LGBTIQ+ body image, gender and DCIS

You may experience changes to your body image and how you feel about your gender through your treatment for DCIS. 

Changes may relate to lumpectomy, mastectomy, flatness or reconstruction, fluid retention, skin marks, tattoos or scarring, ability, mobility, sexuality and intimacy. You may face decisions about your body, such as whether to go flat or have breast reconstruction.

Studies indicate that LGBTIQ+ people’s responses to treatment-related bodily changes vary widely. There are a range of ways you can manage these impacts. 

Body image changes

Your body may change through your DCIS treatment journey. These changes may affect how you feel about your body or gender.

You may experience changes in your sexual feelings, the way you experience pleasure and your responses to intimacy. To find out more about this see Sexuality and Intimacy.

Challenges to gender and gender affirmation

The side effects of treatment for DCIS may impact the way you feel about your gender, or the way you might ordinarily present to others.

If you are trans and need to reduce or stop gender-affirming therapy during treatment, this may present challenges for your self-image or wellbeing. The extent to which your gender is perceived by others may also change. Read more in Trans and Gender Diverse people with DCIS or breast cancer

You may find that DCIS and the side effects of treatment have the opposite effect and affirm your gender - you may feel more empowered. Some people find their gender is unchanged by treatment. There’s no right or wrong way to experience your gender in relation to treatment.

Lumpectomy and mastectomy 

Your treating team may discuss lumpectomy (also called breast conserving surgery) or mastectomy surgery with you.

You may be presented with decisions around what type of surgery is best for you and whether you want to have breast reconstruction.

A lumpectomy is surgery to remove the area of DCIS and some of the normal tissue that surrounds it.

A mastectomy is the removal of all breast tissue, often leaving the underlying chest muscles intact. A bilateral mastectomy is the removal of both breasts. Mastectomies can be ‘nipple-sparing’ where the nipples are preserved at the time of mastectomy, reconstructed following mastectomy, or some people may have to have their nipples removed.

Your feelings about your breasts/chest may influence your decision about whether to have a lumpectomy or mastectomy. Some people don’t have a choice because of the size of the area affected by DCIS.

It's important to be guided by your treating team about the treatments that are most likely to be effective for you.

Breast reconstruction

You may find that surgery affects your body image or the way that you feel about your gender. Your decisions about breast reconstruction surgery may be influenced by these feelings.

Some people report that breast reconstruction 'restores' what was lost, the physical and emotional meaning of their breasts/chest tissue. Reconstruction can be a way of reflecting and affirming bodily pride, sexual identity and gender.

For others, reconstruction is important for body shape, identity or maintaining sex and intimacy after cancer. 

There are different methods of breast reconstruction. Some people choose implants, and others choose reconstruction using tissue from another part of their body such as the belly (called a DIEP flap). This changes other parts of the body like the belly or hips. It can create curves in some areas and reduce them in others, impacting on a more masculine or feminine form. 

Many LGBTIQ+ people are satisfied living without breast reconstruction after mastectomy. You may choose not to reconstruct, called 'staying flat', 'being flat' or 'aesthetic flat closure'. 

Staying flat

Some people ‘go flat’ after a mastectomy and find this affirms them as a LGBTIQ+ person. There are numerous ways to go flat, as there are many different methods of surgery.

Going flat may be a part of gender affirmation, a matter of bodily comfort, or could simply feel like the right choice for you. 

Some people who are flat wear prosthetic chest or breast pieces. Some queer, lesbian and bisexual women like the ease and comfort of living without breasts. Some people report mastectomy without reconstruction affirms their non-binary or trans identities.

Having a mastectomy is different from top surgery, as there is generally more removal of tissue during a mastectomy. If you want to have more of a chest shape post mastectomy, you need to request a reconstruction with minor implants or tissue transfer.

Explaining your desire to go flat, or to have breast reconstruction and your preferred breast size, to your treating team might feel difficult. You might feel they do not understand your decision. You may be concerned they expect you to make a certain decision, due to gender and sexuality norms in health care.

You have a right to access cancer treatment that is free from discrimination, just like any other patient.

Acknowledgements

These materials were developed from the Out with Cancer Study, conducted at Western Sydney University, and funded by the Australian Research Council. Thanks are offered to the Out with Cancer study committee members with lived experience of cancer, BCNA LGBTIQ+ consumer representatives, ACON and LGBTIQ+ Health Australia who contributed their time and expertise.

BCNA's LGBTIQ+ project was undertaken with support from Cancer Australia through the Supporting Women in Rural Areas Diagnosed with Breast Cancer program.

Resources

Cancer Council NSW has information including a downloadable book that will help you understand how cancer and its treatment may affect LGBTQI+ people – lesbian, gay, bisexual, transgender, queer, and other diverse sexualities and genders, as well as people with intersex variations.

The Genders, Bodies and Relationships Passport aims to support clear communication between intersex, trans and gender diverse people, and health and social care services. It's a single location for important information about a person’s gender/s, body, and relationships.

This deMilked blog post shows a series of photos of breast cancer survivors who decided to stay flat after double mastectomy surgery.

This article talks about the difference between Top Surgery and Mastectomy. It includes definitions of both terms, terminology, difference and overlap between them.