Knowledge We Wish We Had

about Flat Mastectomy

As we build out this website, we hope to save you the time, energy, and the uncertainty we faced so you can focus on making the best decision for your own body.

What is an aesthetic flat closure (AFC) after a mastectomy?

Aesthetic flat closure is the surgical process of removing the breast tissue (mastectomy) and then contouring and smoothing the chest wall to create a flat, symmetrical appearance after healing - this contouring process is the reconstructive aspect of surgery.

It is recognized by the National Cancer Institute as a legitimate form of reconstruction and is not considered “doing nothing”.

Aesthetic Flat Closure (AFC): One-Surgery Approach

  • Scar Type & Placement 

    Prior to surgery, preferences regarding scar types should be thoroughly discussed with your surgeon to determine the best aesthetic outcome.

    Scar placement is individualized based on your unique anatomy and surgical needs.

  • Mastectomy

    First the surgeon marks the agreed upon incision lines determining the scar type and placement.

    Next, the breast tissue, including cancer tissue, is removed prior to reconstruction of the chest wall.

  • Excess skin removal

    After the removal of breast/cancer tissue, any skin not needed for reconstruction is removed to create an intentional flat chest.

    Depending on the surgical plan and patient goals, the nipples may be resized, repositioned, grafted, or, in most cases, removed entirely.

  • Chest wall contouring

    Remaining skin, tissue and fat are then carefully reshaped and sculpted to create a smooth, natural chest contour; minimizing side fullness, indentations, and irregularities.

    To align expectations, clear communication with your surgeon before surgery is essential to fully understand the procedure’s benefits and limitations.

Considerations Regarding ‘Flat’ Appearance

All outcomes are unique and may be influenced by factors such as chest size, individual anatomy, and/or the area treated for cancer.

While this is a single surgical procedure, some degree of concavity and/or irregularities may be unavoidable. If this is a concern, additional treatment options - both surgical and non-surgical - may be available to 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. To avoid leaving extra skin that can lead to uneven or unintended results. This is called “flat denial”.

  • 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 does not mean…

  • Not a “simple closure.” It is more than closing the incision without regard for contour.

  • Not leaving excess skin “just in case.” It does not preserve extra skin folds for later use.

  • Not implant or flap reconstruction. It is a distinct surgical option.

  • Not an unfinished result. The outcome is meant to look smooth and intentional.

Aesthetic flat closure (AFC) is about honoring patient choice and providing 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. 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)