Knowledge We Wish We Had
In One Spot, About Flat Mastectomy
As we continue to build out this website, we hope to save you the time, energy, and uncertainty we faced — so you can focus on making the best decision for your body.
What is an aesthetic flat closure (AFC) after a mastectomy?
Aesthetic flat closure is a surgical procedure that combines two steps: a mastectomy, which removes the breast and any cancerous tissue, and a reconstructive phase in which the chest wall is contoured and smoothed to achieve a flat, symmetrical appearance after healing.
It is recognized by the National Cancer Institute as a legitimate form of reconstruction and is not considered “doing nothing”.
Aesthetic Flat Closure (AFC): Single Surgery Approach
Scar placement is personalized. Take time to talk with your surgeon about which scar types are an option for you to choose from.
Often, it's based on your unique anatomy, surgical needs, and what will work best for your body.
This conversation happens before surgery — bring your questions and preferences.
Your surgeon will start by marking the incision lines you've agreed on together, which determines where your scars will be and what they'll look like.
From there, the breast tissue, including any cancerous tissue, is removed to prepare for the next stage.
Incision lines are marked while you're awake — your input is part of the process.
Once the breast and cancerous tissue has been removed, the extra skin not needed for reconstruction is also removed to create a flat, intentional result.
Depending on your goals and surgical plan, the nipples may be resized, repositioned, grafted, or, in most cases, they are removed entirely.
Nipple preferences are another important pre-surgery conversation with your surgeon.
Any remaining skin, non-breast tissue, and fat are carefully reshaped and sculpted to create a smooth, natural chest contour, minimizing side fullness, indentations, and irregularities.
Clear communication with your surgeon before surgery is essential to align expectations and fully understand the procedure's benefits and limitations.
This is the finishing step — the sculpting that makes AFC a deliberate, aesthetic result.
Considerations Regarding a ‘Flat’ Appearance
Every outcome is unique and that's completely normal. Results can be shaped by factors like your chest size, individual anatomy, and the area treated for cancer.
While Aesthetic flat closure (AFC) is a single procedure, some degree of concavity or irregularities may be unavoidable. If that's a concern for you, there are additional options , both surgical and non-surgical, that can help further improve contour and symmetry.
Flat by Choice, Not by Default
Why It Matters
Patient choice deserves precision. Surgical plans should reflect clearly expressed goals.
Clear communication with surgeon is key. Fully understand the benefits and limitations of a flat aesthetic.
Flat is a valid, informed decision. It is not a default when breast mound reconstruction is declined.
Intentional technique creates confidence. Aesthetic planning supports future physical and emotional well-being.
What It Doesn’t Mean
Not a “simple closure.” It is more than closing the incision without regard for contour.
Not leaving excess skin “just in case.” A true flat closure does not preserve extra skin folds for potential later use, that practice is called “flat denial.”
Not implant or flap reconstruction. Aesthetic flat closure is a distinct surgical option.
Not an unfinished result. The outcome is meant to look smooth and intentional.
Your Body. Your Choice.
Knowledge Matters.
You deserve clear information and respect for your decision, whether that means breast reconstruction or not.
All options carry risks. Some involve longer surgeries and more recovery. Others involve less time in the operating room and fewer added procedures.
There is no “right” choice — only the choice that feels safest and most aligned for you.
Flat closure creates a smooth, flat chest wall at the time of mastectomy — without rebuilding a breast mound.
- Shortest surgery
- Lowest blood loss
- No implants
- No additional surgery on another part of your body
- Usually least amount of hospital time
For most, this option involves the least added surgical stress beyond mastectomy itself.
Fat grafting uses liposuction to remove fat from one area of your body and transfer it to the chest.
- Outpatient procedure
- Adds liposuction recovery
- Fat may not fully survive; additional sessions may be needed
- Low overall systemic risk
Some choose this for subtle contouring after flat closure or reconstruction.
Implants recreate breast volume — though additional surgeries, including spacers, are often needed for the final result.
- Moderate-length surgery
- 1–2 day hospital stay
- Implants are not lifetime devices
- Risk of hardening around the implant (capsular contracture)
- Future surgeries are common
The U.S. Food and Drug Administration recommends ongoing monitoring of breast implants.
Flap procedures (e.g. DIEP, TRAM, PAP) move tissue from another area of your body to reconstruct a breast mound.
- Long surgery (often 6–12 hours)
- 3–5+ day hospital stay
- Higher blood loss
- Additional healing at the donor site
- Higher short-term complication risk
The Mayo Clinic flap surgery overview.
Aesthetic flat closure (AFC) is about honoring patient choice and delivering a deliberate, thoughtful surgical result that looks intentional — not unfinished.
Deciding between an aesthetic flat closure (AFC) and reconstruction of breasts, after a mastectomy, is a deeply personal and multifaceted decision. It involves considering your medical needs, lifestyle, values, body image, and emotional well-being.
Check-in with yourself
Questions to Reflect On
What do I feel in my body when I picture myself with a flat chest?
What emotions come up when I picture reconstructed breasts?
What would I say to a friend in my shoes?
If no one else's opinion mattered, what would I choose?
Are practical factors important to me? e.i. additional surgeries, upkeep, potential medical risks…
Does recovery time play a role in my choice?
Factors to Consider
Desire for symmetry in clothing
Importance of breasts to body image
Sense of authenticity
Medical compatibility
Possible surgery fatigue from breast mound reconstruction
Long-term maintenance
Sexual confidence
Social expectations
Emotional response (gut feeling)
*Reconstruction Safety Research
• Autologous fat grafting does not increase cancer recurrence risk following breast reconstruction: https://pubmed.ncbi.nlm.nih.gov/32049757/
• Autologous (free‑flap) reconstruction is oncologically safe with no adverse effect on recurrence rates: https://pubmed.ncbi.nlm.nih.gov/30321805/
• Extensive reviews support that implant‑based reconstruction does not increase cancer recurrence risk:
https://journals.lww.com/plasreconsurg/citation/2022/10001/clinical_and_oncologic_safety_in_modern_breast.1.aspx
• National Cancer Institute fact sheet on breast reconstruction and flat closure: https://www.cancer.gov/types/breast/reconstruction-fact-sheet