No Boobs, No Regrets for Wichita Breast Cancer Survivor

Elizabeth Hotaling is working with a national group to educate women about the possibility of choosing to be flat rather than have an implant after a mastectomy.  The national group is led by the actor who voices a single breast cancer survivor on The Simpsons.  Hotaling made an emotional decision to lay flat after the implants caused her numerous physical and unhealthy problems.

Elizabeth Hotaling is working with a national group to educate women about the possibility of choosing to be flat rather than have an implant after a mastectomy. The national group is led by the actor who voices a single breast cancer survivor on The Simpsons. Hotaling made an emotional decision to lay flat after the implants caused her numerous physical and unhealthy problems.

The Wichita Eagle

After dealing with what she described as “wobbly” implants following her mastectomy for breast cancer, Elizabeth Hotaling made a decision that many in body-conscious American society might find rather bold: She decided to go flat.

It’s a decision the 58-year-old Wichita wife calls boobless, no regrets.

More than a year after her cosmetic flat closure (AFC) surgery to have her implants removed and her chest wall reconstructed, Hotaling is now part of a national advocacy movement working to de-stigmatize a woman’s choice. to have a flat chest after treating with the breast cancerous mastectomies or explantation surgeries, when the failing implants are removed.

Largely, that’s because she says she never had that option when she discussed reconstruction options with her breast surgeon.

In a study conducted by UCLA surgeon Dr. Jennifer Baker on flat closures, 34% of women said they did not receive adequate information about their surgical options.

“In what other condition does a doctor withhold information about options?” hotaling said.

“Unfortunately, like me, many women facing a mastectomy are unaware that the flat is an option. Instead, they are taken straight to reconstruction of the breast mound, something that is not always best for or desired by all. That’s why I joined Renee Ridgeley on the Stand Tall AFC Body Positive Campaign.

Ridgeley is a Hollywood actress who plays Dr. Wendy Sage, a one-breasted hypnotherapist on “The Simpsons,” who became the kind of flat-motion mascot after undergoing AFC surgery after undergoing a single mastectomy. Ridgeley is married to the show’s producer and writer, Matt Selman.

Ridgeley co-founded Stand Tall AFC, part of another advocacy group called Not Putting on a Shirt, in 2021.

As part of the Stand Tall AFC movement, Hotaling has participated in several cancer walks across the country with other self-proclaimed flatterers and surgery supporters. She will lead a team of family and friends and a few housemates in this Sunday’s Making Strides Against Breast Cancer walk, organized by the American Cancer Society. The event begins at noon at the Mid-America All-Indian Museum, 650 N. Seneca.

At times, march organizers proceeded cautiously in welcoming the women, Hotaling said.

During a walk, the group was not allowed to have an information stand. At others, organizers expressed discomfort with the idea of ​​women walking bare-chested. In a recent march, organizers negotiated to connect the Stand Tall AFC movement with its thousands of social media followers if women would not go topless.

During a march last year in Palm Springs, Calif., Hotaling and the other women walking shirtless stopped to dance to “This is Me,” a sort of fight song about people not accepted by the community. company that is part of “The Greatest Showman” soundtrack. A clip of this dance went viral and got 5.5 million views on TikTok.

During a march last year in Palm Springs, California, Elizabeth Hotaling and other women who walked shirtless stopped to dance to “This is Me,” a kind of fight song about people who are not accepted by the company which is part of “The Greatest Showman” soundtrack. Courtesy picture

Get the diagnosis

Hotaling realizes the importance many women place on having breasts and even choosing to enlarge them. She herself underwent cosmetic augmentation in 2000.

But that choice meant more surgeries — three, in fact — to correct the conditions caused by the implants over the next 18 years until she was diagnosed with breast cancer in 2018.

She had her first mammogram in 2001, but never went on to have them, despite being pressured by her daughter Jordan to do so.

Now she credits Jordan for saving her life.

“It wasn’t until she pleaded, ‘If you don’t do it for yourself, will you at least do it for me?’ that I scheduled” the 2018 mammogram in which they found Hotaling’s cancer, she said.

For Hotaling, who led a healthy, active lifestyle — in fact, she had founded a wildly popular women-only group called Adventurous Babes Society in Wichita in 2012 — and had no family history of breast cancer, the results were a shock. Little did she know that only 5 to 10 percent of breast cancer cases are hereditary, according to the Centers for Disease Control and Prevention.

Hotaling was diagnosed with stage 1B breast cancer, which is cancer between 0.2mm and 2mm, the latter being less than an inch, in the lymph nodes and a tumor cannot be detected.

The cancerous spots were described to her as calcifications, “where they see angry-looking irregular cells. Think of calcification like what you would see on a car battery.

She tested positive for the HER2 protein and estrogen receptors, meaning her cancer was fueled by both, making it more aggressive.

She opted for a double mastectomy, to reduce her risk of cancer in her remaining breast. Regarding reconstruction, her surgeon told her that because she had had implants before, she could get immediate reconstruction with implants at the time of her mastectomy. She also underwent 12 rounds of chemo.

But shortly after the operation, her implants went “fake”, as Hotaling describes it. She developed a capsular contraction. Instead of the scar tissue providing a soft or slightly firm protective capsule around the implant, the tissue hardened and became dense, causing his implant to flip back and forth, the bulging side now between his skin and the chest wall and the flat side being the side facing out.

The upturned implant made sleeping uncomfortable. Hotaling had to find ways to hide the symmetry with her clothes. She knew she would likely face more surgeries since implants have a shelf life of 10 years or more.

But she didn’t think her next operation would be because they had gone wobbly. She had fought too hard in her battle with cancer, was losing her hair, had found a physical trainer to get in shape, that she wasn’t going to be destroyed by implants. She consulted with her plastic surgeon, Dr. Amy Sprole of the Plastic Surgery Center, asking if she could remove her implants and provide an AFC. However, she ended up postponing the operation until 2021.

Shortly before her surgery, she heard a TED Talk on breast implant failure and realized she was experiencing many of the symptoms the woman listed – headaches, autoimmune conditions, digestive issues , skin rashes and fatigue.

“A few weeks after being flat, I knew I had made the right decision. My headaches were less frequent, my energy level increased and my skin was clear. The new challenges were the ones I fought internally. How would I dress my new body? Would I still be attractive to my husband? Would I feel the stares and judgment of strangers in the grocery store? »

Her three-year ordeal of going flat fuels her passion for bringing the AFC to the attention of other women.

The flat choice

“There’s definitely a tendency for patients to go flat and don’t want to end up with dog ears or excess skin and wrinkles” after breast removal, said Dr Terri Cusick, surgeon at the breast since 1999 and Medical Director of Breast Care. Specialists in Wichita.

It has always offered that option, she said, although it has not always been officially recognized as an AFC.

The National Cancer Institute has just added AFC to its dictionary of cancer terms for the past two years.

The NCI defines CFA as a type of surgery performed to reconstruct the shape of the chest wall after the removal of one or both breasts. This is when extra skin, fat, and other tissue is removed, with the surgeon tightening and smoothing the remaining tissue so that the chest wall is flat.

“Patients need to know they have a right to be flat,” Cusick said. “I think it’s good that we’re talking about it and letting women know it’s an option.”

For women who can offer the option to their surgeons, some experience what’s called outright denial, “when a surgeon denies his patient an agreed-upon flat closure, either out of negligence or indifference,” according to the UCLA study. In this study, 20% of women said they did not feel their decision was supported by their surgeon.

Often, insurance companies won’t cover another surgery to correct a bad mastectomy. Hotaling and his Stand Tall AFC group said that sometimes insurance doesn’t cover AFC after a mastectomy because it’s considered chest wall reconstruction and not breast reconstruction.

According to, while a 1998 federal women’s health law requires insurance plans to cover breast reconstruction, there is no procedural code for flat closure. The site recommends patients call their insurer to confirm they will be covered and that surgeons code flat closure as reconstructive surgery, which Cusick does.

A journal article for plastic and reconstructive surgeons published earlier this year asserted that it is “crucial to listen to the patient and fully understand their concerns, wishes, and particular esthetics desired.”

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