Bonnie Annis is a breast cancer survivor, diagnosed in 2014 with stage 2b invasive ductal carcinoma with metastasis to the lymph nodes. She is an avid photographer, freelance writer/blogger, wife, mother and grandmother.

Bonnie Annis

Flat as a pancake. Yep, that was me, right after surgery to remove breast cancer. I was different, but I didn’t realize how different how I felt until months later.

A week or two after I’d received my diagnosis of breast cancer, I met with a surgeon to discuss my case. She assumed I wanted breast reconstruction after a double mastectomy to remove cancer—she was wrong. I didn’t want to restore what cancer had taken from me. I told her in no uncertain terms, I wanted to be flat.

“Are you sure?” she asked. “I can leave extra skin so we can insert expanders until you’ve healed enough for implants or; we can move fat and tissue from other areas of your body to sculpt new breasts.” It seemed she wouldn’t take no for an answer. Several more times the surgeon tried to persuade me to opt for reconstruction. She even argued it would make my marriage better. At each insistence, I replied, “No.” I explained if breast cancer was going to take my breasts, I didn’t want any residual evidence of their existence. I would be flat and that was that.

The procedure I’d chosen was called an aesthetic flat closure, one where all extra skin, fat and breast tissue are removed. The doctor explained, after the process was complete, everything else would be tightened and smoothed to provide a completely flat chest wall. She assured me she’d do her best to make sure I didn’t end up with dog ears. “Dog ears?” I questioned. She explained sometimes, when performing an aesthetic flat closure, a patient could end up with extra skin just behind the armpits. Those were called dog ears because of their triangular shape. I definitely didn’t want those.

After the surgery was complete and healing had taken place, I felt very alone. I knew there were other double mastectomy patients, but how many of them had chosen to forego reconstruction? I assumed not many. The majority of women opted for one form of reconstruction or another, or they’d chose implants. Being flat wasn’t popular—so I thought.

One day, while perusing social media, I happened across a group called “Flatties Unite.” As I scrolled through the feed, I was surprised to find others like me who’d chosen not to reconstruct. Quickly, I joined the group agreeing to abide by the rules and accept the privacy conditions. I also agreed not to be offended by topless photos that may appear in the feed. 

As I read through posts, I was overwhelmed by the openness and honesty of the members. They were unashamed of their scars. They had grown to love and accept themselves. They were proud to be alive. Finally! I’d found ladies who understood the ins and outs of living life flat. What a comfort to know I was not alone in my choice.

The “Flatties Unite” group has been a perfect fit. They’ve been understanding and kind. It’s a unique sisterhood. The shared photos have been raw and real. They’ve included ones taken immediately after surgery and others reflecting daily life. There have even been random photo challenges like “Flatties in the Wild.” Each challenge provides fun and encourages members to participate.

The group members find ways of normalizing tragedy and that’s what speaks to me most. Most people understand breast cancer produces physical scarring, but many don’t understand the emotional effect it can inflict upon one’s wellbeing. “Flatties Unite” and other support groups can help a person develop coping skills.

We were built for community. With the social distancing guidelines currently in place, it’s often challenging to gather with others, but virtual tribes provide meetings all hours of the day and night. If you’re not sure where to find others like you, try an internet search for breast cancer survivors, or use the search bar on any social media platform.

Flatties aren’t freaks. We’re women who’ve chosen to forego extra surgeries and live our lives to the fullest, without cumbersome fake breasts. Choosing to live life flat is a very personal decision and one that must be carefully considered. It is not for everyone. Many doctors discourage women from going this route, but you do have the option should you so choose.

Articles

Choosing to forego breast reconstruction after breast cancer surgery can cause one to feel like the lone ranger, but that feeling doesn’t last long, especially upon the discovery of an entire flattie tribe. 

Flatties Unite: The Choice to Forego Breast Reconstruction

Several months ago, I received an Echo Dot from my youngest daughter. She assured me I’d love it. I’d heard of the voice-controlled appliance but had never used one. I’d recently mastered commanding Siri on my smart TV and iPhone, so I was anxious to try it. I assumed Alexa, the wizard of the Dot, would be just as congenial and willing to obey my every command as Siri had been.

It was fun asking Alexa to turn on the Meditation Station or to turn off the lamp in the living room using a smart plug. I also enjoyed using the Dot for quickly accessing recipes or finding out the day’s weather. I kept the little round speaker waiting at the ready on the middle of my desk, it was fun to think of things to ask Alexa to do.

A few days later, when I received an email from the Cancer Treatment Centers of America informing me of a new Alexa powered app, I was intrigued. The email explained the program was developed to help those with cancer questions. I’d never thought of asking Alexa about anything cancer-related. I assumed she was programmed to obey simple commands. I didn’t expect much from her, but as I read about the newly created Cancer Center, powered by Alexa, I was very interested.

The email gave clear instructions on downloading the program. After following them, I decided to give it a try, but instead of asking questions I already knew answers to, I decided to ask questions as if I’d been newly diagnosed.

One of the first commands I gave Alexa through this new skill app, Cancer Center, was, “Alexa, what is invasive breast cancer?”

Within a few seconds, Alexa was giving a detailed description of invasive, or infiltrating cancer. When the information was complete, I was informed I could say “patient advocate” at any time during the conversation and have the ability of connecting with a human being. Of course, Alexa offered a disclaimer for the cancer center stating the information offered by the app was not intended to replace the skilled advice of a medical professional.

Cancer Center was developed by the Cancer Treatment Centers of America, where I receive medical care. Although it encourages patients to entrust their care to that specific facility, I thought it would be a great help to anyone needing general information about cancer.

Through simple commands like "Alexa, how do you diagnose ovarian cancer?" or "Alexa, what surgical options are available to treat breast cancer?" An interested party could receive quick information.

I found the Cancer Center app worked best when using simple phrases such as “Alexa, give me treatment options for cancer.” When asking a more detailed question, the app picked up on general cancer related terms and responded with an answer it thought appropriate.

Today, we’re blessed with access to technology like the Cancer Center app on multiple devices, especially when many are unable to obtain in-person visits with physicians due to COVID-19.

I’m grateful medical centers are realizing those affected by cancer want and need information. By offering applications like this, patients can ask questions at any time or place using an Alexa empowered device.

If you’re interested in the App, visit 

 and follow the instructions for download.

How an app supported by Alexa has helped me answer cancer questions.

How Alexa Can Help With Cancer Questions

I had an annual visit with the cardiologist. It was the first time I’d been to the hospital since the breakout of COVID-19. I knew I’d need to wear a mask before entering the building since most businesses have adopted this policy since the initial spread of the virus.

Entering the building, I walked to the bank of elevators. Pushing the button, I chose the floor for my doctor’s office. When the doors opened, I saw 4 large blue circles on the floor inside. In each circle, the words social distancing appeared. I was caught off guard, realizing, even in elevators people weren’t allowed to be close.

Stepping inside, I obediently stepped on a circle. Right behind me, a man entered. I spoke to him through my mask offering a muffled, “Good Morning.” He did not respond although I knew he heard me. Our eyes locked and his fear was evident as he moved to the far corner of the elevator.

When we reached our destination, we both exited the elevator. I went one way and he the other.

Walking down the halls, I glanced into glass-windowed offices. Inside each were chairs spread apart, many of them numbered. Signs outside office doors notified patients of limited capacity and without an appointment, one could not be seen.

I went in to register, my temperature was taken, and I was asked if I’d been exposed to the virus or if I had any symptoms. Answering the negative, I took my seat.

When the nurse called my name, I was taken to an exam room where I waited for the doctor, before he entered the nurse explained I’d need an EKG. Since I’d never met this particular nurse before, I gave her a heads up. I said, “When you attach the leads, you’ll be surprised.” Her questioning look said it all, that’s when I informed her, I was a “flattie,” a breast cancer victim who’d chosen not to reconstruct. She laughed and said, “I’ve seen everything, honey. Don’t you worry.”

The EKG only took a few minutes and the doctor came in to perform his exam. I received good news and was told I didn’t need to return for a year. Before he left the room, the doctor and I talked.

“You know,” he said, “I had COVID-19 for 2 weeks in late March. It was terrible.” Wondering why he was sharing such personal information, I listened as he continued. “Are you going to get the vaccine when it is released?” I gave him an honest reply, “I don’t know.” He said, “You really should, you know. With your compromised immunity, you should be among the first to get it.”

I was surprised to hear I was considered to have compromised immunity, especially after six and a half years of fighting cancer, but he insisted it was true.

I left his office feeling conflicted. My doctor was advising me to receive the vaccine when it became available but I was concerned. In the first place, the vaccine had barely been tested. In the second place, I had lymphedema, which made receiving inoculations difficult. Instead of being able to receive vaccines in my arms, I needed to receive them in my buttocks. Most nurses gave me a hard time when I tried to explain.

I wondered if the majority of breast cancer patients were being advised to take the vaccine and if so, how many would comply?

I also wondered if many women might forego visiting their doctors during COVID-19? Would they skip having suspicious lumps checked for fear associated with catching the virus? And would all of this contribute to an increase in the number of breast cancer cases next year?

The new year is filled with uncertainty and while we wish we could see COVID-19 completely disappear; it seems it will be around for several more months. Will the vaccine offer hope? Should everyone receive it?

The decision is one that must be weighed individually but for those with compromised immunity, like those affected by cancer, it seems a no-brainer, especially when doctors recommend it.

For more news on cancer updates, research and education, don’t forget to

A recent visit to the doctor helped to put into perspective the concerns I have for the new year and COVID-19, especially for those struggling with breast cancer and its ramifications.

Looking to the New Year Is Filled With Concern For Patients and Survivors of Cancer

This year’s holiday season will definitely be different for many as we continue to push through the COVID-19 pandemic. Feelings of stress and isolation have caused us to react differently to public gatherings, even though gathering with friends and family is usually a time of celebration. Most of us would agree we need social interaction, but with the continued spread of COVID-19, modifications will be necessary through the end of the year and more than likely into next year’s season. 

Last year, the Centers for Disease Control (CDC) and Prevention published 

 for holiday celebrations and small gatherings. In that publication, recommendations were made to provide a safer environment for all. Larger gatherings, according to the article, provided more opportunities for COVID-19 transmissions. In order to reduce risks, the CDC felt it best to limit the size of gatherings to members of one household. For larger groups, they asked people to continue with social distancing and the wearing of face masks. At risk individuals, like those undergoing treatment for severe illnesses such as cancer, were advised against attending in-person gatherings.

As I read the information, I was prompted to write a few helpful tips of my own. My tips focus more on individuals currently in treatment for cancer, or for those who’ve recently completed treatment, such as my experience.

Weigh your opportunities. Consider those most important to you. Consider your energy level and how it may affect your participation in various events. Do what you feel like doing. Start with plan A and go to plan B, C, or D, if necessary. There’s no need to feel like you must do everything you’ve done in the past. ·

If able to attend an in-person gathering, enjoy it but be safe. Pay close attention to those around you. Sniffling, sneezing, and coughing are clues to keep your distance. Wash your hands frequently and avoid commonly touched surfaces.

Being around others during holidays can prevent feelings of depression and isolation. If you’re unable to attend in person gathering, go the virtual route. Zoom calls or FaceTime meetings allow participation without exposure to germs.

Leave options open and allow yourself the privilege of making last-minute decisions. If unable to give an immediate answer to an invitation, leave it open-ended by adding a disclaimer such as: “I’ll try, or I hope you’ll understand if…”

Set limits. Physical or emotional fatigue can affect your choices. Help others understand that holidays can be especially hard when in the middle of treatment, juggling multiple appointments or facing debilitating side effects.

Make lists. Lists can help you manage tasks and remember them. It might be helpful to categorize tasks into “need to” and “want to” columns. Lists can lighten the load of personal expectations. Be careful not to place too much on your plate.

Say yes to offers of help. People typically have good hearts and want to assist but may not know-how. Give suggestions regarding your needs. Both the giver and receiver will be blessed.

If you enjoy shopping, but don’t feel up to the task of getting out in public, use the internet to your advantage. Order online. Use a delivery service like Instacart or ask others to pick up items. Keep your spirits up by doing things you’ve enjoyed in the past but be willing to make compromises when necessary.

Speak your truth. Inevitably, you’ll be asked about your health. Friends and family are normally interested in your wellbeing, but remember, the decision to share or not share is yours. Be honest.

Steel yourself. During family gatherings, others may offer unsolicited advice regarding your health. It’s your choice whether or not to listen and whether or not to take the information to heart.

Take time to enjoy the day. Learn to be present in the moment. Relax! Practice mindfulness. This day comes but once a year. Savor it!

Be intentional. Look for the positives. Focus on blessings. Take time to be grateful.

Everyone looks forward to the day things return to normal, but for now, virtual holidays may be the safest way to celebrate and thankfully, we have that option. Technology has become so advanced it’s the next best thing to being there.

The holiday season is upon us. For the person with cancer, this can be a daunting time. One cancer survivor shares a few tips and tricks for surviving and thriving this unique holiday season.

Bonnie Annis | Contributors

Flatties Unite: The Choice to Forego Breast Reconstruction

How Alexa Can Help With Cancer Questions

Looking to the New Year Is Filled With Concern For Patients and Survivors of Cancer

12 Tips For Celebrating the Holidays Differently This Year

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