Patients and Providers for Optimal Aesthetic Flat Closure
Women facing mastectomy deserve full disclosure of all of their reconstructive options, including aesthetic flat closure, and to have their informed consent respected.
Aesthetic flat closure (AFC) is reconstruction of the chest wall contour.
Institutions support AFC.
“…The consortium focuses on oncoplastic breast conserving surgery, nipple/skin sparing mastectomy with immediate reconstruction and optimal flat closure after conventional mastectomy.“Oncoplastic Breast Consortium
“Many people think of reconstructive surgery as breast reconstruction with tissue flaps or implants. But aesthetic flat closure — considered to be the gold standard for going flat — is also a form of reconstructive surgery.”BreastCancer.org
“aesthetic flat closure:National Cancer Institute, Dictionary of Cancer Terms
A type of surgery that is done to rebuild the shape of the chest wall after one or both breasts are removed…”
“In a total mastectomy with a flat closure, the entire breast, including nipple, extra skin, fat, and other tissue in the breast area are removed. The remaining skin is tightened and sewn together.“National Comprehensive Cancer Network (NCCN) 2022 Patient Guidelines
Medical professionals support AFC.
“Aesthetic flat closure IS a type of reconstruction and is a very powerful choice that deserves just as much care and respect as any other reconstructive surgery.”
Dr. Ron Israeli
Plastic & Reconstructive Surgeon, NYBRA Plastic Surgery
“Patients deserve aesthetic flat closure.”
Drs. Jennifer Baker & Deanna Attai, ASO Author Reflections
“Many women have begun to embrace Flat Closure as a movement and a way of life. Flat Closure is a chance for women to accept their new, post-breast cancer bodies as both beautiful and valid.”
“I think ‘going flat’ just refers to removal of the breast and no reconstruction, and what it should refer to is removal of the breast, no reconstruction, and the surgeon doing everything they can to make it look nice and neat.”
“We believe patients should be fully informed of all their breast reconstruction options, as well as the option of aesthetic flat closure (no reconstruction with a nicely-contoured, truly flat result). It is only once all the options are fully discussed, that patients can take part in a shared-decision-making conversation with their surgical team.”
Patients expect AFC.
“My surgeon gave me a handout on going flat, along with the info about reconstruction, at my first meeting with her… She did a perfect job on my chest.”― Anonymous
“It’s hard enough to have a double mastectomy due to breast cancer, but to have to fight insurance just to be able to look halfway decent and be somewhat comfortable in your own skin is wrong.”April
“I knew I wanted to be flat from the very beginning [but] I was given a skin-sparing mastectomy. I did not consent to that outcome, nor did ever imply that it was anything I wanted. I am devastated.”― Anonymous
Flat Denial: Why Does it Happen?
We face multiple cultural and institutional barriers to ensure that a woman’s choice to go flat is respected, every time. We now have clear language – aesthetic flat closure. But paternalism, protectionism, lack of a defined standard of care, sub-optimal prevalence of oncoplastic training for general surgeons, and an off-kilter reimbursement system are all pieces of the puzzle we still need to address.
Three of every four patients going flat are satisfied with their aesthetic outcome.
1 in 20
About 1 in 20 patients going flat – that’s a 5% risk for each woman who chooses flat closure – are subjected to intentional flat denial.
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