SELECTED TRANSCRIPT (more to come): “Let’s talk about what aesthetic flat closure means. For me, it was just the way you did a mastectomy. Now I want people to know that people aren’t trained [in] that in general surgery. When I went through general surgery training, we were blessed with a breast surgical oncology fellowship at our institution, so the third year residents would rotate with the breast service for about two and a half months. So on that service, you learned how to do mastectomies, lumpectomies – it depended on what surgeon you were with, with how well they closed the chest wall. And most of our women did get reconstructions. So, when I became a fellow, the surgeons that I worked with trained us [but] it’s not a formal technique that you do.
“Being cognizant of how much tissue you have left on that patient – what we call medially and laterally, medially means closer to the sternum or the breast bone, and laterally is near the axilla or under the arm – so if you look at some women who have had mastectomies without reconstruction (or they’ve had the implants removed), sometimes you’ll see tissue left near the sternum. It looks like a dog ear – we call it a dog ear. Or you’ll see a lot of tissue – we call it “redundant tissue” – where the tissue kind of billows out, or kind of sinks in, especially after an implant has been removed. And so if you want to wear a prosthesis after you’ve had the implant removed, it’s not going to fit very well against a chest wall with all that excess skin, plus it will become irritated. And then a lot of ladies will complain of under the arm with all that fatty tissue, it’s hard to put the arm down, it’s unsightly, it doesn’t fit into your post-mastectomy bra very well. So it’s having an aesthetic eye, to understand that that tissue needs to go.”