Improving the Standard of Care Must Be Based on Evidence.
The historic study on patient satisfaction with aesthetic flat closure out of UCLA published earlier this year in the Annals of Surgical Oncology was a critical step forward to parity for flat closure. It established a solid baseline characterization of the patient experience going flat and factors contributing to satisfaction with aesthetic outcome, confirming NPOAS’ own research.
Clearly, according to the data we now have, there is a lot of room for improvement in the way the flat option is presented and executed. If 2-3 in 20 patients going flat are denied a flat closure and another 1-2 experience disregard or disrespect for their decision in consult, improving the situation is a challenge we can, and must, rise to.
Lead authors Dr. Deanna Attai & Dr. Jennifer Baker also wrote this important Author Reflections Commentary contextualizing their research. And Tracy Tyner’s thorough literature review , which was published just before the UCLA study, showed just how little data there is on this important issue, further illustrating the need for more investment in flat closure research.
Extensive News Coverage
In the months since the UCLA study’s publication, multiple media outlets picked up the story to discuss both the study itself and the larger issue of parity for this reconstructive choice. The paradigm shift in considering flat closure as a valid choice worthy of an aesthetic approach is picking up steam! Read:
Fact: This Affects a Lot of Women.
The number of women affected by the current suboptimal standard of care for aesthetic flat closure is significant. Around 70,000 women going flat every year, not including those who explant their initial reconstruction. A 2014 analysis of data from 1998-2007 found that over that time period, 44% of women in the US who have a mastectomy go flat. That figure includes both those who chose to go flat and those who were not candidates for reconstruction and decreased from 54% in 1998 (when the Women’s Health and Cancer Rights Act was enacted) to 37% in 2007. Unfortunately, we are not aware of any similar analysis using more recent data. Note that the above figures don’t include the significant minority (perhaps 5-15% or even higher) of women who initially reconstructed with implants that ended up removing them for one reason or another and going flat.
The Goal: An Improved Standard of Care
The UCLA study confirmed that three in four patients going flat are satisfied with their aesthetic flat closure. This figure can be improved upon by improving the standard of care for this population. According to Dr. Attai, this may involve:
- further research;
- better education for surgeons about the flat option and about the potential for partnering with a plastic surgeon for mastectomy with flat closure; and
- improved access to training in aesthetic flat closure technique for cancer surgeons.
“Our findings reveal a a need for additional research into factors that impact patient satisfaction as well as for surgeon education on how to optimally support women who are not interested in breast mound reconstruction. In addition, surgeons should be trained in techniques to perform an aesthetic flat closure, or partner with their plastic and reconstructive surgical colleagues so that they can provide optimal results for their patients.Dr. Deanna Attai
We couldn’t agree more! These steps are integral to our strategic plan at NPOAS. As we enter the new year, we look forward to further collaborations with researchers, and to continuing to provide support for patients and providers who are interested in aesthetic flat closure.
Our sincere thanks to the entire research team – Dr. Jennifer Baker (the principal investigator at UCLA), Dr. Deanna Attai (UCLA), Dr. Don Dizon (Lifespan Cancer Institute of RI), Cachet M. Wenziger, Elani Streja, Dr. Carlie K. Thompson, Dr. Minna K. Lee, and Dr. Maggie L. DiNome. And to all who contributed and participated in this important research!
To read more about the study’s findings or to request a copy of the article, visit Dr. Attai’s website.
2 thoughts on “Research is Making the Case for Aesthetic Flat Closure”
Thank you for highlighting this study and spreading awareness about going flat and aesthetic flat closure. As someone who inherited the BRCA1 genetic mutation I can tell you that making the decision to have a risk-reducing mastectomy was not an easy one. I am grateful for all of the information on the internet that helped me to make this difficult decision. I am appreciative of groups that are advocating for going flat. I feel fortunate to be alive during a time that this information is accessible. I chose to go flat in January 2021 and was fully supported in that choice by my surgeon who did a beautiful job with my aesthetic flat closure. I am pleased with the results, especially knowing that my cancer risk is so, so much lower now having had the surgery. Thank you for the work that you do! My wish is that all women have the ability to make whatever choice is right for them in regard to their breast surgery options and that they are able to work with doctors who support their decisions and are educated and non-judgmental about all choices.