Evaluation of aesthetic flat closure: A scoping review

Postmastectomy patients may choose to not have breast reconstruction and opt for a flat closure. Aesthetic flat closure (AFC) is intentional incision selection and maneuvers for chest wall contour to optimize the aesthetic result. Patients may have a specific expectation of aesthetic outcomes, making AFC a new type of reconstruction. The purpose of this study is to perform a scoping review to define 1) patients who receive flat closure after mastectomy for treatment of breast cancer and their motivations for flat closure, 2) surgical techniques used to accomplish AFC, and 3) patient-reported outcomes of flat closure. A systematic search was conducted through MEDLINE, Embase, and Scopus. Articles were grouped into three overall categories of population description, surgical techniques, and outcomes. Within each category, major themes were identified. The literature search identified 48 articles and 15 met study criteria. Those who had no breast reconstruction considered risks, breast functionality, recovery time, and foreign body placement. Studies reported lack of surgeon support in patients' decisions for flat closure. Surgical techniques for AFC included scar placement at the inframammary fold, medial and lateral debulking, and dog ear prevention. There were 89.9 % (328/365) of patients who were satisfied in choosing a flat closure and 58.2 % (689/1183) were satisfied with cosmesis. Patients chose flat closure for various reasons including avoiding additional surgery. Surgeon supported decision-making and comprehensive education on reconstructive and non-reconstructive options are critical to patient experiences. While patients are satisfied with their decision of flat closure, optimization of aesthetic results can be achieved by implementing chest wall reconstruction techniques with the specific goal of obtaining an AFC.