FAQ: Going Flat After Mastectomy

Q: Will going flat affect how my mastectomy is done?

A: Compared to mastectomy with immediate reconstruction, going flat involves a wider incision across the chest, preserves only enough breast skin to close the incision, and leaves a visible
scar on the chest. If an aesthetic flat closure is performed (see below), the underlying fat and sometimes muscle are sculpted to leave a flat chest contour, which is not required when reconstruction is performed with a mastectomy.

Q: What is an aesthetic flat closure?

This means removing excess breast skin and fat and tightening the remaining tissue, leaving a smooth, flat chest without bulges of excess tissue or puckers of skin at the ends of the incision.

Q: What are dog ears?

A: Dog ears are areas of bulging or puckered skin at the ends of the mastectomy incision, caused by stitching an elliptical mastectomy incision in a straight line. They can be aesthetically concerning, and in some cases, may chafe against clothing or a prosthesis. Dog ears can be improved with fat grafting or eliminated by reopening and resewing the incision. They can be avoided altogether if the surgeon performs an aesthetic flat closure.

Q: Can you keep your nipples?

A: Yes, if your tumor is a safe distance from the nipple (when mastectomy is performed to treat breast cancer) and doesn't include any cancer cells. Preserving blood supply to the nipple is critical for nipple health. A nipple that doesn't get adequate blood may flatten, look different, lose some or all sensation, or not survive. Be sure to discuss this option during your consultation, since not all surgeons perform nipple-sparing flat closures. If the nipple must be removed, a realistic-looking 3D nipple tattoo is an option.

Q: What if I change my mind after mastectomy about having reconstruction?

A: Reconstruction is always an option, no matter how much time passes after your mastectomy. Your mastectomy scar will appear on your reconstructed breast, but it will fade considerably in time.

Q: What if my surgeon doesn't support my decision to go flat or tries to talk me out of it?

A: If you encounter flat denial, meaning your surgeon isn’t receptive to your decision, or insists that you’ll later change your mind, consider finding another surgeon who supports your decision and performs aesthetic flat closures.

Q: What is a good resource for going flat?

A: Many books, blogs, and websites provide information and support for going flat. Not Putting On a Shirt is a popular, supportive website.