Women reconstructing their chest wall should be able to access a services of a plastics specialist.
The vast majority of mastectomy closures are performed by surgical oncologists, who may or may not have any training in plastic surgery techniques. This is certainly a contributing factor to the 25% dissatisfaction rate for women going flat. Therefore, until oncoplastic training becomes standard for surgical oncologists, women should be able to access a plastics specialist for their initial surgical closure to ensure they get the best possible aesthetic outcome.
Right now, all too often, when a woman tells her surgical oncologist that she wants to be flat, she is cut off from the option of a plastics closure. She may not be referred to speak with a plastic surgeon at all, and if she is, the plastic surgeon most often does not discuss flat closure as an aesthetic option.
The message is clear: if you don’t want breast reconstruction, you must not care about how you look. This harmful myth is reflected in the way that institutions manage our care. Flat advocates want a culture shift. To accomplish that, we must break down the institutional barriers that reinforce the status quo.
That brings us to the NAPBC – the National Accreditation Program for Breast Centers. Run by the American College of Surgeons, this program safeguards patient care by certifying breast centers according to strict quality criteria. Their reconstructive consult protocol delineates what must be covered in a plastics consult for patients facing mastectomy. Entirely missing? Flat closure.
This is why, along with legislative action and improved reimbursement, we are targeting this protocol for amendment. It’s as simple as adding a fourth line item, flat closure, to the existing reconstructive options. It won’t instantly solve the problem… but ensuring that flat closure is framed as reconstructive – and therefore deserving of an aesthetic approach – is a big step in the right direction.