Flat closure after mastectomy

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Aesthetic flat closure after mastectomy is contouring of the chest wall after mastectomy without traditional breast reconstruction. [1] Vernacular synonyms and related vernacular and technical terms include "going flat", [2] "flat closure", [3] "optimal flat closure", [4] "nonreconstructive mastectomy", [5] "oncoplastic mastectomy", [6] "non-skin sparing mastectomy", [7] "mastectomy without reconstruction", [8] and "aesthetic primary closure post-mastectomy". [5]

Women who have decided against traditional reconstructive surgery following mastectomy have gained media visibility in recent years. [9] Media reports have covered patients' claims that their choices not to undergo reconstruction have been overridden by their surgeons. [10] [11] Recent research has characterized the "going flat" movement and patient experience going flat [12] [13] [14] and described aesthetic flat closure surgical technique. [15] [16] [17]

Aesthetic flat closure is the surgical work required to produce a smooth flat chest wall contour after the removal of one or both breasts, including obliteration of the inframammary fold and excision of excess lateral tissue (to avoid "dog ears.") [17] [18] It is defined by the National Cancer Institute as the following: "A type of surgery that is done to rebuild the shape of the chest wall after one or both breasts are removed. An aesthetic flat closure may also be done after removal of a breast implant that was used to restore breast shape. During an aesthetic flat closure, extra skin, fat, and other tissue in the breast area are removed. The remaining tissue is then tightened and smoothed out so that the chest wall appears flat." [19]

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<span class="mw-page-title-main">Breast reconstruction</span> Surgical rebuilding of a breast

Breast reconstruction is the surgical process of rebuilding the shape and look of a breast, most commonly in women who have had surgery to treat breast cancer. It involves using autologous tissue, prosthetic implants, or a combination of both with the goal of reconstructing a natural-looking breast. This process often also includes the rebuilding of the nipple and areola, known as nipple-areola complex (NAC) reconstruction, as one of the final stages.

<span class="mw-page-title-main">Mastectomy</span> Surgical removal of one or both breasts

Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operation as a preventive measure. Alternatively, some women can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and a surrounding margin of healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.

<span class="mw-page-title-main">Mammaplasty</span> Surgically modifying the appearance of the breast

Mammaplasty refers to a group of surgical procedures, the goal of which is to reshape or otherwise modify the appearance of the breast. There are two main types of mammoplasty:

  1. Augmentation mammaplasty is commonly performed to increase the size, change the shape, and/or alter the texture of the breasts. This usually involves the surgical implantation of breast implant devices.
  2. Reduction mammaplasty is commonly performed to reduce the size, change the shape, and/or alter the texture of the breasts. This involves the removal of breast tissue.

Gender-affirming surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.

<span class="mw-page-title-main">Breast augmentation</span> Surgical procedure

Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Augmentation mammoplasty is applied to correct congenital defects of the breasts and the chest wall. As an elective cosmetic surgery, primary augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.

<span class="mw-page-title-main">Medical tattoo</span> Type of tattooing

A medical tattoo is a tattoo used to treat a condition, communicate medical information, or mark a body location for treatment. People may get a paramedical tattoo to conceal a condition or the effects of treatment, such as creating the appearance of an areola after breast reconstruction, or a cover-up tattoo to disguise the area in an artistic way.

<span class="mw-page-title-main">Radical mastectomy</span> Removal of cancerous breast

Radical mastectomy is a surgical procedure that treats breast cancer by removing the breast and its underlying chest muscle, and lymph nodes of the axilla (armpit). Breast cancer is the most common cancer among women. During the early twentieth century it was primarily treated by surgery, when the mastectomy was developed. However, with the advancement of technology and surgical skills in recent years, mastectomies have become less invasive. As of 2016, a combination of radiotherapy and breast conserving mastectomy are considered optimal treatment.

<span class="mw-page-title-main">Male chest reconstruction</span> Surgical procedure

Male chest reconstruction refers to any of various surgical procedures to masculinise the chest by removing breast tissue or altering the nipples and areolae. Male chest reconstruction may be performed in cases of gynecomastia and gender dysphoria. Transmasculine people may pursue chest reconstruction, also known as top surgery, as part of transitioning.

<span class="mw-page-title-main">Breast implant</span> Prosthesis used to change the size, shape, and contour of a persons breast

A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast following a mastectomy, to correct congenital defects and deformities of the chest wall or, cosmetically, to enlarge the appearance of the breast through breast augmentation surgery.

<span class="mw-page-title-main">Tail of Spence</span> Breast tissue extending into the axilla

The tail of Spence has historically been described as an extension of the tissue of the upper outer quadrant of the breast traveling into the axilla. The "axillary tail" has been reported to pass into the axilla through an opening in the deep fascia called foramen of Langer. The "tail of Spence" was named after the Scottish surgeon James Spence, who served as a President of the Royal College of Surgeons in Edinburgh in the latter half of the 19th Century.

<span class="mw-page-title-main">Breast prostheses</span>

Breast prostheses are breast forms intended to look like breasts. They are often used temporarily or permanently by women after mastectomy or lumpectomy procedures, but may also be used by for aesthetic purposes. There are a number of materials and designs; although, the most common construction is gel in a plastic film meant to feel similar to a person's skin. Prostheses may be purchased at a surgical supply store, pharmacy, custom lingerie shop, or even through private services that come to a person's home. There are many types of ready made breast prostheses including full or standard prostheses, partial prostheses such a shell prostheses, and stick on prostheses. Customized options are also available from specialty shops, which are moulded to fit an individual's chest by taking an impression of the breast(s). The areola and nipple may be replicated as part of the breast form or as separate nipple prosthesis. Both custom made and off-the shelf breast prostheses come in varieties that are designed to either be held in a pocket in a specially designed mastectomy bra or attached to the skin via adhesive or other methods and worn with a standard bra. There are many factors to consider when selecting breast prostheses such as different types and the care they require, insurance coverage, and psychosocial effects.

<span class="mw-page-title-main">Inframammary fold</span> Natural lower boundary of the breast

In human anatomy, the inframammary fold (IMF), inframammary crease or inframammary line is the natural lower boundary of the breast, the place where the breast and the chest meet. The choice of the term depends on the prominence of the feature. It is also sometimes called the inframammary ligament. From the cosmetological point of view, it is an important aesthetic component of the breast which should be taken into consideration during various kinds of breast surgery.

Breast cancer management takes different approaches depending on physical and biological characteristics of the disease, as well as the age, over-all health and personal preferences of the patient. Treatment types can be classified into local therapy and systemic treatment. Local therapy is most efficacious in early stage breast cancer, while systemic therapy is generally justified in advanced and metastatic disease, or in diseases with specific phenotypes.

<span class="mw-page-title-main">Breast-conserving surgery</span> Surgical operation

Breast-conserving surgery refers to an operation that aims to remove breast cancer while avoiding a mastectomy. Different forms of this operation include: lumpectomy (tylectomy), wide local excision, segmental resection, and quadrantectomy. Breast-conserving surgery has been increasingly accepted as an alternative to mastectomy in specific patients, as it provides tumor removal while maintaining an acceptable cosmetic outcome. This page reviews the history of this operation, important considerations in decision making and patient selection, and the emerging field of oncoplastic breast conservation surgery.

A DIEP flap is type of breast reconstruction where blood vessels, fat, and skin from the lower belly are relocated to the chest to rebuild breasts after mastectomy. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen. This is a type of autologous reconstruction, meaning one's own tissue is used.

Free-flap breast reconstruction is a type of autologous-tissue breast reconstruction applied after mastectomy for breast cancer, without the emplacement of a breast implant prosthesis. As a type of plastic surgery, the free-flap procedure for breast reconstruction employs tissues, harvested from another part of the woman's body, to create a vascularised flap, which is equipped with its own blood vessels. Breast-reconstruction mammoplasty can sometimes be realised with the application of a pedicled flap of tissue that has been harvested from the latissimus dorsi muscle, which is the broadest muscle of the back, to which the pedicle (“foot”) of the tissue flap remains attached until it successfully grafts to the recipient site, the mastectomy wound. Moreover, if the volume of breast-tissue excised was of relatively small mass, breast augmentation procedures, such as autologous-fat grafting, also can be applied to reconstruct the breast lost to mastectomy.

<span class="mw-page-title-main">Nipple prosthesis</span>

Nipple/Areola prostheses are made of silicone by breast prosthesis manufacturers and anaplastologists for breast cancer survivors who were treated for breast cancer with a mastectomy. Prostheses can be worn weeks after a mastectomy, breast reconstruction, or even nipple reconstruction. As an inexpensive and convenient alternative to surgery, patients may choose to wear them anytime during treatment. Patients who ultimately find nipple prostheses thought that they should be informed of them during the consultation prior to mastectomy.

A preventive mastectomy or prophylactic mastectomy or risk-reducing mastectomy (RRM) is an elective operation to remove the breasts so that the risk of breast cancer is reduced.

Prophylactic surgery, is a form of surgery whose purpose is to minimize or prevent the risk of developing cancer in an organ or gland that has yet to develop cancer and is known to be at high risk of developing cancer. This form of preventive healthcare may include surgeries such as mastectomies, oophorectomies, colectomies and surgical corrections, such as the surgical correction of cryptorchidism or undescended testis. Another less common definition of prophylactic surgery also includes the prevention of other diseases, outcomes or even future appearance.

Rebecca Aft is an American surgical oncologist and breast cancer researcher. Holds the inaugural title of Moley Professor of Endocrine and Oncologic Surgery at Washington University School of Medicine in St. Louis. Aft studies the mechanisms of breast cancer metastasis and explores potential targets for treatment. Her work has identified the anti-metastatic effects of bisphosphonates in patients with breast cancer. 

References

  1. ↑ "About Aesthetic Flat Closure". BreastCancer.org. 2011-02-02. Retrieved 2022-08-12.
  2. ↑ Rabin, Roni Caryn (2016-10-31). "'Going Flat' After Breast Cancer". The New York Times. ISSN   0362-4331 . Retrieved 2020-07-03.
  3. ↑ "NCCN Guidelines for Patients: Invasive Breast Cancer". NCCN.org. Retrieved 2022-08-12.
  4. ↑ "OPBC". oncoplasticbc.org. Retrieved 2020-07-03.
  5. 1 2 Djohan, Michelle; Knackstedt, Rebecca; Leavitt, Tripp; Djohan, Risal; Grobmyer, Stephen (April 2020). "Technical considerations in nonreconstructive mastectomy patients". The Breast Journal. 26 (4): 702–704. doi:10.1111/tbj.13641. ISSN   1524-4741. PMID   31578792. S2CID   203652994.
  6. ↑ Macmillan, R. Douglas; McCulley, Stephen J. (2016). "Oncoplastic Breast Surgery: What, When and for Whom?". Current Breast Cancer Reports. 8 (2): 112–117. doi:10.1007/s12609-016-0212-9. ISSN   1943-4588. PMC   4886147 . PMID   27330677.
  7. ↑ Kinoshita, Satoki; Nojima, Kimihiro; Takeishi, Meisei; Imawari, Yoshimi; Kyoda, Shigeya; Hirano, Akio; Akiba, Tadashi; Kobayashi, Susumu; Takeyama, Hiroshi; Uchida, Ken; Morikawa, Toshiaki (2011). "Retrospective comparison of non-skin-sparing mastectomy and skin-sparing mastectomy with immediate breast reconstruction". International Journal of Surgical Oncology. 2011: 876520. doi: 10.1155/2011/876520 . ISSN   2090-1410. PMC   3263672 . PMID   22312528.
  8. ↑ Harcourt, Diana M.; Rumsey, Nichola J.; Ambler, Nicholas R.; Cawthorn, Simon J.; Reid, Clive D.; Maddox, Paul R.; Kenealy, John M.; Rainsbury, Richard M.; Umpleby, Harry C. (March 2003). "The psychological effect of mastectomy with or without breast reconstruction: a prospective, multicenter study". Plastic and Reconstructive Surgery. 111 (3): 1060–1068. doi:10.1097/01.PRS.0000046249.33122.76. ISSN   0032-1052. PMID   12621175. S2CID   1445626.
  9. ↑ "Why More Breast Cancer Survivors Are Going Flat". Oprah.com. Retrieved 2020-07-03.
  10. ↑ Guthrie, Catherine (2018-09-06). "These Cancer Patients Wanted to Get Rid of Their Breasts for Good. Their Doctors Had Other Ideas". Cosmopolitan. Retrieved 2020-07-03.
  11. ↑ "Breast cancer patient opens up about alleged malpractice in surgery". TODAY.com. Retrieved 2020-07-03.
  12. ↑ Wakeley, Michelle E.; Bare, Colette F.; Pine, Rebecca; Dube, Catherine; Gass, Jennifer S.; Taneja, Charu; Dizon, Don S. (2020). "A social media survey of women who do not pursue reconstruction after mastectomy for breast cancer: Characterizing the "Going Flat" movement". The Breast Journal. 26 (7): 1455–1457. doi: 10.1111/tbj.13781 . ISSN   1524-4741. PMID   32067326.
  13. ↑ "SABCS iPosters". posterview.com.
  14. ↑ "Going Flat After Mastectomy". 23 May 2020.
  15. ↑ Djohan, Michelle; Knackstedt, Rebecca; Leavitt, Tripp; Djohan, Risal; Grobmyer, Stephen (2020). "Technical considerations in nonreconstructive mastectomy patients". The Breast Journal. 26 (4): 702–704. doi:10.1111/tbj.13641. ISSN   1524-4741. PMID   31578792. S2CID   203652994.
  16. ↑ Smith, Monica J. (December 10, 2018). "Managing Patient Expectations Key for Mastectomy Without Reconstruction". Clinical Oncology News. Retrieved 2020-07-03.
  17. 1 2 Morrison, Kerry A. (May 2022). "Not Just a Linear Closure: Aesthetic Flat Closure after Mastectomy". Plastic and Reconstructive Surgery - Global Open. 10 (5): e4327. doi: 10.1097/GOX.0000000000004327 . PMC   9116949 . PMID   35620492. S2CID   248837570.
  18. ↑ Hill, Erica L. (July 2019). "The Angel Wings Incision: A novel solution for mastectomy patients with increased lateral adiposity". The Breast Journal. 25 (4): 687–690. doi: 10.1111/tbj.13301 . PMID   31111601. S2CID   160011773.
  19. ↑ "NCI Dictionary of Cancer Terms - National Cancer Institute". cancer.gov. 2011-02-02. Retrieved 2020-07-03.
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