefore we cannot test the impact of breast reconstruction on quality of life, this could be clarified in a prospective study. The sexual orientation of patients has not been evaluated, and this may have interfered with the results, as the literature shows that women who identify themselves as lesbians or gays are generally not interested in reconstruction [20].…”

Long‐Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care

“…23 Women who choose to go flat describe experiencing negative assumptions or judgment from others, difficulty finding clothing that fits correctly, and repeated suggestions to pursue unwanted treatment. 23 There are currently no peer-reviewed studies regarding heteronormative women who choose to go flat. Regardless, practitioners should explore each woman's wishes and not make assumptions about the need for prosthetics or reconstruction.…”

Health Outcomes of Sexual and Gender Minorities After Cancer: A Scoping Review

“…For WSW, having a partner was associated with better sexual function, greater sexual desire, better mental and physical health, and less fear of recurrence compared to heterosexual counterparts [15][16][17]19,21]. In addition, WSW reported being less focused on body image, suffered fewer identity issues due to breast cancer and chose not to have reconstruction more often than heterosexual peers [14,25,54]. However, WSW reported more challenges with access to care [23] and experienced more physical complications related to mastectomy and radiation than heterosexual peers [18].…”

“…Only four studies included transgender and/or genderqueer respondents [25,54,57,59]. Bryson et al [54] found that intersectional identities impacted the experiences of transgender cancer survivors.…”

“…Bryson et al [54] found that intersectional identities impacted the experiences of transgender cancer survivors. Brown and McElroy [25] described health care providers "gender policing" when genderqueer patients made the decision to "go at" and declined breast reconstruction. These experiences and treatment choices were associated with mixed physical and emotional outcomes.…”