A recent study in PRS Global Open shows an increasing trend in women choosing aesthetic flat closure after a mastectomy. This is the decision to remove both breasts and create a truly flat chest wall contour instead of having breast reconstruction. There are many potential reasons someone may make this choice, including the desire:
– to avoid breast implants
– to avoid the additional scarring associated with flap surgery
– to decrease recovery time and time off work
– to minimize the number of surgeries
– to decrease the risk of complications
– to minimize out-of-pocket costs
Regardless of the type of mastectomy being performed, all mastectomies remove the breast tissue. However, many women are unhappy with the way their chest appears after a mastectomy without reconstruction, due to residual skin folds or tissue (known as “dog ears”) that is often left behind by traditional techniques.
Unfortunately, some patients report they were not given the choice to go flat by their surgeons. Others have experienced “flat denial” – this is when “a surgeon’s unilateral actions deny their patient the agreed-upon flat closure, either through negligence or intentional disregard” (NotPuttingonaShirt.org).
Thoroughly discussing your preferences and expectations with your surgical team ahead of time is important to ensure that, if needed, certain surgical techniques are incorporated to provide the best final contour and a true cosmetically-appealing flat result.
Due to the increasing demand for flat closures after mastectomy, there has been a welcomed increase in focus within the plastic surgery community on improving patient outcomes after going flat.
People in the following situations may wish to consider going flat:
– anyone considering mastectomy because of a breast cancer diagnosis
– anyone considering prophylactic (risk-reducing) surgery because they are at high risk of developing breast cancer
– those who have already had surgery as part of their breast cancer treatment and now wish to be symmetric without reconstruction, with a truly flat chest contour
– anyone who has had breast reconstruction already, is unhappy with their results, and now prefers to go flat instead
Aesthetic flat closure may be performed by a breast cancer surgeon alone or in collaboration with a plastic surgeon colleague.
Many of the techniques used to ensure a flat chest contour are actually plastic surgery techniques (eg V-Y advancement, local tissue rearrangement). Due to the increase in awareness of aesthetic flat closure in the breast cancer community, these techniques are more widely discussed and taught as part of breast surgery training. This will hopefully lead to more surgeons feeling comfortable offering this procedure.
Plastic surgeons are also often asked to perform revision surgery if an aesthetic flat closure was not performed at the time of the mastectomy.
When considering aesthetic flat closure, or any other surgical procedure, it’s important to:
– Take the time you need to research all your options using reputable sources.
– Look at before and after photos to help you figure out how you’d like to look.
– Research your surgeon to ensure they routinely perform the procedure you choose.
– Talk extensively with others who have had the surgery you are considering, preferably with the same surgical team.
By asking these questions and taking the time to research your options, you will maximize your chances of having a good outcome that meets your expectations.
Does my insurance cover aesthetic flat closure?
Insurance companies typically cover going flat as part of breast cancer-related or risk-reducing mastectomies. Prior to scheduling surgery, it’s important to speak with your insurance company and make sure your surgical team has confirmed that it will be covered by insurance.
Download our FREE Breast Advocate App to learn more about going flat (aesthetic flat closure).
Breast implants are NOT the only option
The most commonly performed method of breast reconstruction performed today uses tissue expanders and implants. Although this approach is a good option for many, it’s not the only option. Likewise, implants may not be the best option for some patients. Reconstruction options using your own tissue (referred to as autologous or “flap” reconstruction) is also an option. In particular, after radiation treatment flap procedures are associated with fewer complications than implant-based reconstructions.
Sensory nerve reconstruction may be an option
Following a mastectomy, many patients experience permanent numbness to the chest area and reconstructed breast. This is because the sensory nerves that provide feeling are usually cut during the mastectomy. There is some good news though! Advances in breast reconstruction techniques have made sensory nerve reconstruction possible: reconnecting the sensory nerves in the chest can significantly improve the return of feeling to the reconstructed breast.
Enhanced Recovery After Surgery (ERAS) protocols are making recovery easier
Many surgeons are now implementing ERAS protocols to ensure their patients experience an easier recovery following breast cancer surgery, with or without reconstruction. Regardless of the type of reconstruction performed, ERAS protocols are reducing hospital stays, shortening recovery, and reducing the need for narcotics to control discomfort after surgery.
Shared decision-making matters
Breast reconstruction is not a one-size-fits-all procedure. Ensuring you discuss all your options and how they align with your lifestyle, preferences, and goals is critical in planning the best reconstructive option for you.
You can choose NOT to have breast reconstruction
It is important for patients to remember choosing NOT to undergo breast reconstruction and instead opting to “go flat” is an acceptable choice. Going flat (aesthetic flat closure) gives patients seeking no reconstruction the ability to maintain balance and symmetry without reconstructing the breast(s). Women can also choose to go flat after breast reconstruction if they are unhappy with their reconstruction results or have experienced complications after breast reconstruction.
To learn more about ALL your options, download the Breast Advocate App today!