Surgeons Speak on Flat Closure
By: Kim Bowles | Board Member, Flat Closure NOW & Founder, Not Putting on a Shirt
Advancing the conversation on going flat after mastectomy - addressing flat denial, flat closure techniques, and flat education and advocacy - isn't just the purview of patient advocates like Flat Closure NOW and Not Putting on a Shirt. Medical professionals must have a seat at the table as well.
To recap recent events: in the months following the publication of Catherine Guthrie's scathing exposé on flat denial at Cosmopolitan magazine, awareness began to spread throughout the medical community, sparking conversations within professional circles as well as in the public sphere (articles and analysis can be found at the NPoaS Blog under Medical Professionals Speak Out).
In December of 2018, the American Society of Breast Surgeons (ASBrS) announced that they are developing educational courses on flat closure techniques to support general and breast surgeons who want to better serve their patients who choose to go flat. This move, which was clearly prompted by Guthrie’s exposé, represents an acknowledgment by the medical community of the existence of flat denial, as well as a good faith effort to address the problem effectively.
Today we share with you a continuation of the conversation, from a team of plastic surgeons at Midwest Breast & Aesthetic Surgery in Ohio. Drs. Pankaj Tiwari and Ergun Kocak offer their professional perspective on "Going Flat After Mastectomy.”
They begin by directly addressing the problem of intentional flat denial:
"Many of these patients have been quite clear and explicit in their desire not to undergo any reconstructive surgery... Tragically, some of these patients nonetheless were left with excess skin in an effort to allow for potential future reconstruction. This type of flat denial medical course is one that we as surgeons must re-evaluate." - Dr. Pankaj Tiwari
They also acknowledge the current deficit in oncoplastic training in the general and breast surgery communities - which the ASBrS is now trying to remedy. And they offer their perspective on realistic expectations for patients going flat who wish to be “one and done”:
“I think that promising a single stage [i.e., single surgery] aesthetic flat result is more often than not an unreasonable level of expectation to set for patients.” - Dr. Pankaj Tiwari
It should be noted that plastic surgeons typically have very high standards for aesthetics. Certainly, what constitutes a “good enough” flat result will vary as it is a somewhat subjective judgment. And whether such a result can reasonably be expected in one surgery will depend on the surgeon(s), the patient, and the specific medical circumstances.
While there may be differences of opinion on what constitutes “reasonable expectations,” we can surely all agree on one thing: clear communication is key.
It is incumbent on the patient to be clear about their wishes and expectations… and it is incumbent on the surgeon(s) to be clear about the likelihood that they can meet those expectations in one surgery.
Thank you, Drs. Tiwari and Kocak, for lending your voice to the conversation!