What if I want to go flat, but my surgeon wants to do “skin sparing”?

Tell your surgeon you want an “aesthetic flat closure” as defined by the National Cancer Institute – and make sure it’s recorded in your medical record.

It’s a positive thing that your surgeon is using the term “skin sparing” with you. This means that they are doing the right thing in being clear and honest about their intentions. A skin sparing procedure can be the best option for a patient who is undecided about reconstruction. However, if you’ve decided to go flat, skin sparing is not the right procedure for YOU. The procedure that will give you an optimal flat result is an “aesthetic flat closure” as defined by the National Cancer Institute.

Left: intentional flat denial – this patient received a skin sparing mastectomy against her consent. Right: after aesthetic flat closure at revision.
Top: intentional flat denial – this patient received a skin sparing mastectomy against her consent. Bottom: after aesthetic flat closure at revision.

Your job now is to be sure your surgeon understands that you’ve made your final decision: you do not want reconstruction, ever. You want an aesthetic flat closure. Clarify this right away by speaking directly with your surgeon. Make sure that your decision is recorded in your medical record. It should always be recorded in your consult notes. If possible, it should also be on your surgical consent form – when you sign this document (nowadays this is usually done on the computer), you’re legally giving consent to whatever procedure is listed.

The NCI definition of aesthetic flat closure is very clear that all excess skin should be removed and the area should be contoured in such a way to produce a smooth flat result.

Keep in mind that this is a very new term. This may be the first time your surgeon has heard of aesthetic flat closure, but the procedure itself is not new. We just didn’t have official recognition of the term until recently. Your surgeon may hesitate or push back, because conventional mastectomy doesn’t always include contouring, historically. Some surgeons may not feel comfortable performing the contouring themselves. In this case, you can ask if your surgeon will consider bringing on a plastic surgeon. Our Provider Resources may also be helpful.

If you need a mastectomy for breast cancer, you will not want to delay it significantly because of concerns about aesthetics. However, you do deserve an optimal result. If your surgeon is not receptive to your decision to have an aesthetic flat closure, getting a second opinion may be the best thing to do. But don’t cancel your surgery until you have scheduled with the new surgeon!

The bottom line is that your surgeon needs to understand that what you want is an aesthetic flat closure, and this needs to be in your medical record. You deserve to get an aesthetic result you can live with!

Visit our website for tools and resources to help you advocate for your choice to go flat. Find a Flat Friendly surgeon in your area, and print out one of our helpful brochures for use in consult!

Published by Not Putting on a Shirt

Founder of Not Putting on a Shirt, a mastectomy patients' rights organization that advocates for optimal surgical outcomes for patients going flat.

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