Aesthetic Flat Closure

When I talked to my surgeon about this she told me it's a legal point. The removal of healthy tissue being a mutilation, one of the few things you can be struck off for. So I think that's a major factor when there is no defined clinical need.
It is logical to make aesthetic improvements if it will help you as a human being, from 'just' confidence to potentially serious mental health issues, the mind is just another, albeit complex, organ and it needs health care as much as breasts do.
To have bi-lateral removal where one breast is surgically healthy tissue is surely aesthetic if there is no clinical need? It's just some people like to see something different from some aesthetic preferences perhaps? It's ok not to have everyone wanting the same things; need, choice and individuality is ok and I understand the NHS decides between those factors.

Hi Titania, I was told that if Ihad a lumpectomy and it ended up leaving the operated breast much smaller than the other one I could have a reduction and uplift on that healthy breast. Surely that is the removal of healthy tissue for cosmetic reasons only? 

I agree totally. I have less than 20% left on one side, so have been told as a larger lady I 'qualify' for a breast reduction on the healthy side for my bad back and cosmetic reasons. But when I asked, if I have cystic breasts on both sides and they are both almost impossible to screen (my mamograms were normal a couple of days before surgery), plus DCIS and another tumour on the treated breast, then why not do bi-lateral mastectomy and reconstruction of both and be done with it? That's when I was told about needing genetic evidence of risk to consider removal of a healthy breast or it would be mutilation.
There is a percentage 'cut-off' point'  of un-eveness after surgery I believe, where it's considered allowable to even up because of the mental health considerations, 20% rings a bell, but don't quote me on that - perhaps someone here has found out more about all this?
In private practice it may be different for all I know, perhaps this is a time & money issue for the NHS. It's an interesting medico legal point tbh, that I for one would like to know a lot more about. All this 'stuff' being decided on probably by NICE behind closed doors - why are we not more involved?

The medico legal side of the argument is really interesting, I had never considered the ‘mutilation’ aspect. Another thought that the surgeons may have is that I also know 2 people that initially weren’t bothered about their mastectomy or skin sparing mastectomy (but left with no nipples) whilst they were undergoing treatment, but 1-2 years later, they both changed their mind as it was a constant reminder of their cancer. Both have now had reconstructive surgery. Maybe that is an issue too? I will be very annoyed though if I end up with cancer in the other breast, especially as mine was undetected on mammogram or ultrasound. That’s the problem with being in your 40’s and having dense/fibrocystic breasts as well.

Hi Kaey, people in your situation should definitely be given the choice to have an MX on the 'good' breast if they wish it. Have you asked if you can have the other one removed?

Hi Veeayvee,

Yes I did and my consultant said no. He has applied for genetic testing (takes 18 weeks !! to see if you get approved). If I don't I will pay privately to check. Apart from my mum and grandma, I have no other female relatives. I was not offered a choice of reconstruction anyway yet as I need radiotherapy and he said that would ruin any reconstruction they did so would have to wait to next year if I wanted that. Got to do chemo first, I think starting next week

Hi Kaey, I am in the same boat in that I only have two female relatives whose history I know and as neither of them had breast cancer they assume that I have no genetic risk. I think if I had the BRCA1/2 gene then I might be listened to more. Good luck with the chemo, I have only just had surgery but that will be my next stop I expect as one of my two different cancers is HER2 positive. 

Thanks JIG JOG for the details on facebook of FF UK its very informative and lots of success stories of ladies asking for a healthy breast removed for 'symmetry' there was a live discussion yesterday regarding this and I think its something that is becoming more normal, lets hope so. I would have had both off given the chance, now 5 weeks post surgery and healing well, I am not sure I want to go through it again. It would have preferred just the one surgery.

Like you Lizzy, I would have preferred both off at once and am not keen on another operation. I think I now need to wait and see a) how annoying being lopsided is and b) whether it is clinically a good idea in view of the fact that I managed to sprout two different types of BC and one is the more aggressive HER2 type. 

I am deciding on my surgery choices and also want a flat mastectomy and the RHS to match. I don't want to be lopsided. I am a small person who has endured 32G breasts. I believe having one large breast will impact my posture and be bad for my health. I have been offered TM which would substantially reduce the unaffected side but I just want one operation, one healing time and to be flat. I know what I want. I  know I will not have reconstruction. It was my silver lining after 40 years of discomfort carrying them around. It is really getting me down that this is apparently not a choice. It seems a double standard and I going to be sentenced to increased stares and discomfort, bra finding issues etc. It does not seem fair at all the guidance is not right.