It is always important to discuss your surgical plan and expectations with your breast surgeon before having a mastectomy. Mastectomies can create chest irregularities or leave excess tissue over the side of the chest known as “dog ears.” Some people may find these post-operative results unsightly or bothersome. When going flat, most of the overlying breast skin and nipple are removed, ideally leaving a uniform, truly flat contour. Results can vary widely depending on a person’s body shape as well as the experience and mindset of your surgeon.
Aesthetic flat closure is a breast cancer surgery done by specialists who have an extra focus on mastectomy techniques. As community innovators, Drs. Henderson and Kollmorgen have been trained in oncoplastic procedures not just for preserving the shape of the breast during lumpectomy and hiding scars during reconstruction but also for patients choosing to go flat after mastectomy. 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 chest area are removed. The remaining tissue is then tightened and smoothed out so the chest wall looks as flat as possible. To accomplish this goal we use a number of techniques: V-Y plasty, tear drop incisions, waisted tear drop incisions, L-shape incisions or the Goldilocks approach.
Every chest is different so closures are all unique. Balancing your needs and expectations is an import part of your healing and treatment. For those choosing to embark on a flat chest journey here are a few online resources to explore.
In her memoir, FLAT: Reclaiming My Body After Breast Cancer, journalist Catherine Guthrie talks about how she encountered numerous stories of women who had initially wanted a flat closure.
A recent study found that most women were satisfied with their flat closure results. However, 34% of women reported not receiving adequate information about their surgical options, and 20% did not feel their decision to go flat was supported by their surgeon. Some women even experienced “flat denial” which is when a surgeon denies their patient an agreed-upon flat closure either through negligence or disregard. This type of medical course is something that we at Oregon Surgical Wellness are committed to avoiding. At Oregon Surgical Wellness you have a voice and a choice. We respect the many reasons our patients choose aesthetic flat closure:
shorter surgery
faster recovery
“one and done” surgery
lower risk surgical complications
avoiding a foreign body in their body
no need for muscle or other tissue transfer (flap surgery)
scars limited to the chest
breasts that were causing health problems
easier access to care due to limited plastic surgery coverage
As treatments for breast cancer continue to improve, we stay up to date by offering patients state of the art and innovative solutions. Some life saving treatments can still cause collateral damage. Lymphedema, a well known side effect of surgery and oncologic treatments to the breast and under arm, can be a source of discomfort. That is why we use modern techniques like reverse lymphatic mapping, careful surgical planning and sentinel lymph node biopsy to reduce the incidence of lymphedema. We also work closely with regional physical therapists and integrative oncologists who specialize in lymphedema treatment and prevention. This month we are pleased to announce our latest collaboration with Pacific Integrative Oncology. Our friends at PIO have been awarded a grant to help study lymphedema prevention. “The Feasibility of a Remote Lymphedema Prevention Program for Newly Diagnosed Breast Cancer Patients Undergoing Surgery” study aims to find out if a “change in knowledge” about lymphedema prevention will improve patient outcomes.
The project is funded through the OHSU Knight Cancer Institute Community Partnership Program. This program is designed to build sustainable collaborations with Oregon communities by providing grants and other resources to foster development of community-identified cancer prevention, early detection, treatment and survivorship projects. The OHSU Knight Cancer Institute has made a decade-long commitment to invest in this program to develop robust, sustainable programs that benefit the health of all Oregonians. Additional information about the program is available on the OHSU Knight Cancer Institute’s website. Our goal is to recruit 50 of our patients for this important study. If you are interested in this prevention course sign up at this link. It’s free!
