Topic: Incision preferences for mastectomy with 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 17, 2022 06:29AM - edited Jul 17, 2022 06:37AM by sarahnh

Posted on: Jul 17, 2022 06:29AM - edited Jul 17, 2022 06:37AM by sarahnh

sarahnh wrote:

Hi - I had a lumpectomy recently, but because of some surprises with pathology, I may end up having a mastectomy. If so, I would likely prefer a double mastectomy with no reconstruction -- aesthetic flat closure.

But - I actually care deeply about the aesthetic result. I've looked up photos online, and see a lot of different incision placements. Single horizontal line straight across the chest at (former) nipple level, two flat lines at the bottom of the breast, diagonal lines, curved lines, etc. But the photos are not 100% informative. For one thing, it's impossible to deduce how they would look in different lighting conditions, different body positions, etc.

I'm feeling very lost for information about this...

Scar placement etc is discussed all the time for reconstruction and regular augmentation. But not for flat closures.

Is one type of incision is preferable over the others?

I'd love to hear anybody's experience with flat closure. What type of incision do you have? How has it worked out for you? How do you feel about it? TIA for any info, experiences, and thoughts!

Sarah







______________________

Diagnosis: Mixed IDC and ILC (with DCIS and LCIS). Right breast (5 cm before chemo). Right axillary lymph node.

Biopsy Pathology: ER negative (0%), PR negative (0%), HER2 positive. IHC 3+ (100% of cells). FISH positive (ratio 16.1). Grade 3.

Treatment so far: TCHP (Taxotere, Carboplatin, Phesgo) 6 cycles, Dana Farber Cancer Institute. Lumpectomy (2.5 cm plus margins) and targeted SLNB (4 nodes removed included previously biopsied clipped node, isosulfan blue dye, sulfur technetium colloid radiotracer), Massachusetts General Hospital

Surgical Pathology: PCR for invasive carcinoma, residual DCIS and LCIS
(Putting this info here until the website is fixed) *** DIAGNOSIS:*** Mixed IDC and ILC (with DCIS and LCIS). Right breast (between 2.5 and 4.5 cm). Right axillary lymph nodes (at least 2). *** PATHOLOGY:*** ER negative (0%), PR negative (0%). HER2 positive. IHC 3+ (100% of cells). FISH positive (ratio 16.1). Grade 3. *** TREATMENT:*** TCHP (Taxotere, Carboplatin, Phesgo, with Neulasta Onpro) 6 cycles. Lumpectomy (pathologic complete response) and targeted SLNB (0/7 nodes) *** HOSPITALS:*** Dana Farber Cancer Institute. Massachusetts General Hospital.
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Aug 9, 2022 01:37AM beesy_the_other_one wrote:

Sarah, I agree with LW! I had two radiation buddies who were usually on either side of me during the six weeks of radiation and I became friends with both (sadly, one died last fall but I still keep up with her daughter). The other buddy had a lumpectomy and her nipples were so sore and chapped she just wanted to cry all day every day. She has large breasts, and like LW said, she was just raw underneath of them. I have what my mother calls "cheap Irish skin" . . . and I sailed right through radiation--which started two weeks after the BMX. I would definitely reach out to a radiologist on this one; something smells rotten in Denmark to me about that comment.

Miriandra, your incision looks amazing. I sent photos of mine to Sarah, and she can vouch that I did not end up with such an aesthetic flat closure. I ordered the book Flat & Happy--I'm so glad that resource is out there for women now!

1997: Phyllodes, R breast. 2018: IDC, L breast. TCHP, BMX, Radiation, Nerlynx. Dx 8/20/2018, IDC, Left, Grade 3, 0/1 nodes, ER-/PR-, HER2-
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Aug 9, 2022 01:41AM sarahnh wrote:

miriandra Excellent, I am totally getting tattoo pens!

Unfortunately I probably can't avoid radiation. Pre-chemo, I had at least two positive nodes. Chemo eradicated the cancer in breast and nodes. BUT official guidelines and Drs say I still need radiation -- including hardcore nodal radiation -- even with mastectomy. Because "there is no evidence for omitting radiation" in patients who had positive nodes before chemo.

The guidelines are based on outdated info, and recent data suggests that radiation has little to no benefit for patients like me. There's even a randomized trial currently studying this. But I don't want my Drs to fire me. I may try to argue my way out of radiating the internal mammary nodes tho...


lw422 I totally agree - I do not understand the surgeon's argument. I wonder if she based that on post-mastectomy radiation including the chest wall, whereas post-lumpectomy radiation usually does not? I suspect anyone who requires post-mastectomy radiation would get some kind of "extra" chest-wall radiation if they had a lumpectomy instead.

I clicked your history and it looks like you had post mastectomy radiation? If so, I hope it's not too off-topic to ask, did it cause trouble with range of motion, stretching, skin-hardness, etc?





(Putting this info here until the website is fixed) *** DIAGNOSIS:*** Mixed IDC and ILC (with DCIS and LCIS). Right breast (between 2.5 and 4.5 cm). Right axillary lymph nodes (at least 2). *** PATHOLOGY:*** ER negative (0%), PR negative (0%). HER2 positive. IHC 3+ (100% of cells). FISH positive (ratio 16.1). Grade 3. *** TREATMENT:*** TCHP (Taxotere, Carboplatin, Phesgo, with Neulasta Onpro) 6 cycles. Lumpectomy (pathologic complete response) and targeted SLNB (0/7 nodes) *** HOSPITALS:*** Dana Farber Cancer Institute. Massachusetts General Hospital.
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Aug 9, 2022 03:21AM sarahnh wrote:

beesy_the_other_one Oops I must have been composing my earlier post right as you posted yours! I'm sorry your buddy had a hard time with post-lumpectomy chemo, but it is good information to know.

Best I could tell -- tho I could be wrong! -- the surgeon was talking about more long-term issues like tightness/hardness/discomfort/non-stretchability to the skin and underlying tissue? But you are right, I need to ask the radiation oncologist about that. I swear though, all these doctors give a different story!

I truly appreciate you being willing to share your bad experience of requesting a flat closure, and being a perfect candidate for it, but having the surgeon make the decision to go against your wishes. Simply because they thought they knew better than you. As you mentioned you were slightly ahead of the game, as aesthetic flat closure wasn't an "official" medical term quite yet, so I don't know what you could have done differently. But it is an important cautionary story, especially now that AFC is official!


(Putting this info here until the website is fixed) *** DIAGNOSIS:*** Mixed IDC and ILC (with DCIS and LCIS). Right breast (between 2.5 and 4.5 cm). Right axillary lymph nodes (at least 2). *** PATHOLOGY:*** ER negative (0%), PR negative (0%). HER2 positive. IHC 3+ (100% of cells). FISH positive (ratio 16.1). Grade 3. *** TREATMENT:*** TCHP (Taxotere, Carboplatin, Phesgo, with Neulasta Onpro) 6 cycles. Lumpectomy (pathologic complete response) and targeted SLNB (0/7 nodes) *** HOSPITALS:*** Dana Farber Cancer Institute. Massachusetts General Hospital.
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Oct 9, 2022 08:45PM leoandgeorge wrote:

Hello,


I am new to all of this, but considering going flat. I would be interested in see your surgery results. I wouldnt know where to start. concerned about what my husband thinks, but I dont want to add additional surgeries and complications. it just seems crazy to think this way. Especially because it is DCIS. I am mostly worried about my husbands reaction. We havent met the breast surgeon yet

Dx DCIS, Left, 2cm, Stage 0, Grade 1, ER+/PR+
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Oct 9, 2022 10:27PM - edited Oct 9, 2022 10:27PM by miriandra

Hi L&G! Welcome! I hope you have an easy time on your journey. It's never fun, but we are happy to offer support.

I posted pictures of my incision on the previous page in this thread. You can find them there. I have been very happy with my decision and satisfied with my results. There is also an Aesthetic Flat Closure (AFC) organization, Not Putting On a Shirt, that has a gallery of closure images and a directory of surgeons who do AFC.

I hope your husband's reaction is like my DH's was, "It's your body, hon. Do what you need to do." It's normal to be worried and scared; but in the end, did he marry you or did he marry your breasts? I think he married you.

Hug

Dx 5/31/2019, DCIS/IDC, Left, 1cm, Stage IA, 0/1 nodes, ER+ Surgery Mastectomy (Left)
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Nov 14, 2022 01:35AM sarahnh wrote:

Hi - I'm just checking back in to say how helpful everyone's posts were! I ended up asking my surgeon for separate diagonal incisions, which she said would be gently sloped upward towards the armpit. I'm happy with my result so far, tho it's only been a few weeks. Will post a pic when scars are healed up. Thank you to everybody for being willing to share and discuss this!

(Putting this info here until the website is fixed) *** DIAGNOSIS:*** Mixed IDC and ILC (with DCIS and LCIS). Right breast (between 2.5 and 4.5 cm). Right axillary lymph nodes (at least 2). *** PATHOLOGY:*** ER negative (0%), PR negative (0%). HER2 positive. IHC 3+ (100% of cells). FISH positive (ratio 16.1). Grade 3. *** TREATMENT:*** TCHP (Taxotere, Carboplatin, Phesgo, with Neulasta Onpro) 6 cycles. Lumpectomy (pathologic complete response) and targeted SLNB (0/7 nodes) *** HOSPITALS:*** Dana Farber Cancer Institute. Massachusetts General Hospital.

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