Drs. Angelena Crown and Claire Buchanan of Swedish Hospital in Seattle, WA, wrote a great, groundbreaking editorial on presenting aesthetic flat closure as an equal option to mastectomy with reconstruction! Including technical considerations to optimize cosmesis (aesthetics).
“They say you will always learn more from your patients than you ever will from a textbook or a former teaching attending. Several years ago, a patient in her early 40’s remarked during one of our annual follow ups, that she felt that I had not given as much weight to the option of “not having reconstruction” compared to proceeding with reconstruction. To be honest, that was true. The term “oncoplasty” was in vogue at the time, signaling the field’s reinvigorated commitment to optimizing aesthetic outcomes associated with oncologic resections. Our patient handouts contained nuanced discussions about advanced reconstructive options and highly stylized figures of optimal outcomes with skin and nipple preservation. Simultaneously, emerging studies detailed disparities in access to reconstruction and new guidelines required that patients undergoing mastectomy be offered a referral to a board certified plastic surgeon to discuss reconstruction… This climate provided additional impetus for encouraging reconstruction. I realized that I did not know how to present mastectomy without reconstruction as an equal choice to having reconstruction.”Drs. Crown & Buchanan