Frequently Asked Questions

FAQ for Patients


I’ve just been diagnosed and I want to learn more about what it’s like to live flat. Where do I start?

If you are able, we recommend joining a Facebook support group so you can ask specific questions to a group of women who have been through breast cancer diagnosis and surgery, and can offer personalized support. Some options are Fierce Flat Forward, Breastless & Beautiful, Fabulously Flat, and Flat & Fabulous. You can also watch the Flat is Beautiful video, and read all about going flat on our Going Flat at Mastectomy page, and you can find more resources from there.

What if I want to go flat, but my surgeon wants to do “skin sparing”?

Tell your surgeon you want an “aesthetic flat closure” as defined by the National Cancer Institute – and make sure it’s recorded in your medical record. A skin sparing procedure can be the best option for a patient who is undecided about reconstruction. However, if you’ve decided to go flat, skin sparing is not the right procedure for YOU. (Learn more.)

My initial surgical result is not flat. Why?

When you have clearly communicated your affirmative choice to go flat, the quality of your initial surgical result is largely determined by three things: your specific anatomy, your medical situation and history, and the level of skill and regard on the part of your closure surgeon. (Learn more.)

What is a “flat closure?”

Flat closure (or “aesthetic flat closure“) is reconstruction of a smooth chest wall contour post-mastectomy. It involves careful removal of any excess tissue remaining after excision of the glandular tissue, and can also involve contouring of the remaining tissues. The National Cancer Institute recently added aesthetic flat closure to their Dictionary of Cancer Terms. (Learn more.)

I am large breasted and/or larger bodied. Can I still get an aesthetic flat closure at my first surgery?

The more excess tissue you have in the breast area, the more time and specialized surgical skill is required to achieve an optimal aesthetic result. While there is no guarantee you won’t need a revision, it is absolutely possible and reasonable to ask that your breast surgeon either do this contouring work themselves OR bring on a plastic surgeon to do it, at the initial surgery. Note that plastics closure is not standard practice right now – but we hope that will change as more patients push for better aesthetic consideration.

Do I need a plastic surgeon for flat closure?

The short answer is maybe. Aesthetic flat closure can be done by many, but not all, surgical oncologists without the assistance of a plastic surgeon. Your surgeon’s specific training and skill set, their attitude about whether the flat choice is “deserving” of an aesthetic approach, your body, your medical situation, and other factors will affect your aesthetic outcome. That’s why it’s critical to ask specific questions about HOW they will get an optimal flat contour for YOU – where they’ll plan the incisions, how they will mark you up before surgery, etc. If you sense hesitation or pushback, or if they seem unsure about what you’re asking for or how they’ll do it… ask if they’ll consider bringing on a plastic surgeon!

My cancer surgeon doesn’t have any pictures of flat closures they’ve performed. Should I be concerned?

Patients are only now beginning to ask for flat closure photos in consult. While many plastic surgeons do have such photos in their portfolio, surgical oncologists (who do the vast majority of mastectomies) may not have any such photos at all. This doesn’t necessarily mean they can’t give you a great aesthetic flat closure – but it does mean you’ll want to be very specific in your discussions with them about HOW they will achieve an optimal flat contour for you. Make sure to bring photos of what you expect AND what you want to avoid, to your consult. Learn more.

After aesthetic flat closure, can a patient still get reconstruction if they change their mind?

Yes, absolutely, unless medically contraindicated for some reason. For implant-based reconstruction, the skin would have to be stretched with tissue expanders first to accommodate the extra volume of an implant, and fat grafting might be called for to produce a more pleasing contour. This is a multi-stage process that can take several months. Autologous  (“flap”) reconstruction doesn’t require this “pre-stretching” with a tissue expander since the tissues are harvested from elsewhere on the patient’s body. Regardless of the reconstructive technique that’s ultimately used, delaying reconstruction until later generally also increases the amount of permanent scarring; reconstruction that’s at least started at the same time as the mastectomy (“immediate” reconstruction) usually leads to less scarring. Note: there may be other considerations in your specific case, so ask your surgeon what you can expect.

Is aesthetic flat closure a reconstruction?

Yes. Aesthetic flat closure is reconstruction of the chest wall contour. Breast mound reconstruction restores the shape of the breast(s), while aesthetic flat closure restores the shape of the chest wall – both types of reconstruction correct the “defect” caused by the removal of the breast tissue.

What is a “Goldilocks” procedure and how is it different from aesthetic flat closure?

After the mastectomy removes the breast glandular tissue, there will be varying amounts of extra skin and fat surrounding that location. This tissue can either be completely removed, or it can be rearranged (moved around). The end result will depend on the volume of tissue the surgeon has to work with. In a Goldilocks procedure, your surgeon will try to save the maximal amount of skin/fat to rearrange, with the goal of producing the largest possible breast mound. In an aesthetic flat closure, typically the focus is on producing a smooth, flat contour and any tissue rearrangement has the goal of minimizing concavity.

What is “flat denial?”

Flat denial is when a surgeon’s unilateral actions deny their patient the agreed upon flat mastectomy result – either through negligence or intentional disregard. The patient is left with an egregiously poor cosmetic result with significant excess tissue that can only be remedied with additional surgery. Flat denial is a violation of the patient’s bodily autonomy. (Learn more.)

I think I’m a victim of flat denial. What should I do?

You’re not alone, and this is not your fault. You can read about flat denial and how to navigate the aftermath on our help for victims page, and you can join the Facebook support group I Wanted to Be FLAT to get support from a community of women who have been through flat denial. You can also contact NPOAS directly at info@notputtingonashirt.org.

How do I find a flat friendly surgeon?

You can search for a local flat closure surgeon using our Flat Friendly Surgeons Directory.

There are no Directory surgeons in my area. What do I do next?

If you are not able to find a suitable flat closure surgeon using our Directory, you have options. You can search for an integrated breast center or a hospital with an oncoplastic breast surgery program. You can also search for dual specialty (breast surgical oncology and plastics) surgeons or surgeons who specialize in gender confirmation surgery. Learn more.

If you have few or no options available to you, you will want to vet your surgeon carefully. We recommend printing out one of our publications to use for this purpose. For a general surgeon who has no experience with flat closure at all, we recommend this handout. And please contact us if you need assistance – we are here to help!

My breast implants are making me sick and I want them out and to just go flat. Where do I start?

We recommend joining the Facebook support group Fierce Flat Forward so you can ask specific questions to a group of women who have been through explant surgery and can offer personalized support and direct you to additional resources. You can visit BreastCancer.org, the Healing Breast Implant Illness and Breast Implant Illness websites to learn more about breast implant illness as well (Note: NPOAS is not affiliated with HBII or BII). You can also visit our webpage for explant resources and details about going flat after explant.

How do I recommend my surgeon?

You can recommend your flat closure surgeon by using our easy online form or by contacting us by email to info@notputtingonashirt.org.

How can I share my own mastectomy story with NPOAS?

You can now share your story with NPOAS by using our easy online form.

How do I get some of your brochures?

You can download the printable PDFs of all of our publications, or order brochures mailed, at our Publications Page.

I was told that I would have posture problems if I don’t wear prosthetics. Is this true?

Nope. This myth probably originates from the (correct) observation that some women develop a hunch after their mastectomy. Posture and other related functional problems flow from the amputation itself (and other treatments such as radiation). They generally aren’t related to whether you have reconstruction or not. Flat closure does not cause functional impairment beyond that of the mastectomy itself.

I don’t see my question here.

We are here to help! Please ask your question directly by emailing us at info@notputtingonashirt.org or by using our contact form.


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Not Putting on a Shirt
P.O. Box #111215
Pittsburgh, PA 15215
USA

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