Shortly after publishing “Flat and Happy” I was approached by a reader who had some suggestions for how to make it more inclusive. Jess, who is queer and identifies as nonbinary, rightly pointed out that the book didn’t include a perspective like theirs. At the time we met, they had recently learned that they carry the BRCA mutation and were preparing for surgery (ultimately they underwent mastectomy and oophorectomy). Since then, Jess has patiently educated me about the many ways that their experience has differed from that of a cishet woman confronting a similar diagnosis.
Now that their surgery is largely in the rearview mirror, I sat down with Jess to talk about their flat journey. Here’s what they told me:
The fact that I’m nonbinary made the choice to have the prophylactic mastectomy a lot easier in some respects, and there was never any question in my mind of doing reconstruction. I always assumed that at some point I would get rid of my breasts anyway, I just didn’t know when, or what would make me want to have top surgery. When I found out I had the BRCA mutation, it was like, “Well, there you go.” That’s what it took for me to get the gender-affirming care that I needed and wanted.
On the other hand, being nonbinary also made my feelings more complicated. While the idea of top surgery felt gender-affirming and celebratory, my surgery was for a really scary, stressful reason. So I wasn’t able to fully celebrate what was happening to my body. I found the sorrow, panic and fear confusing: does this mean I don’t want top surgery? No, I do, it’s just that I’m having to do it for a really scary reason.
On the day of my surgery, I was misgendered 99% of the time. Even though “they/them” is in my medical chart, right next to my name, everyone kept using female pronouns. That made me feel unseen as a person, and unsafe. If they couldn’t even get my pronouns right, how were they supposed to get the rest of my medical care right? I work in healthcare, and I just don’t understand why people find it so hard to get this right.
Being nonbinary also made people’s reactions to my body really complicated. Because they assume that it’s sad and difficult to lose your breasts, they tried to leave room for my sadness. But that made me feel unseen too. I wanted to say, “No, it’s okay. I actually like being flat!“ Of course a lot of people who go through this are in mourning for their breasts. But instead of making assumptions that there’s only one way to feel, I wish people would ask me what I need and meet me where I’m at. Like when I went in to remove the drains, they made me put on a gown. I just wanted to say, “Let me revel in my toplessness!”
After surgery, I didn’t look at my chest right away. I didn’t want to look in the mirror until the drains were out and I had showered. I wanted that gender euphoria moment, like all the people on TikTok posting the first time they looked at their chest after top surgery. But I never got there. My first time looking I was happy, it looked good, but I didn’t have the euphoria. Because I removed my breasts to prevent cancer and not for gender reasons, there was always an undercurrent of fear and sickness.
My gender euphoria moment did finally come when I went shopping and picked out all these clothes that looked awesome on my non-binary bod. Back before my surgery, I tried to help people see me by masculinizing my gender expression. I would wear masc stuff most of the time, but even with binding it still looked like I had an A cup. I wanted to be flat-flat.
Now, looking in the mirror and seeing the body I was meant to have, I can just be who I am.
It feels so good to wear things that I could never wear with breasts! I’ve bought more femme clothing – it’s been fun to play with that. I picked out this Courtney Love circa ‘90s silky lingerie top, and I’ve been wearing more skirts and dresses. The juxtaposition of my flat chest against femme clothing really works for my nonbinary perception of myself. I still wear masc stuff because I like it, but it’s much more of a blend now – I get to have more fun.
Cis women have the privilege that their gender matches their gender expression. To have to go through losing their breasts must be shocking for them. For me, it’s different: I’ve already experienced the disconnect, the mismatch between body parts and gender. I’ve lived with gender dysphoria, which is when you feel your body looks a certain way, and then you look in the mirror and see something that just doesn’t belong there. I used to wake up feeling like I was flat, but the mirror showed me these breasts. So I had already done that difficult work of realizing that your gender identity is just who you are. I wish I could tell the cis women who worry about losing their breasts that they don’t have to work at being a woman or being feminine. You don’t have to prove it. It’s other people’s problem if they see you as the wrong gender.
Leading up to the surgery, it took a long time to find a community around mastectomy and flat closure that felt comfortable and welcoming to me. My concerns weren’t matching up with cis straight women’s. I kept reading posts about “Will my husband still find me attractive?” But my concerns were very different, being both nonbinary and queer. A lot of lesbians have top surgery, so my dating life was never a concern. Surgery and medications, sure, but everything else didn’t match up, so I felt very alone.
In the introduction to your book, you write, “to compare [bilateral mastectomy and gender-affirming top surgery] is to deny the grief of one and the relief of the other.” I think the flat community can be more inclusive in understanding there are lots of different experiences. I understand there are a lot of cishet women who need a very specific support network and I want them to have that. But that community could also be more inclusive and open up to people who have other experiences. If they want more people to participate, they need to make it feel safe for people to be included. That means not saying things like “Oh, no! This is the worst thing in the world: someone thought I was trans.” And when there are events or modeling opportunities, it would be so lovely to see people and settings that represent my experience. There is so much love and care in this community. I’m hoping that we can all find the understanding that we need.