*Editor’s note: An image included below the scroll in this article and images included in the video report show women who have chosen aesthetic flat closure not wearing shirts.
GRAND RAPIDS, Mich. (WOOD) — There is a growing community redefining what beating breast cancer and being a woman looks like, not shy about being what they call “flatties.”
These are women who have decided not to have breast reconstruction surgery after a mastectomy. They want others to know they can make the same choice.
At 32 years old, Jamie Kastelic of St. Joseph knew the lump she found in as she weaned her son was breast cancer.
“I had this gut feeling that it was something,” Kastelic said.
She also knew how she was going to attack this diagnosis. Her aunt previously had breast cancer, so she had thought about it.
“I told my husband … if I was ever diagnosed with breast cancer, I would get a bilateral mastectomy, hands down,” Kastelic said.
A double mastectomy followed by breast reconstruction was also Katie Fink’s plan after her cancer was discovered during a breast reduction surgery.
“I was told, ‘You’re so young, you’re active, you’re so healthy. You’re going to be fine'” with breast implants, Fink recalled.
Fink and Kastelic were among them.
“I had seromas, hematomas. I went into the emergency room a few times to have my breasts drained because they were swelling,” Fink said. “In the course of three months, I had gone into the ER two times, three times. I was in so much pain.”
“I was fighting this infection that literally almost killed me for eight days,” Kastelic said. “They thought I was going to have a stroke because I was that sick from this infection.”
They had beaten breast cancer but they were fighting again. The reconstruction process became their enemy.
“I’m done. I’m done,” Fink recalled feeling. “I just want these out of me. I’m not doing this anymore. I can’t take this anymore.”
“My plastic surgeon was like, ‘Come back in three months. We’ll just start over again,'” Kastelic said. “And I said, ‘I will never do this again. I am done. This is it. I am never putting my body through this again.'”
With breasts gone and reconstruction efforts abandoned, both women were left with one option: going flat. It’s called aesthetic flat closure. Women who choose this forego any reconstruction.
Kastelic and Fink, who is from Eben Junction, near Munising in the Upper Peninsula, now openly embrace and actively work to promote the way of life as an option for women battling breast cancer.
“It’s very, very personal, how you feel about your body; how you feel as a woman about what having breasts means to you,” Dr. Amie Hop, a surgeon specializing in breast care at Spectrum Health in Grand Rapids, said. “For some ladies, it’s part of how they identify.”
The American Society of Plastic Surgeons promotes several reconstruction techniques after mastectomy, all of them using implants or a flap closure with tissue from another part of the body to rebuild the breast.
Recently, Hop said, aesthetic flat closure is being talked about more at national surgeon conferences.
“I still feel like that women who might be seeking it as an option feel almost isolated — like a lot of people they talk to had reconstruction or it’s such a large part of the conversation from the beginning of their diagnosis, they feel like maybe they’re an outlier,” Hop said.
Fink, known as “theflatadvocate” on Instagram and the treasurer of the nonprofit Flat Closure Now, works to share her experiences with others and let them know that going flat is an option.
“All reconstructive options have to be given. All of them have to be given with the same emphasis and the same knowledge and the same information for a woman to sort through, for a person to sort through,” Fink said.
Kastelic was moved into advocacy after she was asked by a mammography office to pose for a photo shoot, pictures that later went viral.
“I contacted a friend and I asked her if she would paint my chest. She said yes. I looked in the mirror during that photo shoot and I was like, I can do this. I can rock this flat chest and it’s going to be fine,” said Kastelic.
“You do have options,” Kastelic added. “I knew I would never go through the surgeries again, but I did want to have options. So for me, custom breast prosthesis, it’s kind of like wearing earrings, it’s like an accessory. I have customs on right now and I still have cleavage, so how cool is that?”
Kastelic’s friend Lori Miller owns Studio I Boutique in St. Joseph.
“I’ve seen a lot of chests, a lot of surgeries,” Miller said. “They suffer in silence and they’ll stuff socks (in their bras). It’s so sad what I see.”
For years, she has been giving women an option with custom-fit prosthetics.
“We take a scan of the chest wall and they match that on to your chest like a puzzle piece,” Miller said.
Kastelic wears her prosthetics some days. Some days she doesn’t.
She and Fink want other women diagnosed with breast cancer to have that same option.
“(Aesthetic flat closure) is a normal, beautiful, healthy option that should be normalized,” Fink said.
“You can still be beautiful and you can still rock your flat chest and be fine with that,” Kastelic said.
Flat Closure Now, the nonprofit Fink works with, provides information on aesthetic flat closure, often through sharing pictures of what going flat looks like.
“I’m on TikTok now and people are like, ‘Put your shirt on.’ And I’m like, ‘I can’t,'” Fink joked.
Dr. Hop says as word spreads, surgeons need to be ready to serve their patients.
“We need to challenge ourselves to say we’re offering this option. How can we best meet the patient’s needs, whether that’s on our own as a breast surgeon or whether that’s in conjunction with a plastic surgeon,” Hop said.