Clear Language: “Aesthetic” vs. “Cosmetic”

Not Putting on a Shirt Logotype with mission Patients and providers for optimal flat closure

Aesthetic Surgery = any surgery done with special attention to the external appearance.

Cosmetic Surgery = elective aesthetic surgery to enhance a normal anatomic contour.

Reconstructive Surgery = aesthetic surgery which restores a normal anatomic contour.

“Aesthetic surgery” includes both reconstructive (restorative) surgery and cosmetic (enhancing) procedures. The term “aesthetic” simply refers to a surgery that is done with care and attention to external appearance. Both reconstructive and cosmetic surgeries entail an aesthetic surgical approach.

One of the most important distinctions for patients is that health insurance covers reconstructive surgery, but usually does not cover cosmetic surgery, as the latter is considered “elective” (i.e., not necessary). Clear language matters!

aesthetic flat closure before and after illustration
Aesthetic flat closure before and after.

The NCI term, “aesthetic flat closure,” (AFC) is critically important in large part because it specifies an aesthetic surgical approach. Too often, when a patient chooses to go flat, they are left with a result that is clearly not aesthetically pleasing. This is in addition to being physically uncomfortable, especially when large dog ears remain under the arms. And this can happen even when the patient has specifically requested a smooth, flat chest wall contour.

That’s because AFC can require additional surgical work beyond the removal of the breast tissue. For a patient to receive a satisfactory AFC, their surgeon must:

  • understand that this is what the patient expects,
  • agree to perform the additional work, AND
  • have the technical skillset required (or bring on another surgeon who does have the skillset)

When patients use the term “aesthetic flat closure” to tell their surgeon what they want, the first requirement is satisfied. That is why widespread adoption of the term is foundational to ensuring parity for flat closure! Patients must be sure that their surgeon is willing to give them an aesthetic flat closure AND has the skillset to do so… that’s why it’s critical to ask your surgeon specifics about HOW they will achieve an optimal contour for you.

A note about “reconstructive surgery”: this category includes, among others, breast reconstruction and chest wall reconstruction. Both procedures restore a normal anatomic contour (body part shape, i.e. breast and chest wall) and are therefore reconstructive (i.e., restorative) and should be covered by insurance under the federal WHCRA legislation.

flat closure is reconstructive flow diagram breast cancer mastectomy reconstruction choices Not Putting on a Shirt

Were you aware of the term “aesthetic flat closure” before your mastectomy?

How did you learn about it? Was your surgeon familiar? And did you get the surgical outcome you expected? We’d like to hear from you! (Get in touch)




Published by Not Putting on a Shirt

Founder of Not Putting on a Shirt, a mastectomy patients' rights organization that advocates for optimal surgical outcomes for patients going flat.

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