Summary
Some patients choose not to restore breast contour after mastectomy. Those individuals still have options to improve the way their chest wall looks and feels after surgery. Mastectomy closure may not always be approached by breast surgeons in a way that prioritizes aesthetics. This means that excess skin may be left behind, resulting in irregular chest contour. Aesthetic flat closure removes or rearranges that excess skin to create a smooth, even chest wall contour.
Aesthetic flat closure on one side
Aesthetic flat closure on both sides
Types of Aesthetic Flat Closure Procedures
Immediate Aesthetic Flat Closure
Delayed Aesthetic Flat Closure
Patients who have already undergone mastectomy who are not happy with their chest wall contour may have it corrected at a later date. This would require a second, typically outpatient, procedure with a plastic surgeon completing the closure. Skin may need to be removed and rearranged on the chest. In some cases, liposuction or fat grafting may further improve contour at the time of an aesthetic flat closure procedure.
Aesthetic Flat Closure After Prior Reconstruction
Chest wall contour is smoothed and restored after a prior, unsatisfactory reconstruction is removed. In cases of prior implant reconstruction, the implants and surrounding capsules would be removed. For patients unhappy with a natural tissue reconstruction, the tissue from the flap reconstruction would be partially or completely removed. In all cases, the remaining skin would be rearranged to allow completion of the aesthetic flat closure.
Procedure details:
- During surgical planning, a surgeon considers scar positioning based on breast size and contour
- A plastic surgeon marks excess skin for excision before surgery
- During surgery, incisions may be extended along the side of the chest to adequately contour skin and tissue below the armpit
- A surgeon saves or repositions excess skin to correct contour irregularities as needed
- In some cases, simultaneous or second-stage fat grafting further smooths the chest wall
Risks & Benefits
Patients with larger breasts should be aware that they will have longer scars as compared to patients with smaller breasts. It is also important to know that aesthetic flat closure is not the expectation of a mastectomy without breast reconstruction. If flat closure is your goal, it is essential to share your expectations with your surgical team.
Residual skin laxity or excess may require a second stage procedure to provide the best possible outcome following aesthetic flat closure.
Most patients recover from this procedure well, satisfied with the smooth, even, flat chest contour it provides.