Aesthetic Flat Closure Should Be Considered as a Reconstructive Option After a Mastectomy
CancerBreast Cancer

Why Aesthetic Flat Closure Should Be a Reconstructive Option After a Mastectomy

Going flat is about finding a pleasing look that makes us feel beautiful.
Why Aesthetic Flat Closure Should Be a Reconstructive Option After a Mastectomy
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for Awaken Your Wellness
Published on November 26, 2024
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Everyday Health Blogs

“You will be psychologically scarred if you choose to not have breasts,” she said.

This was my second consultation with a plastic surgeon, and I left in tears.

I remember it like it was yesterday. I thought this appointment would be better since the doctor was a woman, but it turned out to be worse.

Contrary to what I was told, it has now been four years since my decision to have an aesthetic flat closure (AFC) — also known as “going flat” — after my preventive mastectomy, and I could not be more emotionally or mentally at peace with my choice. In this post, I will share my thoughts on why AFC should be offered as a reconstructive option after a mastectomy.

What Is Aesthetic Flat Closure?

Aesthetic flat closure is a procedure performed when a patient makes the intentional decision to not have breast reconstruction after a mastectomy. This means that instead of having implants or using tissue from other parts of the body to create new breasts, the chest remains flat. Extra skin and fat are removed, and the remaining tissue is tightened, giving the chest a smooth appearance.

This option has been gaining popularity among people who have had preventive mastectomies due to genetic mutations or high-risk factors for breast cancer, yet there is no standard of care when it comes to surgical techniques or patient education about this choice.

Results from a survey published in 2021 showed that up to 74 percent of women who chose not to get immediate reconstruction were satisfied with their choice, yet around 22 percent of women faced “flat denial,” which means their surgeon didn't offer AFC, didn't support their choice of AFC, or intentionally left extra skin during the surgery despite a woman’s expressed desire to go flat.

Why Do I Need to Know About Aesthetic Flat Closure?

The decision to have a mastectomy, whether preventive or for treatment of cancer, is a life-changing one that can have long-lasting physical and mental impact. The reconstructive option chosen after mastectomy is directly linked to those same impacts.

Sadly, when it comes to mastectomies, many women don't receive enough information about their reconstructive options and everything that comes with the choices they are making. A study published in JAMA Surgery of women planning to undergo a mastectomy found that the majority lacked clarity on reconstruction risks and benefits, leading to poor-quality decisions.

 This highlights the need for improving shared medical decision-making so women can make informed decisions about their bodies and quality of life.

For me, going against the societal norms of what a woman’s body should look like and redefining for myself what beauty is by choosing AFC was extremely empowering. In addition, I didn’t have to undergo multiple surgeries, and it gave me control over my own healing journey.

Why Aesthetic Flat Closure Should Be Considered as a Reconstructive Option After a Mastectomy

Reconstruction after a mastectomy has always focused on creating new breasts after surgery, with either implants or tissue from other parts of the body. However, with more women expressing interest in going flat after a mastectomy, this definition doesn't capture the full range of choices available.

Just like other reconstructive options, flat closure requires fully understanding the woman's wishes, concerns, and desires for the aesthetic look she wants for her body. It’s so much more than removing the breasts and simply closing up the chest wall. When AFC is considered as a reconstructive option, the surgical techniques focus on symmetry, smooth contours, nipple placement, and avoiding excess skin (also known as dog ears) to provide the woman with an aesthetically pleasing look that will allow her to feel beautiful and confident in her skin.

 For example, I have always been small breasted, so I chose to have a nipple-sparing AFC, while most women choosing AFC do not keep their nipples.

AFC requires a level of planning and attention to detail that is similar to what goes into traditional breast reconstruction surgeries. When AFC is looked at from this surgical perspective, it should become a standard of care among the reconstructive options after mastectomy. It should be a choice offered to all women undergoing a mastectomy. It shouldn’t be a choice that women have to plead and cry for while searching for a surgical team willing to perform it.

5 Questions to Ask if You’re Interested in Aesthetic Flat Closure

Here are my top five questions to ask your surgical team if you’re interested in learning more about aesthetic flat closure:

  1. Have you done aesthetic flat closure (with or without nipples) before?
  2. What would I look like if I chose to go flat after a mastectomy? Can you draw me a picture of what you think my chest will look like? What will my scars look like?
  3. If I keep my nipples, where will they be? Where will my scars be?
  4. Will I need revision surgeries?
  5. If I change my mind, can I get delayed reconstruction (implants or flap)?

Conclusion

It's been four years since my choice to go flat after a mastectomy, and I honestly couldn't be happier or more confident with how my body looks. AFC is a beautiful option that deserves to be recognized as a choice alongside implant and flap reconstruction after a mastectomy. Explore your options, advocate for your desires, and make the decision that feels right for you and your body. AFC may not be widely recognized as a reconstructive option yet, but I truly believe that every woman has the power to change that by being her own advocate and spreading awareness about this choice.

Important: The views and opinions expressed in this article are those of the author and not Everyday Health.

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Lisa D. Curcio, MD, FACS

Medical Reviewer
Castle Connolly Top Doctor
Lisa Curcio, MD, is a board-certified general surgeon and a fellowship-trained surgical oncologist. She is currently the medical director of breast surgery at Northern Dutchess Hos...
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Simran Malhotra, MD

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Simran Malhotra, MD, DipABLM, CHWC, is a triple board-certified physician in internal medicine, hospice and palliative care, and lifestyle medicine, as well as a certified health a...
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Resources
  1. Aesthetic Flat Closure. National Cancer Institute.
  2. Morrison KA et al. Not Just a Linear Closure: Aesthetic Flat Closure after Mastectomy. Plastic and Reconstructive Surgery Global Open. May 18, 2022.
  3. Baker JL, Attai DJ. ASO Author Reflections: Patients Who Go Flat After Mastectomy Deserve an Aesthetic Flat Closure. Annals of Surgical Oncology. January 21, 2021.
  4. Lee CN et al. Quality of Patient Decisions About Breast Reconstruction After Mastectomy. JAMA Surgery. August 16, 2017.