There are a lot of terms used in relation to "going flat", breast cancer and it's various surgeries and treatments. We know it can be a *tad bit* confusing and intimidating! Hopefully this glossary helps.
Aesthetic Flat Closure: A type of surgery that is done to rebuild the shape of the chest wall after one or both breasts are removed. An aesthetic flat closure may also be done after removal of a breast implant that was used to restore breast shape. During an aesthetic flat closure, extra skin, fat, and other tissue in the breast area are removed. The remaining tissue is then tightened and smoothed out so that the chest wall appears flat.
Ancillary fat roll: In patients who are heavy set or heavy-breasted, the side of the breast may run into a fat roll that extends around the back body. If a surgeon does not have a plan for contouring the ancillary fat roll, the patient may be left with substantial tissue under the arms and be unable to lower their arms completely.
Axillary: situated in or around the armpit.
Axillary tissue: armpit fat.
Bilateral mastectomy: Removal of both breasts.
Complication: When a surgery or recovery does not go according to plan.
Concavity: Scooped or hollowed out.
Contour: This is word for “shape” often used by surgeons. For instance, you’ll want to talk to your surgeon about how to get a smooth, flat chest contour. Another way of thinking about it is that the chest contour is a topography of the tissues and structures remaining after a flat closure.
Contralateral prophylactic mastectomy: Removal of the second, healthy breast.
Defect: Plastic surgery parlance for an imperfection in the contour of the breast.
Dog ears: A dog ear is excess skin and tissue left behind after mastectomy. Dog ears are often at the lateral end of the mastectomy scar and result from poor incision planning and surgical technique. (Some surgeons call them angel wings but that sounds like even bigger bullshit to us than dog ears.) Dog ears are the result of a surgeon who doesn’t know how to contour the band of fat that starts at the outer side of the breast and extends around to the back body. (see entry for fishtail incision)
Excess skin: Skin that is unnecessary or redundant.
Explant: Removal of breast implant.
Fat grafting: Also called autologous fat transfer, fat grafting is when fat tissue is transferred to the chest from other parts of the body – most often the belly, thighs, or buttocks. Fat grafting is usually done via liposuction and, therefore, falls under the domain of plastic surgery.
Fishtail or fish-shaped incision (also called a “y closure”): An incision that resembles a fishtail and addresses the problem of dog ears. A fishtail incision contours the band of fat that wraps from outer breasts around the side body. The goal is to remove redundant tissue and reduce the occurrence of dog ears. In a review of surgical approaches to avoiding dog ears, published in the International Journal of Surgery, Fish-shaped incision was found to be the most commonly used technique and deemed safe. (Want more detail? Watch this. Please note: this video is of an actual mastectomy surgery and, therefore, is not for those with weak stomachs.)
Flat closure: A flat closure after a mastectomy means the surgeon removes not only breast tissue but also excess skin and tissue to achieve a smooth, flat result.
Inframammary fold, crease, or line: The boundary (from below) of where a breast meets the chest wall. This fold is considered important scaffolding for breast reconstruction and thus is often maintained in patients who choose recon.
Necrosis: Tissue death.
Outcome: The end result of the surgery.
Prophylactic: When something is done preventatively.
Redundant skin: Excess skin and tissue left behind after mastectomy is a common problem. The drivers are two-fold. Some surgeons don’t have the skill necessary to contour a smooth, flat results. Others don’t take the time. Surgeons we’ve spoken to say it’s not unusual for it to take an hour longer to achieve a flat result after mastectomy. Find a surgeon who is willing to give you that extra hour. Perfection is hard to achieve. We get it. If a surgeon doesn’t feel they can remove all the skin and tissue in one surgery, make sure they tell you that upfront so you can devise a plan for a revision.
Resection: Surgical removal of all or a part of the body.
Revision: Taking another pass to correct something.
Shared Decision Making (SDM): a collaborative decision making process in which the clinician offers options and describes risks and benefits, and the patient shares their preferences and values (vs. clinician making a recommendation and the patient passively accepting or rejecting)
Unilateral mastectomy: Removal of one breast.