{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T18:51:24Z","timestamp":1780080684467,"version":"3.54.0"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A growing number of young breast cancer survivors are seeking information about surgical options after bilateral mastectomy. This study explores the factors influencing decision\u2010making and interactions with the cancer care system among young breast cancer survivors who went \u201cflat,\u201d or pursued aesthetic flat closure (AFC) post\u2010bilateral mastectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighteen breast cancer survivors in the United States diagnosed before the age of 45 who had aesthetic flat closure completed semi\u2010structured interviews. Verbatim transcripts were analyzed using Interpretative Phenomenological Analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighteen survivors (average age 39\u00a0years) completed interviews lasting between 54 and 88\u00a0min. Eight themes about factors that influenced decision\u2010making were identified: centering self or romantic partners' perspectives; emphasizing body functionality, faster recovery, and fewer surgeries; viewing flat as the safest, healthiest, and most natural option; negatively experiencing breasts; questioning the purpose of breasts; benefiting from transgender liberation; serving as a role model; and treatment information gathering and self\u2010advocacy. Regarding medical system interactions, the data revealed themes of assuming reconstruction; infantilizing survivors; dehumanizing survivors; gender\u2010affirming surgeries advancing surgeons' skill sets; and supporting, communicating, and collaborating.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Young survivors, who opt to go flat, prioritized functionality, faster recovery, and freedom of bodily autonomy and gender expression over societal beauty standards when making post\u2010mastectomy surgical decisions. Survivors frequently had to advocate for AFC as a treatment option. These findings highlight the need for providers to present a range of affirming and accessible post\u2010mastectomy treatment options. To improve young survivors' cancer care, providers can promote bodily autonomy and include AFC when presenting treatment options.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70468","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T02:30:28Z","timestamp":1776997828000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["\u201cBest for Me\u201d: Decision\u2010Making and Medical System Interactions When Going Flat After Bilateral Mastectomy"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9775-7725","authenticated-orcid":false,"given":"Trisha L.","family":"Raque","sequence":"first","affiliation":[{"name":"Department of Counseling Psychology Morgridge College of Education University of Denver  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie","family":"Creegan","sequence":"additional","affiliation":[{"name":"Department of Counseling Psychology Morgridge College of Education University of Denver  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2012-3561","authenticated-orcid":false,"given":"Keiko","family":"McCullough","sequence":"additional","affiliation":[{"name":"Department of Counseling Psychology Morgridge College of Education University of Denver  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Norling","sequence":"additional","affiliation":[{"name":"Department of Counseling Psychology Morgridge College of Education University of Denver  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara Belfort Resende","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Counseling Psychology Morgridge College of Education University of Denver  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srujana","family":"Gummalla","sequence":"additional","affiliation":[{"name":"Department of Counseling Psychology Morgridge College of Education University of Denver  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Anain","sequence":"additional","affiliation":[{"name":"Department of Counseling Psychology Morgridge College of Education University of Denver  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"Key Statistics for Breast Cancer [Homepage on the Internet].American Cancer Society; [cited 2025 October 10] https:\/\/www.cancer.org\/cancer\/types\/breast\u2010cancer\/about\/how\u2010common\u2010is\u2010breast\u2010cancer.html."},{"key":"e_1_2_14_3_1","unstructured":"Breast Cancer Among Women Younger Than 45 [Homepage on the Internet].Centers for Disease Control; [Cited 2025 October 10] https:\/\/www.cdc.gov\/united\u2010states\u2010cancer\u2010statistics\/publications\/breast\u2010cancer\u2010among\u2010young\u2010women.html."},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.51348"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soi.2024.100049"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2022.04.071"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2024.01.003"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12282\u2010023\u201001471\u20104"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2023.103600"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpra.2025.08.024"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.13781"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010023\u201013845\u20101"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bodyim.2023.07.009"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105314562085"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2021.08.017"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004327"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000007106"},{"key":"e_1_2_14_18_1","unstructured":"Aesthetic Flat Closure [Homepage on the Internet].National Cancer Institute[cited from 2025 November 12] https:\/\/www.cancer.gov\/publications\/dictionaries\/cancer\u2010terms\/def\/aesthetic\u2010flat\u2010closure."},{"key":"e_1_2_14_19_1","unstructured":"What Is Aesthetic Flat Closure [Homepage on the Internet].Not Putting On a Shirt[cited from 2025 December 1] https:\/\/notputtingonashirt.org\/whatisflatclosure\/."},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010020\u201009448\u20109"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000007997"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"e_1_2_14_24_1","volume-title":"Interpretative Phenomenological Analysis : Theory, Method, and Research","author":"Smith J. 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