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Topic: Going Flat? Be Clear! "Aesthetic Flat Closure"

Forum: Living Without Reconstruction After a Mastectomy — Discuss prostheses, swimsuits, bras, and other options for women not having reconstruction or waiting for reconstruction.

Posted on: Jul 4, 2020 01:15PM

bowleskimberlyb wrote:

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

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Jul 6, 2020 06:57AM - edited Jul 6, 2020 06:59AM by Hhsandy7

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

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Jul 6, 2020 07:51AM bowleskimberlyb wrote:

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

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Jul 16, 2020 10:41PM Miriandra wrote:

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

Dx 5/31/2019, DCIS/IDC, Left, 1cm, Stage IA, 0/1 nodes, ER+ Surgery 8/14/2019 Lymph node removal: Sentinel; Mastectomy: Left
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Jul 17, 2020 05:36AM - edited Jul 17, 2020 05:36AM by bowleskimberlyb

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

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Jul 17, 2020 01:10PM edj3 wrote:

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?

Tried the tamoxifen, no thanks. Dx 4/9/2019, IDC, Left, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 5/5/2019 Lumpectomy; Lymph node removal: Sentinel Dx 5/6/2019, LCIS, Left, <1cm, 0/1 nodes Radiation Therapy 6/2/2019 Whole-breast: Breast Hormonal Therapy 9/22/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jul 17, 2020 01:23PM bowleskimberlyb wrote:

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. :)

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Jul 17, 2020 01:45PM edj3 wrote:

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.

Tried the tamoxifen, no thanks. Dx 4/9/2019, IDC, Left, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 5/5/2019 Lumpectomy; Lymph node removal: Sentinel Dx 5/6/2019, LCIS, Left, <1cm, 0/1 nodes Radiation Therapy 6/2/2019 Whole-breast: Breast Hormonal Therapy 9/22/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jul 18, 2020 06:55AM Aussie-Cat wrote:

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.

Diagnosed with nerve pain (post mastectomy pain syndrome) July 2018. Twin sister died of breast cancer May 2019. Surgery 6/19/2018 Prophylactic mastectomy: Left, Right
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Jul 18, 2020 07:31AM cyathea wrote:

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.

Dx 6/17/2019, DCIS/ILC, Right, 5cm, Stage IV, metastasized to bone, Grade 2, ER+/PR-, HER2+ (FISH) Targeted Therapy 7/31/2019 Perjeta (pertuzumab) Chemotherapy 7/31/2019 Carboplatin (Paraplatin), Taxotere (docetaxel) Chemotherapy 10/8/2019 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 10/10/2019 Herceptin (trastuzumab) Surgery 3/17/2020 Lymph node removal: Left, Right, Sentinel, Underarm/Axillary; Mastectomy: Left, Right Chemotherapy 4/15/2020 Other Radiation Therapy 5/31/2020 3DCRT: Breast, Lymph nodes, Bone Hormonal Therapy 8/20/2020 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Herceptin (trastuzumab)
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Jul 18, 2020 09:57AM edj3 wrote:

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.

Tried the tamoxifen, no thanks. Dx 4/9/2019, IDC, Left, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 5/5/2019 Lumpectomy; Lymph node removal: Sentinel Dx 5/6/2019, LCIS, Left, <1cm, 0/1 nodes Radiation Therapy 6/2/2019 Whole-breast: Breast Hormonal Therapy 9/22/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jul 20, 2020 08:43PM DebJenx2 wrote:

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.

Dx 11/10/2005, IDC, Left, 3cm, Stage IIB, Grade 3, 1/13 nodes, ER+/PR+, HER2+ (IHC) Surgery 11/30/2005 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left; Reconstruction (left): Silicone implant Chemotherapy 12/31/2005 AC + T (Taxotere) Hormonal Therapy 4/30/2006 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy 4/30/2006 Herceptin (trastuzumab) Dx 6/5/2020, IDC, Right, 3cm, Stage IV, metastasized to other, Grade 2, ER+/PR+, HER2- (IHC) Chemotherapy 7/13/2020 CMF Chemotherapy 8/12/2020 CAF
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Aug 2, 2020 05:11AM mheibel wrote:

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.


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Aug 2, 2020 11:11AM bowleskimberlyb wrote:

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

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Sep 26, 2020 08:29PM WordGirl1968 wrote:

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.

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Sep 27, 2020 08:06AM JavaJana wrote:

WordGirl196, if you go to the NotPuttingonaShirt website, there are lots of resources such as talking points, photos, etc. that can help with your discussion with your surgeon. Not all surgeons have expertise in this procedure (it is beyond just a mastectomy), so you may need to find a different surgeon and or more likely get an experienced plastic surgeon to co-operate on you. Best wishes!

Xgeva 9/2/2020. History: 2 Borderline Serous Ovarian Carcinoma TAH/BSO, 0/15 nodes - 2/18/20. Benign Papilloma/ADH Left breast, excisional biopsy 10/11/2016 Dx 10/1/2019, IDC, Left, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2+ (IHC) Dx 10/23/2019, LCIS/DCIS, Right, 0/1 nodes Surgery 11/18/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right Dx 3/25/2020, IDC, Stage IV, metastasized to bone, 0/2 nodes Targeted Therapy 4/7/2020 Perjeta (pertuzumab) Chemotherapy 4/8/2020 Taxotere (docetaxel) Targeted Therapy 4/8/2020 Herceptin (trastuzumab) Hormonal Therapy 8/12/2020 Femara (letrozole)
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Sep 27, 2020 09:50AM - edited Sep 27, 2020 09:57AM by bowleskimberlyb

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!!!!

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Sep 27, 2020 12:36PM - edited Sep 27, 2020 12:38PM by MinusTwo

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.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Sep 27, 2020 02:18PM bowleskimberlyb wrote:

Exactly, MinusTwo!!!!! 🎯

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Sep 28, 2020 10:28AM WordGirl1968 wrote:

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.

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