Flat Friends at ABS 2025: Raising Awareness, Shaping Conversations

Flat Friends and The Association of Breast Surgeons (ABS) Conference 2025

ICC Birmingham– 19-20 May 2025

Once again, this year we were able to have an exhibitor’s stand at the annual ABS conference, along with a few other charities. This is a great opportunity to raise our profile with Breast Surgeons and Breast Care Nurses (BCN).

Sarah Coombes (Chair) and Nicky King (Trustee) manned the stand. 900 delegates attended the 2 days with a full programme of updates and invited speakers, 26 sessions in all, posters summarising research and audits or work in progress as well as a large exhibition hall for the financial sponsors to promote their offerings.

The four charity stands – Flat Friends, Breast Cancer Now, Future Dreams, and Independent Cancer Patients’ Voice – were in the foyer, Cancer Research UK were in the main exhibitor hall. The foyer was a good location as everyone had to walk past to register and to get their coffee and lunch!

We met a lot of people over the two days, many had heard of us, but to some we were new, with most of them grateful for our availability to their patients. The new booklet with additional photos of mastectomy scars was certainly valued and Sarah had almost 50 requests from Breast Care units for more booklets and flyers.

Symmetrising surgery remains the biggest area of contention with a few surgeons remaining opposed to the whole concept. Mostly though we found there was sympathy for the patients who make this request. A couple of BCNs even said to me that should they find they needed mastectomy they would “go flat”.

It was a good opportunity to meet face to face with some of the doctors and researchers who we have been involved with, having reached out to us to be a part of the patient participation element required in designing and carrying out their research ideas. Ms Jenna Morgan, Surgeon from Doncaster and researcher with The University of Sheffield had the opportunity to speak in the second session of the first day, Mastering Mastectomy, and to present her initial work on Flat mastectomies, and her research student had her poster accepted for display, Patient Satisfaction and Scar Cosmesis in mastectomy without reconstruction: A systematic Review. Adele Ketley et al. (Photo). It was encouraging to see Flat Mastectomy getting mentioned and Flat Friends mentioned by these researchers.

Nicky, as a retired doctor and hopefully able to keep up with some of the medical jargon (although not all!), took the opportunity to pop in and out of the sessions to see if there were any new developments or contentious areas that might be of interest to Flat friends.

A theme of the conference was that there should be less mastectomies and more breast conservation surgery. It seems that research shows good outcomes and not the risk of recurrence I would think, and newer surgical techniques can result in good cosmetic outcomes. In the future we may say less women having mastectomies.

Jenna Morgan’s presentation of Flat mastectomies made it clear that at the moment 70% of women remain flat. This seems a high number but we need to bear in mind that many women are not fit for the type of big and prolonged surgery needed for reconstruction, contraindications being multiple other health conditions, older age, oncology treatment requirements, insufficient donor site options for reconstruction.  Jenna’s aim is to produce a pathway for flat mastectomies that recognise it was a valid choice, gives time to patients to discuss this option and then to discuss outcomes and set realistic expectations. Her interviews with health care professionals and patients show currently they have very different views and understanding of a good outcome. It is agreed that currently counselling is poor and should be improved with an opportunity to see photos of outcomes and discuss things like scar placement, and that revisions options should be more explicit.

In the same session a surgeon spoke about when mastectomies go wrong and the need to consider the risk factors and reduce them if possible. Risks for a poor outcome include age, weight, diabetes, smoking, clotting disorders. Optimising all those prior to surgery should be the aim when the surgical procedure is not urgent. We know radiotherapy impairs wound healing but it was helpful to hear chemotherapy has no overall effect on mastectomy outcomes.

A more controversial topic was then raised by a consultant from the Royal Marsden, the Contralateral Breast. She started by stating that according to ABS guidance contralateral mastectomy is not required and that according to American guidance is it should be actively discouraged. What she was discussing but not clearly qualifying was requests for mastectomy of a normal breast to reduce the risk of further breast cancer. She explained that the annual risk for all patients is 0.5-0.75%, and for a patient who has had one breast cancer the increase is small 1.9% at 5 years, and 4.6% at 10 years.

The risks of a second cancer are higher with age, lobular variety, higher grade and larger tumour size, ER/PR negative, higher BMI and a family history.

The feeling of the professionals is that if a second cancer should develop it will be detected early with a good outcome. They feel the risks of surgery are higher than the benefits. She did however accept that patient satisfaction with a contralateral mastectomy is high, 82-98% and remains high after 20 years, 90%. However, there is not always a great satisfaction with the appearance of the scar or if it’s felt to have reduced their sexuality.

She discussed guidelines which I am not sure have been accepted or are recommended only, which take a stepwise approach to such requests. 1. History, 2. Calculate recurrence risk, 3. Cooling off period, delay until primary cancer treatment completed, 4. Discuss at MDT, 5. Fully consent.

When questioned afterwards she accepted that requests for a contralateral mastectomy for flat symmetry are different and could be dealt with more sympathetically than requests for risk reduction.

From listening to this talk I could understand why so many Flat Friends have felt a reluctance from their treating team to comply with their wishes, and would re-enforce the guidance we often give on the FB chat, that going flat for symmetry and comfort needs to be emphasised over and above any relief that might be perceived from a reduction in the risk of a second cancer.

There was a good session on Secondary Breast Cancer in which a BCN talked of the improving outcomes, and that now we should consider it treatable rather than incurable. However, patients with secondary breast cancer are not counted specifically in any currently collected data so the numbers of women living with secondary breast cancer is unknown which makes funding for their specific needs harder.

Lesley Stephen, from the charity ‘Make 2nds Count’ spoke of her experience as a patient, diagnosed with metastatic breast cancer 10 years ago. The charity provides a range of support including retreats and an annual patient conference. They have recently employed a research nurse who can be contacted and she will see if a person can be matched to any trials. Lesley credited her long survival to being on an early trial of targeted therapy. Make 2nds Count :: Giving hope to those affected by secondary breast cancer – Make 2nds Count

Another charity given the opportunity to present was Breast Cancer Now. They chose to talk about the risk of misinformation in social media and the threat to patients. It was not surprising that so many people turn to social media for advice these days, 1 in 5, but worrying that so many feel harmed by misinformation. This has got worse since Meta and X removed their fact checking process. She also pointed out that many searches now result in an AI summary, which is dominated by American information.

It was good to know that Breast Cancer Now is a recognised Trusted Information Creator with high quality information visited every month by quarter of a million people. So go there for advice, not Tik Tok! We’re Breast Cancer Now | Breast Cancer Now

Many of us will have had the advice regarding our treatment discussed using the PREDICT tool. Predict Breast This is for those who have had surgery as their first treatment and need to consider what further treatment options will confer any benefits for them. It’s based on a lot of patient data collected over many years and helps consider prognosis, benefits and harms of the various treatments available. There is a new version available, version 3, which gives some quite different figures to the v.2 which was probably the one our teams used. It seems that over the years the overall survival rate for everyone has gone up (death rate from all causes reduced), due to improvements in coronary artery disease, vascular diseases etc. This has had the effect of making the benefits from surgery alone seem to have improved but the absolute benefits of all other modes of treatment reduced. This was explained by understanding that the absolute benefit is the change in survival with or without the treatment, so if your survival is going to be better anyway, there is a smaller difference. I can see that this could make decision making much harder in future.

Another session which improved my understanding was in relation to genomics. We often see Facebook chats about family history and inherited risks and what is and isn’t available in the way of genetic testing is confusing. And particularly what tests provide what information. The important difference for us is between what is called somatic genome and germline genome. The germline genome is the inherited cancer susceptibility, such as BRAC 1 and 2 mutations. This can also reveal toxities to certain treatment agents. Whereas the somatic genome is tested on the cancer tissue itself and is testing what targeted therapies will be effective against that individual’s particular cancer, at the time that sample was taken. This may change as the cancer mutates and grows or metastasises.

Who is eligible for testing under the NHS is very carefully assessed and the eligibility criteria can be checked on the internet NHS England » National genomic test directory where there is a link to the eligibility criteria PDF document.

A new area is ctDNA which is the DNA found in circulating blood and contains germline DNA and DNA from tumour cells. This is being used to check current tumour status, due to the way the tumour will change over time, particularly useful when someone relapses on a targeted therapy, which will be due to a mutation within the cancer. But it has also been seen to pick up unexpected germline mutations.

One of the exhibitors in attendance that may be useful to many of us was Pelvic relief, www.pelvicrelief.co.uk . They market a variety of products designed to help people with the impact cancer has on genitourinary health and sexual wellness. They partner with Menopause and Cancer, a non-profit organisation dedicated to supporting women after cancer experiencing a sudden and abrupt menopause. Home – Menopause and Cancer with Dani Binnington

Future Dreams were also exhibitors. Future Dreams | In-person and virtual breast cancer support They offer a wide range of support, in person and online, for those diagnosed with breast cancer. Their physical base is in London, near Kings Cross, but they offer a full and busy timetable of online support as well.

I wasn’t aware that Cancer Research UK has an online shop offering a range of items for all stages of treatment and recovery, including post-surgery bras, breast forms and swim suits, well worth a look. All Cancer Care products – Cancer Research UK

We were also honoured to meet Leena Chagla, President of the Association of Breast Surgery.

It was an excellent two days and hopefully one that will bring dividends as our profile is raised with Breast Care Units and our willingness to be involved with research noted and acted upon.

Nicky King

May 2025