More women embracing 'going flat' after mastectomy

January 04, 2021

LOS ANGELES -- A growing number of women forgoing reconstruction after a mastectomy say they're satisfied with their choice, even as some did not feel supported by their physician, according to a study led by researchers at the UCLA Jonsson Comprehensive Cancer Center.

The study, published in the Journal Annals of Surgical Oncology, surveyed 931 women who had a unilateral or bilateral mastectomy without current breast mound reconstruction to assess the motivating factors for forgoing the procedure and to measure whether surgeons provided adequate information and support for "going flat."

Out of the women surveyed, 74% were satisfied with their outcome and 22% experienced "flat denial," where the procedure was not initially offered, the surgeon did not support the patient decision, or intentionally left additional skin in case the patient changed her mind.

The team also explored reasons given for the choice and found women pointed to a desire for a faster recovery, avoidance of a foreign body placement and the belief that breast mound reconstruction was not important for their body image.

"Undergoing a mastectomy with or without reconstruction is often a very personal choice," said Dr. Deanna Attai, an assistant clinical professor of surgery at the David Geffen School of Medicine at UCLA, and senior author of the study. "We found that for a subset of women, 'going flat' is a desired and intentional option, which should be supported by the treatment team and should not imply that women who forgo reconstruction are not concerned with their post-operative appearance."

The results challenge past studies showing that patients who chose not to undergo breast reconstruction tend to have a poorer quality of life compared with those who do have the surgery.

Attai and her team found that a majority of patients who elected to go flat were in fact satisfied with their surgical outcome. The authors believe the survey tool commonly used to asses outcomes was biased towards reconstruction. To avoid that bias, Attai partnered with patient advocates to develop a unique survey to assess reasons for going flat, satisfaction with their decision, and factors associated with satisfaction. They also identified concerns unique to these patients not captured by other validated surveys.

While a majority of the women surveyed reported they were satisfied with their surgical outcomes, 27% of patients surveyed reported not being satisfied with the appearance of their chest wall.

"Some patients were told that excess skin was intentionally left -- despite a preoperative agreement to perform a flat chest wall closure -- for use in future reconstruction, in case the patient changed her mind," said Attai, who is a member of the UCLA Jonsson Comprehensive Cancer Center. "We were surprised that some women had to struggle to receive the procedure that they desired."

Surgeons may hesitate to recommend mastectomy without reconstruction surgeons due to being less confident that they can provide a cosmetically acceptable result for patients who desire a flat chest wall, noted Attai.

"We hope that the results of this study will serve to inform general and breast surgeons that going flat is a valid option for patients, and one that needs to be offered as an option," said Attai. "We also hope the results may help inform patients that going flat is an option, and to empower them to seek out surgeons who offer this option and respect their decision."
-end-
In addition to Attai, study co-authors were Dr. Jennifer Baker, Dr. Carlie Thompson, Dr. Minna Lee and Dr. DiNome of UCLA; Dr. Don Dizon of the Brown University and the Lidespan Cancer Institute; and Dr. Cachet Wenziger and Dr. Elani Streja of the University of California Irvine School of Medicine.

University of California - Los Angeles Health Sciences

Related Mastectomy Articles from Brightsurf:

National clinical trial provides mastectomy alternative for recurrent breast cancer
Mastectomy has historically been the standard treatment for breast cancer patients experiencing recurrence after an initial lumpectomy and whole-breast radiation.

Breast cancer recurrence after lumpectomy & RT is treatable with localized RT without mastectomy
Approximately 10% of breast cancer patients treated with lumpectomy (breast-conserving surgery [BCS]) and whole-breast radiation (WBI) will have a subsequent in-breast local recurrence of cancer (IBTR) when followed long term.

Analysis by surgical trainees examines recommendations for mastectomy across the UK
A woman's decision to undergo mastectomy for breast cancer relies on communication with her surgeon and, in addition, often draws on recommendations from a 'multidisciplinary team' (MDT) of doctors from different specialties such as oncology and radiology.

Less-invasive mastectomy safe for more breast cancer patients, Mayo Clinic study finds
A less-invasive mastectomy that leaves the surface of the breast intact has become a safe option for more patients, including those whose breast cancer has spread to nearby lymph nodes or who have risk factors for surgical complications, a Mayo Clinic study shows.

Future breast imaging and biopsy are not eliminated after mastectomy
A new study led by researchers at the Icahn School of Medicine at Mount Sinai has determined that having a mastectomy does not completely eliminate the need for further breast imaging studies.

Breast cancer detected in transmen undergoing mastectomy
The number of transmen seeking gender-confirming surgery has risen in the past decade.

Web-based decision aid may help with breast reconstruction decisions following mastectomy
A new Psycho-Oncology study indicates that a free web-based decision aid that helps women with breast cancer make decisions regarding reconstruction surgery after mastectomy is likely cost-effective.

Double mastectomy to prevent cancer reduces risk of dying in BRCA1 mutation carriers
Healthy women who carry a breast cancer-causing mutation in the BRCA1 gene, not only reduce their risk of developing the disease but also their chances of dying from it if they have both breasts removed, according to new research presented at the 11th European Breast Cancer Conference.

Breast cancer patients often mispredict well-being after mastectomy
Women with breast cancer who underwent a mastectomy without breast reconstruction generally underestimated their future quality of life, while those who had immediate reconstruction generally overestimated it.

Study finds double mastectomy tied to more missed work
As more breast cancer patients are choosing to remove both breasts, researchers examine the impact this aggressive surgery has on their employment.

Read More: Mastectomy News and Mastectomy Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.