In the summer of 2016, Paulette Leaphart walked over 1,000 miles topless, baring her mastectomy-scarred chest.

“I wanted to show women who lost their breasts that we are still women and have nothing to be ashamed of,” Leaphart told Healthline. “Breasts don’t define us. It’s our strength and courage and self-worth that make us women.”

Leaphart didn’t always feel positive about her scars, though. When she was diagnosed with late-stage breast cancer, she underwent a double mastectomy with the hope of receiving reconstruction surgery.

“When the doctor told me I wouldn't be able to have reconstruction because I have a rare blood disorder that made the surgery risky, I was devastated,” Leaphart said. “First, they amputated my breasts and then they didn’t give me anything to replace them. I felt like Frankenstein, and went into a deep depression.”

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Image source: Anastasios Ketsios and Angela Eve

About eight months after her mastectomy, Leaphart says she had a spiritually-driven “aha” moment. To escape her sadness and to take a break from post-surgery cancer treatment, she took four of her five daughters to the beach in her hometown of Biloxi, Mississippi.

“The beach was always a sanctuary for me as a kid when things were really hard. While I was sitting there watching my girls play, I could feel the depression lifting off me, and then God spoke to me. He said, ‘Take off your shirt and take pictures,’” Leaphart said.

That’s exactly what she did. “I called my daughters over and told them I was going to take off my shirt and asked my 12-year-old to take pictures. I started posing. Soon, I had a crowd standing around me. Many were crying, many were cheering and clapping, and many were talking to me. It empowered me,” she said.

What I learned from my mastectomy »

With encouragement from her daughter, Leaphart posted the photos on her Facebook page. Within an hour, the pictures went viral with 100,000 views. The next day they grew to 300,000, and eventually Facebook reported that 20 million people from 10 countries had viewed the pictures.

“That’s when I decided to embrace my scars to do more good,” Leaphart said.

Her 1,034-mile walk began in Mississippi and ended in Washington, D.C. on her 50th birthday. She stayed in DC for four days talking with Congress about financial burdens breast cancer puts on women who don’t have insurance coverage or who are underinsured.

“I was angry with the system and all the women who didn’t die because of cancer but because of lack of financial assistance to pay for treatment,” Leaphart said.

Why more women are ‘going flat’

More women like Leaphart are opting out of reconstruction surgery, whether by choice or for medical reasons. The decision not to have reconstruction is often referred to as “going flat” or “living flat.”

According to, a 2014 study found that about 56 percent of women who had mastectomies also had reconstruction, leaving 44 percent without reconstruction.

For some women, the reasoning is medical. For example, health complications like Leaphart’s might make reconstruction risky. For other women, it’s the lack of support, whether that means a lack of adequate insurance coverage or the inability to take more time off to recover from the reconstruction surgery.

The power of ink

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Image source: Rhiannon Whitney for

Whether they opt for reconstruction or not, many women who get mastectomies face insecurity following their surgery, and look for solutions that build their self-esteem. For some, that solution comes in the form of a tattoo.

Bernadette McLaughlin had mastectomy and reconstruction performed on each of her breasts, seven years apart. Nine years after her second mastectomy and reconstruction surgery, a blunt force trauma on one side meant the reconstruction had to be removed. She spent two years trying to replace it, but a staph infection caused her to lose most of the remaining chest muscle and skin.

Our readers’ inspiring mastectomy tattoos »

“I was left with a terribly scarred chest, concave and filled with lumps and bumps at the same time. I felt totally disfigured,” she says.

Looking for inspiration, she reached out to Scout Willis — the daughter of Demi Moore and Bruce Willis — via social media, to ask about Willis’s topless walk through the streets of New York City.

“I was wondering whether I would get arrested in New Jersey if I walked topless since I had no breasts. Amazingly, [Willis] wrote back and asked me to send her a picture of my chest,” McLaughlin says. “[She] told me about mastectomy tattoos and hooked me up via social media with Friday Jones.”

After learning about scar-covering tattoos from Jones, McLaughlin connected with, a nonprofit organization that connects tattoo artists with breast cancer survivors. Since 2013, events have been connecting tattoo artists with women looking to get scar-covering, post-mastectomy tattoos. On Days, the artists donate their time and service to the women.

McLaughlin was selected for the 2014 Day, choosing to get a black, flowery vine tattoo.

“During the process, I felt an explosion of varying emotions from absolute joy and excitement to fear of pain, but never any doubt. I was totally confident in my decision to be tattooed and in the talent of my artist,” she says. She liked her tattoo so much that she decided to have it continued across her chest a few months later.

“It’s a choice that’s just as permanent as the scars,” she says. “Losing my breasts was a choice forced upon me. The other choice was losing my life. I made the decision to fight for my survival. I was given the opportunity, a choice, to feel happy about my reflection in the mirror through tattooing. And I took it!”

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Image source: Anastasios Ketsios and Angela Eve’s founder and executive director Noel Franus says the organization’s Days across 25 cities have inked over 175 survivors and pre-survivors, women who choose mastectomy due to being at high risk of developing breast cancer.

“When we started, there was no elevation of the artists who are skilled enough to do this work,” he says. “We wanted to change the culture of healing, and the first part of that is getting everybody and their mother or sister to see this as a viable third option. If reconstruction is one option and no reconstruction is a second option, then mastectomy tattoos are a third,” he says.

Shane Wallin is one of Franus’s go-to artists. He travels between his tattoo shops in San Diego, California and Minneapolis, Minnesota. A tattoo artist for 23 years, Wallin inked his first mastectomy client in 2012.

“Effects that it had on her self-confidence were very inspiring to me. Her tattoo got an overwhelming response on social media. This led to my involvement with,” says Wallin, who now mostly works with breast cancer survivors.

How this comedian is tackling the stigma of mastectomy scars »

“When you can have such a profound effect on someone’s self-image, the feeling is immeasurable. It’s helping to provide positive reinvention, instead of looking at scars as a harsh reminder of a terrible experience and hiding from the mirror,” Wallin says. “The amazing women I work with can be proud to look at themselves and enjoy their vision of beautiful artwork.”

However, mastectomy tattoos aren’t for everyone. When asked if she would consider getting one, Leaphart said she would not, and that she’s learned to embrace her scars.

“They tell my story. I would also say ‘no’ today to implants if I could get them. I don't need breasts to be a woman,” she says. “Plus, breast cancer is not pretty. Women die every day from this disease. The shock value that seeing a woman with no breasts brings is priceless. Women run to take care of themselves when they see the scars.”