Frequently Asked Questions

Aesthetic flat closure (or “flat closure”) is reconstruction of a smooth chest wall contour post-mastectomy. Aesthetic flat closure involves careful removal of all redundant lateral tissue (to avoid “dog ears”), obliteration of the inframammary fold, and the production of smooth, symmetric incision closures (Karp et. al., 2022). The National Cancer Institute recently added aesthetic flat closure to its Dictionary of Cancer Terms.

Aesthetic flat closure refers specifically to the contouring work that is performed after removal of the breast tissue, whether at the initial surgery or at a later timepoint (i.e., revision or explant), to restore a smooth, flat chest wall contour. Patients who choose to go flat almost universally desire aesthetic flat closure. But until very recently, they have not had clear language with which to express this desire. The language deficit has also presented a problem for providers in managing patient’s expectations. The National Cancer Institute’s definition of aesthetic flat closure should resolve this issue.

You can visit the Provider Resources Page to learn more. This page is continuously updated with the latest news and information about aesthetic flat closure.

It’s a matter of informed consent. Unfortunately, in the past, a small number of providers have taken advantage of the murky language situation in order to impose their own preferences for breast mound reconstruction on their patients, directly against the patients consent. This is flat denial. Under certain circumstances, we also include egregiously poor aesthetic results resulting from lack of skill or care. You can read some of these patients’ experiences here.

Minor imperfections are normal and expected and do not constitute flat denial (which involves egregiously poor aesthetic results). We discuss contributing factors to the aesthetic outcome here. We discuss expectations and shared decision making here. We welcome your input on this issue – please do not hesitate to contact us!

Yes, but most patients going flat strongly prioritize being “one and done.” For this reason, if they do not feel they can provide the result the patient expects, some cancer surgeons may elect to bring on a plastic surgeon to perform an aesthetic flat closure after they perform the mastectomy/ies.

No. The IF is completely removed for an AFC along with all other excess tissue.

Yes. As a matter of ethics and historic policy, our medical Advisors review all of the information we provide.

You can apply to be listed on the Directory here. At this time we are requiring at least 1-2 photos of your AFC work *OR* a direct patient recommendation. You can also contact us directly online or by email to providers@notputtingonashirt.org.

Update your listing online or by email to providers@notputtingonashirt.org.

You can order brochures mailed at no charge, at our Publications Page.

There is no unique code for aesthetic flat closure at this time. We have found that most surgeons use codes 1430X (if tissue rearrangement is involved) or 1310X (if no tissue rearrangement is involved). More at NotPuttingonaShirt.org/Coding.

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