One Woman’s Decision to 'Go Flat' After Mastectomy

by Pamela Kaufman Health Writer

Women who have had a mastectomy don’t often hear much about the option of “going flat” for the rest of their lives. But Rebecca Pine has been working to change that. Pine, a breast cancer survivor, wants other women to know that healing is a highly personal process and that reconstructive surgery, while right for many women, may not be right for everyone.

Here, Pine talks to HealthCentral via email about the many ways she defied convention in her breast cancer journey, including her choice to eschew reconstruction and her decision to have a baby. She also describes The Breast and the Sea, a project she launched with photographer Miana Jun on Long Island, New York, that aims to help women affected by cancer find emotional strength and redefine physical beauty.

HealthCentral (HC): How did you come to be diagnosed with breast cancer?

Rebecca Pine: I knew that my mother had the BRCA-1 genetic mutation, so I began getting mammograms in my early 30s. My second mammogram detected irregular clusterings of cells, and a biopsy revealed cancer. I was 33 and just about to get married, blend our two families, and move out of state.

I also learned that I, too, carry the BRCA-1 gene. Although counseled to have a double mastectomy, I initially opted for a single, with a tissue expander followed by a saline implant and reconstructed nipple. As I was stage 1, the guidelines stated that chemo was an optional treatment, and I declined.

HC: Could you describe some of the emotions you grappled with during this difficult time?

Pine: I never identified myself with my breasts, so I was surprised by how attached I felt to them when faced with their loss. Losing my breasts was traumatic for me. I was afraid I would feel less whole. The experience was overwhelming. I found stability, surprisingly, through giving myself permission to delve deeply into the uncomfortable process of grappling with fear and mourning the uncertainties at hand.

I examined my fears, sorrow, and hopes during visits to the sea, and recorded these reflections in my journal. The water and the wind helped me come to terms with the inevitable, and ultimately accept the changes in my body and my life.

HC: What went into your decision to have a baby after your first mastectomy?

Pine: My husband and I wanted to have a child together. We had no idea if this would be feasible after breast cancer, as many women are advised not to even consider this as an option, due to the large amount of estrogen present in the body when pregnant. But the possibility of having another child gave us a lot of hope. My medical team consulted with the tumor board to discuss treatment options and the risks associated with pregnancy, and we decided to proceed. We were blessed with a healthy baby girl.

Breastfeeding had been a meaningful part of raising my son, and I wanted to try to breastfeed my daughter with my remaining breast. Although there were bumps in the road, I was able to produce enough milk; a mother’s body is incredible in the way that it makes adjustments for the needs of the baby. It was a precious time, and I treasured the “ordinary miracles” of carrying life and breastfeeding.

HC: Could you talk about your decision to “go flat?”

Pine: I was unhappy with the saline implant I had after my initial mastectomy. As I began preparing for my prophylactic mastectomy four years later, I knew I wanted to try something else. I was looking into microsurgical flap options, which graft tissue from other areas of the body to make “breast mounds.” But the length of time in surgery, long recuperation period, and greater risk of complications were not sitting right with me. I began to notice that I felt tension whenever I considered reconstruction, which eased up when I thought about “going flat.” It was subtle at first, but it grew increasingly more clear that microsurgery was not the route for me.

“Going flat” meant I was able to heal faster and return to the things that were most important to me sooner, like picking up and holding my toddler and playing active games with her. While it’s not the right choice for everyone, choosing not to reconstruct has been the right choice for me. I feel comfortable with my body and my decision.

Rebecca Pine the Breast and the Sea Project
Rebecca Pine worked with photographer Miana Jun to create The Breast and the Sea project. / Miana Jun

HC: Can you talk about The Breast and the Sea project?

Pine: When I was faced with surgical decisions, I found few images online, which made it difficult to envision what my body might look like after mastectomy. Plus, while there were lots of technical and personal accounts of cancer treatments, there was little about the inner, emotional struggles that I was going through.

I knew that I must not be the only young woman wanting to have children after breast cancer. I kept asking myself why I couldn't find their stories, and why I felt so alone grasping for answers and seeking support. I decided it would be important to share my story, and wished to find other stories to compile.

Shortly before my second mastectomy, I commissioned photographer Miana Jun to take photos of my breast and of me breastfeeding my daughter. We began collaborating on The Breast and the Sea shortly after that. Our project evolved to incorporate workshops at the sea, with a focus on the inner, emotional healing process. We cultivate an environment that is safe, supportive, and connected to deeper aspects of ourselves, one another, and the elements of nature.

Part of the experience involves baring our scars in the water, with a guided movement experience, empowering breast cancer survivors, previvors, and patients to embrace ourselves exactly as we are. Portraits are taken during our time in the sea, capturing moments of connection and quiet reflection. Participants come out of the water visibly changed, appearing lighter, more peaceful, and with a newfound level of self-acceptance.

The goal of The Breast and the Sea is to empower those affected personally by breast cancer, to provide support and tools for a meaningful inner healing experience, and to normalize our changing bodies. Our work involves focusing on the “inner scars” of breast cancer, which involve body image, redefining beauty, and reclaiming a sense of wholeness.

Breast cancer survivors come together in the waves for The Breast and the Sea project.
Breast cancer survivors come together in the waves for The Breast and the Sea project. / Miana Jun

We dream of bringing our workshop to communities of people who cannot travel to New York. We are also working on a book and are seeking publication.

Pamela Kaufman
Meet Our Writer
Pamela Kaufman

Pamela Kaufman got her professional start covering health at Vogue, where she wrote two columns on news and trends as well as feature stories. Her interest in healthy eating brought her to Food & Wine, where she became executive editor. Today she writes articles about health and food, profiles courageous people living with chronic disease, and pursues all kinds of great stories. You can follow her adventures as an eater, mom, and traveler.