Resources for Providers

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Our Commitment to Evidence-Based Medicine

From our inception, Not Putting on a Shirt has been committed to ensuring that all of the information that we provide is medically sound and consistent with the existing body of scientific evidence.

In the case of patient satisfaction with flat closure, there is a distinct lack of data. That’s why we’ve conducted our own pilot studies and are actively promoting larger-scale research with validated tools. We presented a poster with the combined results of our two pilot surveys this past December at SABCS 2019. Read our report from the first pilot, take a look at the UCLA flat closure study, or view our SABCS poster.


Resources

You may find the following to be useful. Please let us know what we’re missing, too – we want to support providers as much as we want to support patients!


Informational Videos

Our esteemed advisors, Drs. Tiwari and Kocak at Midwest Breast & Aesthetic Surgery in Gahanna, Ohio, have put together a series of informational videos on technical subtopics concerning aesthetic flat closure – both explanting to flat and going flat at initial mastectomy. Take a look below. For more videos, check out MWB’s YouTube channel!

What is a flat closure after mastectomy?
Do you consider a flat closure to be a reconstruction?
Should a plastic surgeon always be involved with a flat closure?
What are the 3 reconstruction options after mastectomy?
How to address shape and form vs. scar
Can large breasted patients expect to have a good flat closure?
How to address concavity after a flat closure?
Is fat grafting possible to address concavity after a flat closure?
Muscle repair after explant
Why is it important to take out the entire capsule?

Articles about Aesthetic Flat Closure

Technical Considerations
Patient-Reported Outcomes and Decision Making

Statistics on Aesthetic Flat Closure

Patients going flat have unique values and priorities.

Multiple studies have confirmed that the population of patients who choose to go flat from the outset has distinctly different values and priorities that lead them to this path, vs. the population who chooses breast mound reconstruction (BMR).

Patients who choose FLAT

About 45% of patients.

  • want to avoid additional surgery
  • do not consider a breasted appearance to be important
  • worry about health impact of implants
  • tend to be older (over age 60, 4/5 choose flat)

Patients who choose BMR

About 55% of patients.

  • accept the possibility of additional surgery
  • want to maintain a breasted appearance to “feel whole”
  • do not want to use prosthetics
  • tend to be younger
Patients expect aesthetic flat closure.

According to our research, patient factors associated with egregiously poor expectation match are age older than 55 years and higher than “normal” BMI. Surprisingly, in our data set, larger breast cup size was NOT associated with poorer expectation match. (Note: further studies are needed to confirm and determine the specific nature of these correlations.)

Fig. 1 Expectation match by age group (red = poor, green = excellent)
Fig. 2 Expectation match by BMI category (red = poor, green = excellent)

There is room for improvement in patient satisfaction with their aesthetic outcome.

44%

Of all mastectomy patients choose to go flat.

BreastCancer.org

75%

Three of every four patients going flat are satisfied with their aesthetic outcome.

NPOAS Survey 2018

1 in 20

About 1 in 20 patients going flat – that’s a 5% risk for each woman who chooses flat closure – are subjected to INTENTIONAL flat denial at the hands of an unethical provider.

NPOAS Surveys 2018-19


Coding & Reimbursement

Coding for aesthetic flat closure, whether at the initial surgery or at revision, depends on whether tissue rearrangement is involved. If yes, the CPT code is 1430X. If not, the CPT code 1310X. Other CPT codes have been used but are likely to be denied by insurance, at least initially, and especially without additional documentation. Fat grafting may also be a component of aesthetic flat closure, but not at the initial surgery (more here).


Oncoplastic Training


A Note on Language

“Flat Closure” and “Aesthetic Flat Closure”

“Flat closure” is the term we are using to describe the reconstruction of the chest wall contour without breast mounds after mastectomy. This procedure falls squarely under the reconstructive (not cosmetic) category of surgery as it restores a normal anatomic contour – the chest wall. Recently the National Cancer Institute added “aesthetic flat closure” to their Dictionary of Cancer Terms, defining it as:

“A type of surgery that is done to rebuild the shape of the chest wall after one or both breasts are removed. An aesthetic flat closure may also be done after removal of a breast implant that was used to restore breast shape. During an aesthetic flat closure, extra skin, fat, and other tissue in the breast area are removed. The remaining tissue is then tightened and smoothed out so that the chest wall appears flat.

For a more in-depth discussion about terms of art, visit the blog.

Tell us what you think about the language issue!


Questions?

You can use the form below to inquire about having your listing added to our Flat Friendly Surgeons Directory, to tell us what you’re thinking about, to learn how to support our work, or to find out how to get involved. You can also email us directly at providers@notputtingonashirt.org

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FAIR USE STATEMENT

This site contains copyrighted material. Not Putting on a Shirt’s educational materials and resources on this site are freely available for “fair use” (Title 17 U.S.C. Section 107) in accordance with our mission to advocate for optimal outcomes for those who choose to go flat after mastectomy.  The copyrighted material on this site is distributed for educational purposes without profit – all donations to Not Putting on a Shirt directly fund our advocacy work. If you wish to use copyrighted material from this site for purposes that go beyond “fair use”, you must first obtain explicit permission from the copyright owner. Please direct requests or questions to info@notputtingonashirt.org.