"What If You Change Your Mind?" - Why Surgeons Push Back on Aesthetic Flat Closure | Lacey Marie

I believe two doctors tell me that they didn't know what was happening. You're not going to make it. You probably should go home and start getting your affairs in order and plan your funeral. And the oncologist looked me right in the eye and said, it's not if, but when you get cancer, do I have to have boobs or can you just cut everything off? That is where I started to get quite a bit of pushback. I'm way happier now than I ever was with breasts. I feel more sexual and more healthy and just more like myself.

Foreign. Marie is a survivor advocate and the founder of Boobless life. After nearly losing her life to breast implant illness and discovering she carried genetic markers for breast cancer, Lacey made the radical decision to remove both her implants and her breasts. Her journey did not stop there. In the same season, she also lost her marriage, religious framework, and her business. But she rebuilt from the ground up. Today she is a mother of four, a speaker, and an outspoken advocate for women's health and self love. Through her story and her mantra, Boobless and fabulous, Lacey inspires women to reclaim their health, redefine femininity, and find freedom beyond society's expectations of the female body. Welcome to the show, everybody. Laci Marie. Oh, I have a special guest today. I have Lacy Marie. And I caught her story on after watching her TED Talk. And it's something that after my sister passed away from breast cancer in 2024, after a very long period of time with it, it's something that and Lacy and I were talking offline about it, Aesthetic flat closure is something that has become more and more prevalent. And I was explaining to La Lacy how it was a discussion that was not necessarily one I had very often. And we can go into why. But thanks for coming on the show, Lacy.

Yes, you're welcome. Thank you for having me.

So I've heard your story. I would love for my audience to know a little bit more about you and your story so we can better kind of communicate, I think, some very interesting things that questions I have for you and hopefully you have for me.

Perfect. Yes. Okay. So I decided to get breast implants at a fairly young age. I had had three kids and I was like, man, you know, my body's changed. I want to continue to look the way that I did and fit in to society. How I was seeing projected. And it was shortly after I had my breast implant. I had a surprise pregnancy with number four. And then I never seemed to. That pregnancy was the hardest for me. Me. And then I never seemed to recover, and I just got incredibly sick, which now I know was breast implant illness symptoms. But at first, man, just like every other woman I've talked to, was like, so incredibly scary because I had no idea what was going on. And it got clear to the point that I had, I believe two doctors tell me that they, at this point, they didn't know what was happening. I had been through multiple surgeries, having everything else removed but the breast implants, you know, like, you know, a full hysterectomy, gallbladder removal, you name it. And, you know, I was continuing to get sick. And so at this point, they're like, you're not going to make it. You probably should go home and start getting your. Your affairs in order and plan your funerals or plan your funeral. And so I did. And if it got to the point that I just was like, this is not how I'm. How I want to go out. This is not it. So I started turning into, like, looking for other healing modalities and got to the point that I was a little bit. I was able to function. I was able to function. And as I continued down that journey, I still fought and was like, I want these breast implants out. I want to see if I'll get feeling better if these are removed. And as I started down that journey, we discovered through all of these other different tests and trials that I had two markers for breast cancer. It's not the main markers, not the brca, there are several others, but I did have those too. And I remember sitting in. I'd been meeting with plastic surgeons for years, general surgeons, and now I found myself in an oncologist office. And the oncologist doctor said, looked me right in the eye and said, it's not if, but when you get cancer. And you are super lucky because. Because we can just remove your breast tissue and keep your implants, and you're going to have a much easier surgery. And I about lost my mind. So that was the point that I started pushing back because I said, but that's the whole reason why I started on this journey was to get the implants out. And so we started going through other reconstruction options. And I had watched so many people, so many women in my family go through this and was their caretaker. And so I. I remember just looking at an oncologist and saying, do I. Do I have to reconstruct? Do I have to have breasts? Do I have to have boobs? Or can you just cut everything off? And that is where I started to get quite a bit of pushback. And I pushed back until I got my way. And so here we are today.

Well, I want to say from the patient perspective, certainly you have to stay firm in what you want to have done and like you did, advocate for yourself. It sounds strange, but when I used to see patients who had been given a diagnosis of breast cancer, often I was the last person to see them in that course of appointments. And probably like you, you're getting all that information was. It's a large amount of information and you're meeting with different specialists depending on what you've been, you know, shown and what the potential follow up, you know, whether it's an imaging study or like you said, a genetic test shows. And it's really challenging and you know, many times they don't have anybody with them. I remember patients coming to see me alone and early in my career I would just sit there and I'd try to listen and then see where the patient was at. And like you said, you were like, oh, I don't want to have reconstruction. And so for everybody listening, so I would always explain option wise. And the first option is obviously to not do a reconstruction at that time. And that can be a patient saying they want, like Lacy has set a aesthetic flat closure, which is slightly different. So they're, you're not leaving any additional skin for a delayed reconstruction because some people just wanted to do a delay and, and that's, that's a different conversation. So obviously do nothing and then depending on that, work it out. You know, secondly, you can certainly do your own tissue reconstruction depending on your frame and there's lots of options. I, I did the deep flap reconstruction for many, many years. That was my thing. Coming out of training seems like ages ago, but in the late 90s, early 2000s, that was something that I was very focused on doing. Um, and did that for a variety of, of reasons. I did perforator reconstruction, so I did it for head and neck sarcoma. And obviously breast is more prevalent than all those. So I did that the majority of that. And then the, the implant based reconstructions and then combos of implants and your own tissue. So there are multiple ways to do things depending on who you have a conversation with. And I think that was one of the points of your TED talk was that's very different depending on. Is it Idaho Falls where you were.

Yes. Yep. I don't. Yeah, Idaho Falls in Utah area. Yeah. So it is very different. And one thing that I, I want to like, I guess point out or bring up, because I love everything that you're saying. And that is, is that I feel like I had an unfair advantage compared to every. Anybody else who is going through this journey, because I, like I mentioned earlier, I had watched, I think it was at that time, like, eight of my family members go through cancer, right? So I had seen the journey. I had seen from diagnosis, treatment to, you know, being in remission. And I got to see it from many different perspectives. And so when. So you're exactly right. So when they get a diagnosis, it's all of a sudden all of this information, they're just being inundated with it, and they have to make so many choices, really big life choices that they haven't had time to think about or research or dive into. And they have to usually make them very quickly. And so I. I had the advantage of watching it through all of these years and then me getting sick and then getting the diagnosis of the. The genetic markers. And so I wasn't rushed. I had plenty of time. I had been researching things. I had, like, you know, fil into a little bit of, like, what it was that I wanted. And. And then just continuing to watch women go through this, like, that is one of my biggest things that I advocate for and try to help them advocate for is just to take it slow, like, do whatever you need to, you know, if you are diagnosed with cancer, to get that taken care of immediately. But maybe do the, you know, skin sparing mastectomy so that you can decide later. Because at that point, and I mean, I'm not a doctor educated, but from what I've seen is at that point, you can then kind of choose and have some more options. You can still go. You can still go aesthetically flat closure, or you can choose to do like, you know, the body flaps or if it's an option, you know, different transfers.

So it is. It is definitely one of you had experience, and that's lacking because, you know, unfortunately, that's something that we don't have to want to have a lot of experience with. But you did. And then access is, I think, something that you bring up in your talk that I try to explain to everybody. I think people lose a little bit of the concept of the size of our country. So I'm in Austin, Texas, and Spain fits in Texas. So if you were to get an hour outside of where I am, you would have a totally different discussion on options. And that leads to kind of what we're talking about is access. And, you know, you would have never met Anybody like me, because there was very few people with my skill set. You would had to be at a, you know, a big center to have, you know, had a discussion with me. So when I hear somebody didn't have a discussion, I, I understand why. And so I always say the same thing so that people understand this. And it's. If you go through training like I did, so I did general surgery and plastic surgery and a microsurgery fellowship that I did nine years after I got out of medical school, the shortest route you can do is. And then you can go practice and maybe someone you know is practicing in or around your area. The hospitals will have a certain ability to do certain cases and there's equipment, nursing, skilled nursing, ICU care, all these different things dictate what gets done at a particular hospital. I mean this, we're very spoiled because we have access typically to really high level care, but we have such a big country that it drops. I wouldn't say the care drops, but the access to types of care will change just the further you get out from a major city. And that was something that I conceptually knew about. But because of what I did for cancer reconstruction, I always was getting all these different access to subspecialists and specialists and you know, working in places where of course they had breast MRIs and all the things that you pet scans and these things weren't hard for me to, you know, have access to either the specialist or the, the teams involved to take care of them. But like, as you go further and further out in our country, it's very complicated very quickly. So the standard of care would have been have a discussion with a plastic surgeon if they had one available for you in a small area. And they probably would have given you a very limited set of options if they could do anything outside of a implant based reconstruction. So for everybody listening, that is still the dominant method of reconstruction. And it's always going to remain that way because of the size of the country. It's just not ever going to magically you're not going to have 20,000 people like me that trained for nine years and did all these different techniques. And that's just, it's not practical, not in our country, not due to its size. And just it's in Texas alone. I mean, it's just you could drive eight hours and still not be out of the state of Texas from where I am. So it's just very, it's hard. So I. Do you, you brought up things in your talk that I think we should Touch on too. And you had dense breast tissue which made it hard to surveil. You had implants and which does make it harder to surveil. And you had a genetic predisposition already based on your family history. And then you had some genetic testing and you said you didn't have a BRCA. But there's things like CHEK2ATM, there's other mutations certainly that some things that can be wrong with tumor suppression or DNA repair or other things that just set you up for cancer, but more importantly like for screening and things you would have had trouble because of dense breast tissue and the options to get screening. So maybe touch on that a little bit so everybody understands that.

Yeah, yeah, absolutely. So, and I'm, I love that you are bringing up the access and the distance in the size of our country, because that is exactly what happened. You know, I remember, I think it was right after I had my second child. I was still in my early 20s and that's when my first lump was discovered. And that's when I went in. And at this point I did not have my breast implants, but I went in for a mammogram and they could not get a proper reading or imaging on it. And so they had to send me to the closest university that had access to the specific MRI machine that they wanted for me to get this, you know, image in this reading. But it was a four hour drive one way and I had two little kids and you know, I was new, we were married, but young couple trying to figure everything out. And it, it was a big muscle movement for us to, you know, get, get four hours away one way, have this imaging and then I had to stay around for a while because if they needed to get different imaging or you know, use a different technique or a different machine and then drive home for hours. So that was my first introduction to it. And then as my journey continued like we did move, we moved and lived in, near Phoenix, Arizona, in Seattle for a while. And it was easier for, to get, you know, to get access to the imaging. But then as soon as we moved back to Idaho Falls, Idaho, it was like, and they are doing better now. They have more technology and you know, machines and stuff here. But it was, it was, it was impossible until I, and I was at the point that I was needing to go in about every six months to be checked. And it just emotionally took a toll on me. It took a toll on my schedule and you know, it was just, it got really rough to the point that I was like every six Months I'd go in and there would have to be, you know, we finally got it kind of dialed into what imaging we needed in, like, the sequence. Right. But then it would still get to the point that I'd. I would be on pins and needles waiting for that phone call to come back to say, okay, you're clear again, or, hey, we need you to come in for a biopsy. And then you have to wait for the biopsy results. And yeah, it's just a wild, wild experience.

I often sit and I read reports now that I'm encouraged by. And one of the biggest holdups is what you're describing, which is waiting for an interpretation of an exam. And we're just going to say a radiologic examination. And I'm not here to be, you know, like, the fear of being replaced by AI or anything like that, but reading and interpreting studies, especially the MRIs and things like that. And I'll be the first to say I was not some expert throughout training on breast or mari, especially because it was coming to fruition that that was going to be incorporated towards the end of my, you know, my training. But if you asked me to look at a CAT scan of anybody of anything like that was no problem for me because that was already ingrained, you know, throughout my training. And probably listening to CAT scan is just like stacking up pizza boxes and you're just looking at. At cuts. And then MRI is different because you, you can change the appearance of the. If you want to think of, like, the grayscale. So, like, whether it's black or gray or white or it's just different in, in terms of understanding that. I'm, I'm super hopeful that the things I read about, interpretation of those different images with AI will help diminish what you and others experience in terms of weight. So if something, you know, that has to be looked at critically, carefully, accurately, all the time can be learned and that gap close, that's how I think about it. Things that would. There's inertia, right? There's delays because of what you experienced. And nobody wants to make an error. I think everybody needs to understand none of us want to ever make errors when we're trying to interpret these things. But if you've ever looked at an ultrasound or a mammogram or a breast mri, a lot of gray. It's not super simple. And I'm, you know, I've looked at thousands of, you know, those types of studies, and I would not sit here and go, oh, oh, yeah, that one's fine. I mean, no way. Those things are not easy to interpret. So having dense breast tissue and in Texas there's Hinda's law for dense breast tissue that, you know, helps abdicate and allow people to get MRIs so you can better characterize it. I think too I get a lot of patients, obviously in my work with patients, uses our explant. There are many, many other types of studies being done, whether it's different scans or thermographic imaging or QT imaging. And everybody kind of needs to understand and I explain this all the time and this is a good, you know, the Birads classification is created so that every doctor in this country can communicate about what's seen on those studies and have the same language. You know, the breast imaging reporting and data system is standardized just to help doctors communicate because your primary in, you know, Rhode island has to be able to understand if you get a imaging study in Idaho Falls and vice versa. Everybody has to have the same communication system. And I think all of us would embrace something that's easier for patients, quicker, you know, safer, easier to interpret, less like overreads or under reads. Nobody wants to miss anything. But it's definitely not simple. Definitely not simple, definitely not. I look forward to. That's one place in medicine I see, amongst other like little things that I'm just, I'm, I'm being greedy because what I see as a big like choke point is just interpretation of imaging for patients like you and others who are waiting and waiting. Like, like you said, you're trying to sequence your life around getting an exam done. Now that's, you know, obviously we talked about access, you know, to drive four hours to get the right access. That's, you know, because you're trying to get a 3 Tesla MRI, which for everybody listening, 3 Tesla MRIs in our country, you know, like go into a big grocery store, there's a lot of them, or like a, like a superstore or something like that. If you were in Europe, they would mostly give you access to what's called A1 Tesla MRI, which is like watching for all you folks who still remember this regular definition TV versus high definition tv, you know, we have, we're a little spoiled because we can get access to a 3 Tesla MRI pretty easily. So everybody's going to be switched off after I gave that explanation. But in terms of maybe just ask a little bit, you know, you've told me a little bit about your, your messages used to be very, you were concerned about them still not having access. Like you didn't have access, but that started to shift a little bit.

Yes. Yeah. So the thing that's really starting to shift, that I'm starting to see, like, and hear different stories, is it used to be I'd get contacted by women all the time and they would, you know, just say, how. How do I get to this point? How do I get my implants out? How do I get, you know, because I' in a unique situation that I hear from women who are wanting their implants out, whether they had them for cosmetic reasons or, you know, or cosmetic reasons due to. To breast cancer. Right. Then I also have the breast cancer side where they're like, hey, I was just diagnosed with breast cancer. How I told my surgeon I wanted to go with aesthetic flat closure. And I'm completely botched. And I don't use that word lightly. Like, these pictures that I get are beyond heartbreaking. And what is. What is fun for me is I am the half, you know, the glass half full type of girl. But I am starting to actually get some stories where women. We'll just go on the breast cancer side right now where women will come and they'll say, oh, my gosh, Lacey, look at this. I was able to. Because we've got a little PDF thing that. That we can, you know, that we have downloadable and so that people can take into their doctors and, you know, have different examples of what acidic FL closure is and what it means to them. So with that, we are starting to. I am starting to get immediate aesthetic flat closure results, and the women are just ecstatic and so happy. But then also on the flip side, because with the breast implants, because I have so many friends and people that I know that have breast implants, and they are. When they do decide to have them removed, they are being listened to a lot faster than even four or five years ago when I was. Well, six. Six years ago now, when I was really going through this. And so it does give me so much hope. Like, so much hope, because there. There is some progress, I feel like. And even in. In my small town, in. I hear from people all over the world and that there is progress being made. So that's where I'm like, okay, okay, we're. We're getting somewhere it shouldn't be.

And I gave you my story because I worked in big centers where there was a lot of multidisciplinary group treatment. The breast surgeons would have the discussions with the patients, and if the patient chose not to have reconstruction, I was never included. I wouldn't have ever seen you as a patient. That's just the referral would have had to have been made for you to have seen me in that system. Otherwise the breast surgeon would have taken care of the patient who said, I don't want any reconstruction. And I'm trying to think of why there would be so many, you know, problems with, you know, the, the closure. Typically there would be what's called standing combs or dog ears. If somebody didn't, you know, remove the tissue, that would be one issue. And then the thickness of the, the skin flaps created is always different side to side. I mean, that's, that's never going to change throughout time.

And like, I think part of it is, from just what I've seen is that the. And in small towns, all we have is general surgeons that don't, you know, specifically work in the breast sector. But from what I have noticed, and that's even across the country, is that I don't know if it's lack of education and knowing how to do it, because I think, I think that they understand a little bit of the skin sparing mastectomy. But the message that we hear over and over and over from surgeons, whether breast surgeons or general surgeons or plastic surgeons, is that they don't want to go and do aesthetically flat closure. Because what if you change your mind? What if you change your mind? So they leave lots of excess stuff. So it's almost like a lot of these women, it's almost like they have breasts still, but not. And they're just like really deformed, you know, so they'll like, have some hanging this way and some going this way. And I mean, they literally are being botched and deformed. But with everyone that I've spoken to, as far as the patients, the, the women that. That's the same. I get the same, the same response every time is that the surgeon was just convinced that they, they needed to prepare and make. They were seeing it from their perspective because they're like, we need to leave all this extra skin and make it this way so that if this patient changes her mind, it will be easier on the next surgeon or their job to do a reconstruction process. So just irritates me.

Right? Because it's a very, it's a very reactive way to practice. And instead of having the discussions and everything in a logical way up front and deciding, and when someone can't make a decision, then that would be the time to, if you want to say, defer that to, to later. But I mean, that's even that I understand the kind of concerns and, and from the, the plastic surgery perspective, once again, I wouldn't even have heard about that case in the time that I, you know, for 20 plus years that I did reconstruction because that person would have never gotten to me.

Correct. Correct. Yeah. So it's, it's having to help educate and make this type of a, a scenario and situation aware for all different types of surgeons. So it's like the oncologist needs to know about it, the general surgeon needs to know about it. The, the plastic surgeon needs to, you know, it's. And it's, it's. It's wild because know what section the patient is going or going to be referred to. And so, you know, that's really part of my mission, is educating women in general so that they can, if or when they're ever in this situation, have some knowledge and some resources to hopefully, you know, go through and make their decision and know what they want to do. But then also on the backside, I'm trying to help educate the doctors or bring awareness to it with the surgeons and hospitals and nurses and stuff, stuff like that, so that we can, we can try to make this just very prevalent and aware that it, that it is an option and it is possible.

That's something that, you know, breast surgery has grown out of general surgery, and many people aspire just to do it their entire focus, and that will help obviously get things moved further. Dr. Harold Cheek was like the. One of the first breast surgeons, and he was in Dallas, Texas, and it basically was born out of the fact that he had developed such a breast practice that he could just do breast surgery. So when someone comes out of training, if that's their desire, which I assume that's becoming more prevalent, it goes back to, are there enough patients who have that problem, then support that type of practice for them. Because once again, our country is very spread out, and that would be pretty complicated in a smaller place like Idaho Falls. It just wouldn't be simple for that surgeon to come and be able to create a practice, support the patients, get the staff to help the patients. We're not really saying the. All the things that have to go on out loud here, but the, the surgeons involved are just, you know, I'm gonna say bit players, but there's big teams that revolve around taking care of. Of cancer patients that much in the way I run my explant team here in Austin, it's more of a multidisciplinary team with different levels of, you know, nursing Nurse practitioners, nurses, medical assistants. We have folks that help with the recovery portion that are separate from surgical recovery. They help with, for lack of a better word, detox, things of that nature. Trying to get someone's gut back on track or run a process to get a mold or parasite, you know, I dare say controlled, but get that, get a balance restored. Because, you know, hearing your story, you got really out of balance, which is what I hear a lot of. And a lot of chronic inflammatory symptoms are very, very common, you know, in my patients. And trying to get them back in some semblance of balance. I unfortunately have time to time found a patient after the fact who had breast cancer. And then my one is, it's only been a handful though, so I'm, I'm pretty fortunate. We found some deep l breast cancer, early stage on a patient. And she's obviously very thankful that we found it and got sorted out and could be followed very carefully because otherwise it would have been missed. To your point, it was very, you couldn't see it on imaging. It was too, too deep and in a difficult area to see. So those, fortunately, those are few and far between. We still have all of these breast implant associated cancers that are wildly interesting and challenging. Don't know how we're gonna resolve all that and still just try to take good care of patients. Obviously I get asked a lot. I take implants out now and I was never, I didn't do a lot of breast implant based reconstruction because I did all those other types. So I was the guy you would, you know, seek out to do the other types. It would be very hard for me to do all of them equally. It would just be too challenging. And so I got very experienced about any implant based problem, whether it was a cosmetic or reconstructive, whether it was from capture, contracture, from scarring or radiation or, or infection or whatever. I mean, run the gambit. All those things happen all, all the time. So you can't put in an implant and think it's a single, you know, a lifetime, you know, device. It's not. That's just, it's unfortunate. I hear that all the time still, which is kind of odd. It's not. There's no device ever created that's, you know, meant to last a lifetime. That's medical. They all things all break or wear out. Hips, knees, cardiac stuff, neural stuff. I mean, yeah, all of it's fraught with its own problems in terms of what would be a really good resource for them. They say, where would good places go for them to learn more so they could advocate with their, their teams or their surgeons or help loved ones or family members.

Yeah, so there, there are several different places. So I have all the, the non profit and the different groups linked on my website and my website is just boobless, not life. And, but then there, there's also, and this, you can get links from my website there. But there's aesthetic flat closure. There's you know, links to different people that I, that I have worked with and support, support and trust like and like you in the breast implant illness world. There's Flat Out Love, which is another non profit that is, that helps women, you know, advocate, move forward for themselves. And also, especially with Flat Out Love, I'm noticing a trend in that one that they're working and focusing more like on mental health. Okay, good with that. Which I think is fascinating. So it's like the aesthetic flat closure.org that one is more like I was saying was like pamphlets and like things to help promote and educate and then it kind of moves down the way. But that's, that's another thing and that's one place that I really try to work and work hard in is, is the mental health side of it. Because going back to my point that I, I got to make this decision for me, right like, and I wasn't in a timeline crunch because I had a diagnosis. I, I'd been sick for a long time and I needed them out, my implants out. But like I said, I had a lot more information than most people do. And so I had time to process in a different way and get to a different or get to this confident result of who I am, that I love how my body looks, I love how I feel. I'm way happier now than I ever was with breasts. And it has nothing to do with sexuality, it has everything to do with the diabetes. Feel more sexual and more healthy and just more like myself. But I, I am thankful because I know that I was able to get to that point a lot quicker than a lot of women because of how, because of my journey, because of how I got there. And so now I'm really trying to hone it in and help women get to this point, whether they come to me immediately and they're like, hey, I was just diagnosed with breast cancer, I'm going to go flat. Or I've had breast cancer and I did impl as reconstruction but I need them out. Or even a lot of women who are like, I'm getting my implants out and I'm going to be really, really tiny breasted again. Like, how am I going to love myself? And that is so important to me because just like the whole reason I did my TED talk and that sparked everything in me for this was that I saw, I saw these women who had, you know, just a few of them who had gone boobless and they were devastated and hated how they looked. And all I saw was like the most gorgeous, strong, courageous woman or women. And I was like, no, no, no, no, no, no, no. I want to reflect and show you. I want to be the mirror. I want to show you what I see in you. And that, that is my passion, that is my why. And I have seen such a big difference in women of these things. You know, whether it is how to say goodbye to the breasts or different things to do along the way, or if they come to me afterwards and say be. In some, some of the women, they end up coming to me because all these other options have failed. They've tried implants, they've tried different reconstructive method methods and they haven't worked their bodies, rejected it for whatever reason, you know, due to radiology or chemo or whatever it may be. Regardless, we're all in the same boat and our bodies look very. And so let's find a way to love them, embrace them, and work on the mental health side to know that you are just as feminine, you are just as gorgeous, and you're just as badass as you ever were and maybe even more.