Women who decide not to undergo a breast reconstruction still have options to improve the appearance of their chest wall. When not approached aesthetically, mastectomy closure often leaves excess skin and tissue, creating contour deformities. Aesthetic flat closure is a surgical procedure that removes or rearranges excess breast skin and fat after a mastectomy to produce a smooth, flat chest wall contour. The National Cancer Institute now includes this procedure in its dictionary of terms.

Types of procedures

    • Immediate aesthetic flat closure: This procedure is performed immediately after mastectomy as part of the same surgery.
    • Delayed aesthetic flat closure: This type of closure is performed on patients who have already undergone mastectomy and are unsatisfied with their chest wall contour.
    • Aesthetic flat closure after prior reconstruction: This suits women who choose to remove a prior, unsatisfactory reconstruction.

Procedure details

  • Excess skin is marked before surgery.
  • Consideration is given to scar positioning, especially if a future tattoo is planned to conceal the scar.
  • The planned skin excision may extend along the side of the chest to properly contour the skin and tissue under the arm.
  • Excess skin may be saved and repositioned to fill contour irregularities .
  • Fat grafting may be performed simultaneously or at a later date to correct residual contour irregularities.

Risks & Benefits

It’s important for patients to understand that scar length is directly proportional to breast size. Larger breasts require the removal of more excess skin, which creates longer scars.

As with any reconstructive procedure, it is essential to share your goals and expectations with your surgical team. Aesthetic flat closure is generally a well-tolerated procedure, and most patients are satisfied with the smooth, flat chest wall contour that it produces.

Frequently Asked Questions

If I decide to have aesthetic flat closure after my mastectomy, should this be done by my breast surgeon or by my plastic surgeon?

Aesthetic flat closure can be done by either your breast surgeon or your plastic surgeon. The advantage of having a plastic surgeon involved in this procedure is that additional stages such as fat grafting can be planned if needed to provide the best possible outcome.