Aesthetic Flat Closure Following Mastectomy: A Systematic Review of Techniques, Outcomes, and Patient Perspectives

Aesthetic flat closure (AFC) after mastectomy is increasingly chosen by patients who forgo traditional breast reconstruction. Despite rising demand, there is limited evidence guiding optimal surgical techniques or evaluating patient-reported outcomes (PROs).

We performed a systematic review according to PRISMA guidelines. Four databases (OVID MEDLINE, Central, Embase, and Web of Science) were searched from inception through May 29, 2024, for studies addressing surgical techniques or outcomes related to AFC. Inclusion criteria required original data on incision patterns, tissue handling, closure methods, or PROs in patients undergoing oncologic mastectomy. Risk of bias was assessed using the ROBINS-I tool.

Of 142 screened studies, 6 met inclusion criteria (n = 1,577 patients). Three studies described specific surgical techniques-Angel Wing (AW) and a single-incision approach-primarily in obese patients. The AW technique showed no increase in arm lymphedema (15.6% vs 11.1%, p = 0.18) or decreased range of motion (11% vs 15.2%, p = 0.22) compared to non-AW closure. The single-incision method had a 40% wound complication rate and 20% revision rate. Three studies evaluated PROs using investigatorgenerated surveys. Common concerns included asymmetry, excess skin, and inadequate surgeon communication. No studies used validated PRO instruments.

Evidence on AFC remains limited, with only a few studies describing operative approaches and none using validated PRO tools. Future research should aim to standardize surgical techniques, incorporate validated outcome measures, and address patient-surgeon communication to improve satisfaction and aesthetic outcomes.

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