New Flat Closure Study in Body Image Journal

A stellar new study on patients’ flat closure experiences by lead author Dr. Tracy Tyner has just been published in the prestigious journal Body Image!

This was a qualitative study, which means nothing was measured specifically, but rather interviews were conducted with patients who had gone flat and those interviews were analyzed for themes and contextualized within what we already know based on existing research. It’s a wonderful deep dive into the diversity of the patient experience, from flat denial to optimal aesthetic flat closure, and from the decision making process to post-operative adjustment to living flat.

Some highlights from the study include:

  • Aesthetic Flat Closure (AFC) should be offered as a valid surgical option for women undergoing mastectomy, on equal footing with breast reconstruction.
  • Patients need access to flat closure education and photo galleries prior to their surgeries, as well as psychological support after their surgeries (particularly peer support).
  • Suboptimal flat closures resulted in patient disempowerment and led to psychological distress and body image disturbances.
  • Body comfort/acceptance was variable from day to day and from individual to individual, but improved over time and with flat closure revision surgery for those with suboptimal outcomes.

The entire article is available free of charge at the Elsevier website until the beginning of October. Here’s the official abstract (summary):

This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women’s flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31–72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women’s decision-making and mirror-viewing experiences and assist women in adapting to their new body image.

Tyner et. al., 2023

We couldn’t be happier to read this excellent study, and we hope every surgeon working with mastectomy patients gets the chance to read it as well! It’s now archived on our Provider Resources page.

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.

3 thoughts on “New Flat Closure Study in Body Image Journal

  1. This is soooo . . . needed. Any support to include AFC as an option is vital. I will be giving this information to the breast cancer board at the Audie Murphy Veterans Hospital in San Antonio, Texas.

  2. Agree that it is the best option. I am so comfortable with my decision. Love the way I look and feel. My husband does as well. Very romantic

  3. I never seriously considered anything other than flat closure. My age at the time was one important factor – I just didn’t want the higher risk of needing further surgeries at an even older age. My doctors agreed and did a fairly good job on the first surgery. I did have a revision surgery afterward that cleaned up some of the excess fat/skin that was due to my larger size. Overall, I am quite pleased with the result. I just could not accept a lesser surgery that would have left me with more worries of a recurrence. I don’t wear prosthetics and no one seems to notice.

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