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Going Flat? Be Clear! "Aesthetic Flat Closure"

If you're going flat, be clear. Ask for an "aesthetic flat closure" as defined by the National Cancer Institute, to ensure your surgeon understands you want a smooth, flat chest. We don't have to deal with ambiguity anymore - clear language is key to protecting your choice. Spread the word, ladies!! #aestheticflatclosure

Comments

  • Hhsandy7
    Hhsandy7 Member Posts: 1
    edited July 2020

    Thank you!! Speaking with the PlasticSurgeon in half an hour

  • bowleskimberlyb
    bowleskimberlyb Member Posts: 10
    edited July 2020

    Great! Best of luck and I'd love to know what your plastic surgeons response is!

  • miriandra
    miriandra Member Posts: 1,972
    edited July 2020

    Nice! This also ensures that the doctor can't decide against your wishes to leave skin for reconstruction. There have been several arbitrations that I read about (after patients were forced to sign away their rights to sue) where the surgeon decided to leave skin for reconstruction "just in case", strictly against the woman's directives. This will make that dodge more difficult if one specific procedure - aesthetic flat closure - is requested, but another specific procedure - skin preserving - is carried out.

    How Sexism in Medicine is Hurting Breast Cancer Survivors - Cosmopolitan.com

  • bowleskimberlyb
    bowleskimberlyb Member Posts: 10
    edited July 2020

    Miriandra, I know this all too well. That's me in the Cosmo article holding the protest sign. These arbitrations - where can I find information on them? I know of two lawsuits that were filed, but hadn't heard the conslusion yet. Skin sparing vs aesthetic flat closure... that's exactly what it is - a bait and switch. I wrote about this exact angle last week at NotPuttingonaShirt.org/Blog/skinsparing

  • edj3
    edj3 Member Posts: 1,579
    edited July 2020

    I've got a question--I'm not faced with an MX right now but if my BC recurs, then I'll definitely want that. And I know now after having the LX that implants are not for me.

    But I do like my nipples (which sure sounds weird in a sentence)--do you know if the aesthetic flat closure precludes sparing the nipple if removal isn't indicated by the DX?

  • bowleskimberlyb
    bowleskimberlyb Member Posts: 10
    edited July 2020

    From from an aesthetic standpoint, aesthetic flat closure is "nipple neutral" At least the way it's defined currently. There may be medical reasons to excise the nipple though. Most women do have their nipples removed, but if that's something that's important to you (you're not alone, I actually know several women who feel the same way) you can absolutely discuss it with your surgeon. We actually have one of these women featured in our gallery at NotPuttingonaShirt.org/Gallery/#explant - She had her implants removed and kept her nipples, and got a nice smooth contour. :)

  • edj3
    edj3 Member Posts: 1,579
    edited July 2020

    Thank you--as I said, not facing this at the moment. But one good thing about starting with the LX--I so dislike the way my left breast looks, so artificially perky and swollen 14 months post-op, and after having read about how implants feel I know that's not at all for me. And yeah, nipples do sometimes have to go, I get that.

  • aussie-cat
    aussie-cat Member Posts: 5,496
    edited July 2020

    edj3, I think the underlying philosophy behind the aesthetic flat closure movement is that within medical guidelines, a woman should have the right to choose what her chest ends up looking like, including keeping her nipples if there's no medical reason not to. We should be informed of all our choices and get to make the best decision for ourselves.

  • cyathea
    cyathea Member Posts: 321
    edited July 2020

    Hi edj3, I asked to keep my nipples and have an aesthetically pleasing flat chest. My breast surgeon connected with a PS in my health system that had FTM Surgery experience. Although the PS had not done a nipple graft for my case (I didn’t want a “male” chest), he was able to give me very nice flat results with nipple grafts that were larger than a typical FTM nipple graft and where the placement of the nipples was more female than male.

    I hope you don’t need the BMX, but if you do, here are my suggestions about doing nipple grafts as part of your flat closure:

    - Make sure to discuss the size and shape of the areola. FTM areolas are usually a perfect circle. This makes it easier to place the graft. I requested my original size and shape, which was relatively small and more elliptical than circular. So, one side has a perfect placement where the longest part of the ellipse is horizontal, but the other side is just slightly “off” horizontal. Thus, getting exact symmetry might be very tough if you keep your original shape. That said, our bodies are rarely perfectly symmetrical before surgery, so I’m still pleased with my results

    - It is very difficult to discuss placement of the nipple grafts when you still have your breasts. I could not visualize what I would look like or where my nipples should be. My PS noted that when they do the FTM transition surgery they place the grafts further apart than mine are. Mine were placed in the symmetrical centers of each side, but if I could have it done again, I would ask him to place them just a little closer together, i.e. closer to the center of my breast bone than they are now.

    - Ask for the smallest incision possible. If they have to cut under your arms to remove lymph nodes, plan on a longer recovery to heal the cut nerves that go down your inner arms. The surgeon can’t see these nerves so she can’t avoid them. (The burning pain is brutal at first, but it gets better with time.)

    - Ask the PS to use liposuction to remove any “dog ears” of fatty tissue near your armpits. I got very nice results but I’m hoping for an even better look after my swelling is reduced and I lose a few pounds.

  • edj3
    edj3 Member Posts: 1,579
    edited July 2020

    Thank you so much--I'll keep this thread in my favorites and hope that I never need it. But if I do, your generosity in sharing has just been wonderful.

  • debjenx2
    debjenx2 Member Posts: 3
    edited July 2020

    Thank you for the correct words it made the conversation so much easier! We have agreed on to do the aesthetically flat no nipple on the right side and remove the reconstruction i did in 2006 on the left. I was advised there could be some extra scars due to the previous lift on the right and reconstruction but as I've been living with them 14 yrs it's part of me.

  • mheibel
    mheibel Member Posts: 19
    edited August 2020

    Thanks for sharing this information! I had a bilateral mastectomy on June 25th and was originally going to do reconstruction, but I'm now I am recovering from a staph infection that I got from the PS's office after they were "cleaning up" my left side that wasn't healing correctly. I had my left expander explanted a week ago and will have the right explanted on Tuesday and have decided not to have reconstruction.

    I've had a difficult time with my expanders and are not sad to see them go. I could have done without the infection. I'm a little mad, because if I would have decided no reconstruction from the get go, I would be almost through the healing process, but now I'm facing another surgery.

    Can anyone recommend some good bras? I'm very active and go swimming a lot too. Thanks.


  • bowleskimberlyb
    bowleskimberlyb Member Posts: 10
    edited August 2020

    Hindsight is always 20/20, isn't it? Full information is a gift that allows us to make choices that minimize our chance of having these feelings of regret later - that's why it's so important. Bras - most flat women I know don't wear bras, unless they're wearing prosthetics. Busted Tank is one of my favorites for soft material and fit. AnaOno also has a wide selection of post-mastecomy lingerie. Best of luck to you! - Kim

  • WordGirl1968
    WordGirl1968 Member Posts: 29
    edited September 2020

    Hi everyone— I’m scheduled for bilateral mastectomy on Oct 5th...that’s soon! I’m 100% committed to aesthetic flat closure but I’m not completely confident that my surgeon has enough experience in the details of this procedure. I’ve asked for a consultation this coming week to explicitly explain that I’m seeking the NCI’s definition of a smooth flat chest. If he’s not willing to take time to discuss this, I’ll find another surgeon.

    Any suggestions in navigating this conversation? He’s considered a very skilled surgeon but perhaps his communication skills are not the tops, plus his scheduling assistant is very difficult and dismissive. It’s a huge deal, as you all know, so if I cant get his ear this week, I should walk, right?

    Thanks for your help.

  • bowleskimberlyb
    bowleskimberlyb Member Posts: 10
    edited September 2020

    WordGirl, yes definitely speak with the surgeon and don't be afraid to ask questions to make sure he understands exactly what you want. While it's not good that his scheduling assistant is rude, 1) the surgeon himself could be great, and 2) he will most likely want to know that his assistant is treating patients like that so he can correct the situation. If you get into the consult with him, and you get push back about going flat, or just get a bad gut feeling, yes, get another surgeon. This is your body and your decision. You got this!!!!

  • minustwo
    minustwo Member Posts: 12,994
    edited September 2020

    I would definitely look at having a plastic surgeon do the closing.

    BTW - I didn't choose flat. But why should people with recon have the surgeon hand over to a plastic surgeon to do the finish up & closing, and not those of you who choose to go flat.

  • bowleskimberlyb
    bowleskimberlyb Member Posts: 10
    edited September 2020

    Exactly, MinusTwo!!!!! 🎯

  • WordGirl1968
    WordGirl1968 Member Posts: 29
    edited September 2020

    Thank you for the support on this. I'm hoping for a response from the surgeon's office tomorrow (Tues). My surgery is scheduled for a week from today but I still have so many unanswered questions specifically regarding the closure. I do agree that this type of closure may merit consultation from a plastic surgeon. If I opt for that, they'll likely have to delay the surgery in order to coordinate. Someone mentioned on this thread or another, that it may be worth consulting with a surgeon who has performed gender reassignment surgery, female to male, since that's the result I'm seeking.

  • alijohnes
    alijohnes Member Posts: 1
    edited April 2021

    hi! I’m new to this site and have my mastectomy next Wed. I also just lost my partner - he died in a surfing accident - so feeling overwhelmed re decisions re surgery. I couldn’t find any pictures or anyone who chose to go flat and keep their nipples. Would you be open to chatting this weekend? If not, no worries but I would super appreciate! Warmest, Al

  • bowleskimberlyb
    bowleskimberlyb Member Posts: 10
    edited April 2021

    Hi Al,

    So sorry you're dealing with surgery, especially so soon after your family's tragedy. For the type of pictures you're seeking, I recommend joining a Facebook support group for flat women & women considering going flat. A couple good ones are Fabulously Flat: Unreconstructed Breast Cancer Survivors and Fierce, Flat, Forward. I know a couple members in those groups who kept their nipples - it's not a common thing but it's not unheard of either & it's a valid choice! Although, you probably won't retain sensation in them. Sending hugs!

  • bowleskimberlyb
    bowleskimberlyb Member Posts: 10
    edited April 2021

    How did your sugery go?

  • moderators
    moderators Posts: 7,679
    edited April 2021

    Hi alijohnes, We are thinking of you, especially after such a horrible tragedy to have to manage this. Here is a section on a nipple-sparing mastectomy. This will help you learn if you are a candidate for it. Also, Mastectomy: What to Expect.

    We're here for you. We'll be thinking of you Wednesday, and here if you have questions.


    Medicating


  • Rubytoos
    Rubytoos Member Posts: 44
    edited May 2021

    I am looking for recommendations for a plastic surgeon who will do aesthetic flat closure. My breast surgeon is affiliated with Duke University, so am seeking someone in that area. With my initial diagnosis 4 years ago I did meet a plastic surgeon she referred me to, but the PS was all about reconstruction and would not even consider what I was asking for. I opted for breast conserving surgery at that time, but now, with a recurrence at the lumpectomy site, I want a mastectomy. So if anyone had a good experience with a PS in the Research Triangle Area/Durham/Raleigh, would appreciate any information. They want to schedule me for surgery in a couple weeks and things are moving fast. And if this is not appropriate, to ask for this type of referral, I apologize in advance.

  • bowleskimberlyb
    bowleskimberlyb Member Posts: 10
    edited May 2021

    It might be tough to secure a plastic surgeon for surgery that soon, but I would call Duke's gender affirmation clinic to see who they would recommend. I do curate a flat friendly surgeon's directory at mine non-profit, but we don't have anyone listed that meets your criteria. If I were in your shoes I would start here:

    https://www.dukehealth.org/treatments/adult-gender...

    Best of luck to you!!

    Kim




  • mightlybird01
    mightlybird01 Member Posts: 161
    edited May 2021

    I had my mastectomy at a University hospital and the breast surgeon who did the mastectomy also made my flat closure. It looks and feels amazing. You may not need a plastic surgeon at all. I did not have one and I could not be happier with the outcome.


    Well, I guess I should add that I had small breasts, so that makes live easier for the surgeons I suppose.

  • lw422
    lw422 Member Posts: 1,375
    edited May 2021

    I'm glad to find this thread. I had my first meeting with my surgical oncologist yesterday and I made it clear that my desire (single mastectomy) is to have the aesthetic flat closure. NO reconstruction, NO skin sparing, NO "dog ears" to have revisions, NO NUTHIN' but the best looking smooth scar I can get. She immediately stated that a plastic surgeon will be called in to do the surgical closure, so YAY. My surgery isn't until August, so I expect I'll have another appointment with the SO and the plastic surgeon in advance, and I'll have plenty of questions for them.

  • Rubytoos
    Rubytoos Member Posts: 44
    edited May 2021

    Thank you Kim. Brilliant idea.

  • Rubytoos
    Rubytoos Member Posts: 44
    edited May 2021

    Also a good idea. I am not especially busty. My surgeon did learn suturing techniques from a PS so I may not need anyone else. I will definitely explore!