Topic: Esthetic flat closure question

Forum: Breast Reconstruction — Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Jul 23, 2022 01:01PM - edited Jul 23, 2022 01:03PM by 2ally2

Posted on: Jul 23, 2022 01:01PM - edited Jul 23, 2022 01:03PM by 2ally2

2ally2 wrote:

Hello,

Had a mastectomy with reconstruction about 4 years ago. On the side that had radiation, I have a grade 4 contracture. I have decided to go for an esthetic flat surgery but am looking for some folks to help me out with some questions.

What was your outcome? Did you have one or two scars?

What was your range of movement after recovery?

I heard an interview where someone said something about two scars are better for range of movement but didn't find any info that mentions this. My surgeon told me that if I want two scars it may not be as smooth and could have puckering. I emailed him back to clarify puckering. Any insight from folks that have had this procedure would be great. Thank you!

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Aug 2, 2022 05:31PM ailenroc wrote:

Hello Ally,

Sorry no one has responded yet. I just started looking at 'going flat' after implant rupture but decided against it after a bit of research and talking to my surgeon who did the recon in 2008. I am sharing my notes to self below; your situation is different given the contracture post radiation, but perhaps you find something useful. The link to the website has much info. Best wishes for you.

Going Flat Info:

https://notputtingonashirt.org/directory/

8/2/22: not an option for me: I did not know that I would have 2 concave holes in my chest wall due to having had expanders and implants! PS says that most of the 500 cc's of my implants are inside the chest. The 500 cc’s were the size of my naturals; no augmentation. I was always 36C.

Heads Up: Potential Anatomic Changes From Implants

Pectoral muscles.Most breast implants are placed under the pectoral muscle. This involves some separation (cutting off of the chest wall) of part of this muscle. Ask your surgeon whether your implants are under or over the muscle, and how they approach potential muscle repair during explant. Muscle repair is an aspect of explant that seems to be largely a matter of surgeon preference based on their own clinical experience.

Physical therapy can drastically improve your muscular function after mastectomy or explant. Ask your surgeon or your PCP for a referral. The Lymphedema Association of North America certified physical therapists (find a PT here) are trained in mastectomy massage for breaking up scar tissue as well as general rehabilitation post-mastectomy.

Rib cage.The forces produced by tissue expanders and implants between the pectoral muscle and the rib cage, can cause rib cage deformation – this means that there may be an indentation (concavity) left where the implant was removed. This is usually purely a cosmetic issue that may improve with time.

Be very specificin your discussion so there is no room for miscommunication:

Have they performed aesthetic flat closuresfor previous patients? Ask to see photos of their work (note: plastic surgeons should have these readily available; general and breast surgeons may not)

Will your surgeon(s) be able to complete the job in one surgery, or is it likely that you will face additional surgery?

How will your surgeon(s) address any special challenges in your case – for example, very large breasts or obesity?

Should you expect concavity, and how will this be addressed?

How will they avoid "dog ears"? How far will the incisions extend on the lateral chest in order to achieve a flat contour?

A single incision may be insufficient to create a flat contour. What type of incision will your surgeon use, and why?

How will they account for gravity? Will they mark you up in a sitting position either before or during the surgery?

aesthetic flat closure ?

recommendations?

Recovery time? drains needed?

Pro Flat

Flat Cons

Implant Pros

Implant Cons

Done once and for all?

No need for revisions?

Various risks mentioned above;

Possibly easiest solution right now

Determine whether new implant is even possible

Removal of silicon: potential relief from autoimmune issues

much research nec;

May allow to do one side only right now

Further complications associated with implants

Feeling lighter?

Aesthetics / concavity / chestwall deformity / repeat repair necessary?

Psychological adjustment to new body image

Irreversible

Need entire new wardrobe

May not be covered by insurance?

Aesthetic flat closurewas only defined as reconstructivein mid-2020 and institutions have yet to catch up. Your surgeon's office should know how to code for the procedure correctly and be equipped and willing to do the legwork required, including appealing denials.

Oncotype score: 1; BRCA neg; bilat bc & bilat mx w recon; Dx 5/30/2008, IDC, <1cm, Stage IB, Grade 1, 0/5 nodes, ER+/PR+, HER2-
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Aug 4, 2022 08:45AM blinx wrote:

Hi Ally -- I'm only a month out from my aesthetic flat closure from my BMX. I have 2 scars with about a 1 inch space in the middle. It's still pretty bumpy, especially on the sides where lymph nodes were removed. I had said to my surgeon that I had wanted to be "one and done", but she cautioned me that many of these surgeries would need touch up surgery somewhere down the line. I'm also going to undergo radiation which will further change things. I did a web search for "mastectomy scars" and found a page that had before/after photos of revision surgeries. It's amazing what a small amount of "clean up" surgery can do, along with waiting many months for the scars to fully heal.

Dx July 2007 DCIS Grade 3 (at age 46); Lumpectomy Sept 2007. ER+/PR-; Finished 33 rad tx Jan 2008. 3.5 years of Tamoxifen then quit.. Chemotherapy 3/1/2022 Other Dx DCIS, Right, <1, Stage 0, ER+ Dx IDC, Both breasts, 6cm+, Stage IIIC, Grade 3, ER-/PR-, HER2+, ISH
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Aug 4, 2022 07:52PM - edited Aug 4, 2022 07:52PM by janiehs

Hi 2Ally2 - I am almost 2 years out from my BMX - flat closure. I have full range of motion with both arms (lymph nodes taken just on left side) which I attribute at least to some extent to swimming which I try to do most days during the short summer we have here in the Pacific Northwest. I have one scar on each side that runs from my armpit to the middle of my chest. They are actually becoming less and less visible as time goes on. Altho I am not a big fan of FB, I do follow a group on there called “Fabulously Flat (Unreconstructed Breast Cancer Survivors)" which sometimes has good tips and also allows you to see what a lot of women look like post BMX (I am not up for posting a picture of my chest but an amazing number of women do). I do have to say that after seeing some of the pics, I am immensely grateful to my surgeons for the job they did! Best of luck. Janie.

Surgery 2/11/2020 Mastectomy; Mastectomy (Left); Mastectomy (Right)
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Aug 5, 2022 07:49AM proudmom_wife wrote:

Hi Ally,

I explanted (deconstructed) with an Aesthetic Flat Closure a little over 4 months ago after reconstructing 11+yrs ago. My saline implants were placed under my pectoral muscles, which my surgeon repairs as part of the surgery.

Now that I am flat I have better range of motion. My lymphedema (which will never go away) actually improved slightly, probably because the pressure from the implants on my lymph system is no more. Everyone's lymph system is different, so maybe I just got lucky.

I can sleep on my stomach now, sleep through the entire night without waking up to readjust because of implant discomfort. I am doing exercises, Yoga, Pilates, lifting weights, etc... now without the restricted feeling and discomfort I had before. Definitely able to do more already.

I have two scars basically straight across my chess and going a little around my sides with a small gap between them in the center of my chest. With the exception of about 1/2 inch on either side of the scars I have full feeling/sensation now. A more natural feeling.

No regrets at all. I am so happy I did this surgery. Wish this was an option before.
Dx 10/1/2010, IDC, Left, 1cm, Stage IIA, Grade 2, 2/4 nodes, ER+/PR+, HER2- Surgery 11/17/2010 Mastectomy; Mastectomy (Left); Prophylactic mastectomy; Prophylactic mastectomy (Right); Reconstruction (Left): Tissue Expander; Reconstruction (Right): Tissue Expander Chemotherapy 1/5/2011 AC + T (Taxol) Surgery 4/25/2011 Reconstruction (Left): Tissue Expander; Reconstruction (Right): Tissue Expander Radiation Therapy 5/16/2011 Hormonal Therapy 7/1/2011 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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