Dr. Chang specializes in this method, aiming to enhance your post-mastectomy aesthetic outcome by providing a smooth, flattering contour that allows you to comfortably fit into clothes.

Aesthetic flat closure is an innovative approach designed for patients who choose not to pursue breast reconstruction following a mastectomy and prefer a flatter, smoother chest profile. Instead of attempting to recreate a breast mound, aesthetic flat closure focuses on creating a visually pleasing and natural appearance by skillfully reshaping the skin and underlying tissues to achieve a contoured, flat result. 

Overview & Why Choose Dr. Chang

Aesthetic Flat Closure

  • Patients Undergoing Mastectomy Not Interested in Breast Reconstruction – Pursuing breast reconstruction is a completely personal decision, and many patients choose not to undergo breast reconstruction. Undergoing mastectomy alone unfortunately leaves behind a lot of redundant skin and fat on the chest wall. While the extra skin may bother some people aesthetically, for many people the redundant skin folds can become uncomfortable, irritating, and prone to developing rashes. An aesthetic flat closure addresses those problems by strategically removing the excess breast skin to produce a smooth, even chest contour.

  • Patients with Comorbidities Resulting in Unacceptably High Risk of Complications from Implant or Autologous Reconstruction – Certain comorbidities—primarily obesity, diabetes, smoking, autoimmune conditions, vascular disease, and cardiopulmonary disease—significantly increase the risk of surgical complications. Aesthetic flat closure is one of the lowest-risk types of breast reconstruction and may be the best option for your safety




Who Is a Candidate?

  • Medical Evaluation – Dr. Chang will review your medical conditions, medications, prior surgeries, and personal and family history of breast diseases, masses, and cancers. Some patients may be referred to their primary care doctor or a specialist to ensure you are medically optimized for a safe surgery under general anesthesia and post-operative recovery. 

  • Breast Examination – Dr. Chang will perform a physical examination of your breasts. This will include measurements of the size, location, and symmetry of the breasts. 

  • Clinical Photographs – Clinical photographs from multiple views will be taken of your breasts. These photos are used to plan for your individualized surgery and compare before and after surgery. No photographs will be published online without your written consent. 



Pre-Operative

Mastectomies remove all of the breast tissue and a variable amount of breast skin and subcutaneous fat. If the incisions are simply sutured together, you may be left with a chest wall with redundant skin folds that can form an uncomfortable, uneven chest contour once healed. Patients may be bothered by the appearance of their chest afterwards and also suffer from discomfort and/or rashes from the skin folds. An aesthetic flat closure is performed after your breast surgeon completes the mastectomies. Dr. Chang strategically tailors and removes the excess skin and fat remaining on your chest to yield a relatively uniformly flat chest contour. You will have a single, transverse scar running completely across your chest at the level of your former inframammary fold. For patients with significant excess skin, the incisions will be extended toward the axillae or the back in order to prevent a dog-ear deformity.







How Aesthetic Flat Closure Is Performed

  • Dressings and Incision Care – Your incisions will be dressed with surgical bandage strips and/or surgical skin glue. You will be wearing a comfortable surgical chest vest stuffed with gauze pads. The vest should be snug but not overly tight. You should try to wear the surgical vest as much as possible but may remove to shower and to wash the vest. You will have surgical drains. They will be removed at your first post-operative visit. You may shower the day after surgery but cannot bathe or swim until instructed to do so.

  • Pain Management and Medications – Local anesthetic (numbing medication) will be injected at your surgical sites to minimize your immediate post-operative pain. You should take acetaminophen and an NSAID around-the-clock, according to instruction, for the first 72 hours and then as-needed thereafter. You can purchase these over-the-counter. You will be given a small number of low-dose narcotic pain medications for breakthrough pain only for the first 72 hours.

  • Recovery Period – Most patients are admitted for 1-2 days after surgery for pain control. While in the hospital, you are expected to ambulate the same day of surgery. Depending on your occupation, you may return to work 2-4 weeks after surgery. You may resume light cardio exercises at 2 weeks after surgery. You should not lift anything heavier than 5 pounds or extend your arms extensively over your head for the first 2-4 weeks after surgery. You may resume all physical activities at 4-6 weeks after surgery. You should expect some drainage from the incisions and mild bruising around the incisions. You will be swollen, and it can take up to 3-6 months for the swelling to reside. Your incisions will take 2-4 weeks to completely heal, but the final scar will take 6-12 months to mature. Scar care will be discussed at your 1 month post-operative appointment.

  • Follow-Up Visits – If you have any urgent concerns, you may call the office at any time. Otherwise, expect follow-up visits at 1 week, 1 month, 3 months, 6 months, and 1 year.





Post-Operative

  • Asymmetry – No one’s breasts or chest walls are perfectly symmetric. While the goal is near-perfect symmetry, there may be some asymmetries in chest contour or thickness and scar position.

  • Unmet Expectations – Despite thorough pre-operative planning and discussions, you still may not be fully happy with your aesthetic results.

  • Poor Scarring – Everyone scars differently. The final scar takes 6-12 months to mature. In rare cases, hypertrophic scars or keloids may form and may require secondary revision.

  • Wound Healing Issues – There may be small areas where the incisions do not fully heal. In these cases, the wounds will be allowed to heal on their own with dressing changes. Severe cases may require a secondary revision procedure.

  • Infection – Infections are managed with antibiotics. In severe cases, you may need an additional procedure.

  • Bleeding – Significant bleeding after surgery may require an urgent return to the operating room. Smaller collections of blood may be treated conservatively or managed with a small procedure in the office or the operative room.

  • Seroma – Fluid collections may develop in the chest. Small ones will be absorbed by the body, but larger ones will need to be aspirated in the clinic.

  • Need for Revision Surgery – For any number of reasons, revision breast reconstruction may be needed to properly achieve your functional and aesthetic goals.

Risks of Aesthetic Flat Closure

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