Flat closure after mastectomy explained

Aesthetic flat closure after mastectomy is contouring of the chest wall after mastectomy without traditional breast reconstruction.[1] Vernacular synonyms and related vernacular and technical terms include "going flat",[2] "flat closure",[3] "optimal flat closure",[4] "nonreconstructive mastectomy",[5] "oncoplastic mastectomy",[6] "non-skin sparing mastectomy",[7] "mastectomy without reconstruction",[8] and "aesthetic primary closure post-mastectomy".[5]

Women who have decided against traditional reconstructive surgery following mastectomy have gained media visibility in recent years.[9] Media reports have covered patients' claims that their choices not to undergo reconstruction have been overridden by their surgeons.[10] [11] Recent research has characterized the "going flat" movement and patient experience going flat[12] [13] [14] and described aesthetic flat closure surgical technique.[15] [16] [17]

Aesthetic flat closure is the surgical work required to produce a smooth flat chest wall contour after the removal of one or both breasts, including obliteration of the inframammary fold and excision of excess lateral tissue (to avoid "dog ears.")[17] [18] It is defined by the National Cancer Institute as the following: "A type of surgery that is done to rebuild the shape of the chest wall after one or both breasts are removed. An aesthetic flat closure may also be done after removal of a breast implant that was used to restore breast shape. During an aesthetic flat closure, extra skin, fat, and other tissue in the breast area are removed. The remaining tissue is then tightened and smoothed out so that the chest wall appears flat."[19]

Notes and References

  1. Web site: 2011-02-02. About Aesthetic Flat Closure. 2022-08-12. BreastCancer.org. en.
  2. News: Rabin. Roni Caryn. 2016-10-31. 'Going Flat' After Breast Cancer. en-US. The New York Times. 2020-07-03. 0362-4331.
  3. Web site: NCCN Guidelines for Patients: Invasive Breast Cancer. 2022-08-12. NCCN.org.
  4. Web site: OPBC. 2020-07-03. oncoplasticbc.org.
  5. Djohan. Michelle. Knackstedt. Rebecca. Leavitt. Tripp. Djohan. Risal. Grobmyer. Stephen. April 2020. Technical considerations in nonreconstructive mastectomy patients. The Breast Journal. 26. 4. 702–704. 10.1111/tbj.13641. 1524-4741. 31578792. 203652994.
  6. Macmillan. R. Douglas. McCulley. Stephen J.. 2016. Oncoplastic Breast Surgery: What, When and for Whom?. Current Breast Cancer Reports. 8. 2. 112–117. 10.1007/s12609-016-0212-9. 1943-4588. 4886147. 27330677.
  7. Kinoshita. Satoki. Nojima. Kimihiro. Takeishi. Meisei. Imawari. Yoshimi. Kyoda. Shigeya. Hirano. Akio. Akiba. Tadashi. Kobayashi. Susumu. Takeyama. Hiroshi. Uchida. Ken. Morikawa. Toshiaki. 2011. Retrospective comparison of non-skin-sparing mastectomy and skin-sparing mastectomy with immediate breast reconstruction. International Journal of Surgical Oncology. 2011. 876520. 10.1155/2011/876520. 2090-1410. 3263672. 22312528. free.
  8. Harcourt. Diana M.. Rumsey. Nichola J.. Ambler. Nicholas R.. Cawthorn. Simon J.. Reid. Clive D.. Maddox. Paul R.. Kenealy. John M.. Rainsbury. Richard M.. Umpleby. Harry C.. 1445626. March 2003. The psychological effect of mastectomy with or without breast reconstruction: a prospective, multicenter study. Plastic and Reconstructive Surgery. 111. 3. 1060–1068. 10.1097/01.PRS.0000046249.33122.76. 0032-1052. 12621175.
  9. News: Why More Breast Cancer Survivors Are Going Flat. en-us. Oprah.com. 2020-07-03.
  10. Web site: Guthrie. Catherine. 2018-09-06. These Cancer Patients Wanted to Get Rid of Their Breasts for Good. Their Doctors Had Other Ideas.. 2020-07-03. Cosmopolitan. en-US.
  11. Web site: Breast cancer patient opens up about alleged malpractice in surgery. 2020-07-03. TODAY.com. en.
  12. Wakeley. Michelle E.. Bare. Colette F.. Pine. Rebecca. Dube. Catherine. Gass. Jennifer S.. Taneja. Charu. Dizon. Don S.. A social media survey of women who do not pursue reconstruction after mastectomy for breast cancer: Characterizing the "Going Flat" movement. The Breast Journal. 2020. 26. 7. en. 1455–1457. 10.1111/tbj.13781. 32067326. 1524-4741. free.
  13. Web site: SABCS iPosters. posterview.com.
  14. Web site: Going Flat After Mastectomy. 23 May 2020.
  15. Djohan. Michelle. Knackstedt. Rebecca. Leavitt. Tripp. Djohan. Risal. Grobmyer. Stephen. 2020. Technical considerations in nonreconstructive mastectomy patients. The Breast Journal. en. 26. 4. 702–704. 10.1111/tbj.13641. 31578792. 203652994. 1524-4741.
  16. Web site: Smith. Monica J.. December 10, 2018. Managing Patient Expectations Key for Mastectomy Without Reconstruction. 2020-07-03. Clinical Oncology News.
  17. Morrison. Kerry A.. May 2022. Not Just a Linear Closure: Aesthetic Flat Closure after Mastectomy. Plastic and Reconstructive Surgery - Global Open. 10 . 5 . e4327 . 10.1097/GOX.0000000000004327 . 35620492 . 9116949 . 248837570 . free.
  18. Hill. Erica L.. July 2019. The Angel Wings Incision: A novel solution for mastectomy patients with increased lateral adiposity. The Breast Journal. 25 . 4 . 687–690 . 10.1111/tbj.13301 . 31111601 . 160011773 . free.
  19. Web site: 2011-02-02. NCI Dictionary of Cancer Terms - National Cancer Institute. 2020-07-03. cancer.gov. en.

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