"Going Flat" After Mastectomy: A Social Media Analysis of Patient Perspectives and Educational Needs

Aesthetic flat closure (AFC) is a surgical option following mastectomy that aims to create a smooth chest wall. Although formally recognized by the National Cancer Institute in 2020, patients continue to report challenges in accessing AFC. Social media platforms may serve as an important source of support and education for patients considering this option. We characterized patient perspectives and experiences related to AFC through analysis of discussions on Reddit and TikTok. Using the search term "flat," posts from the r/breastcancer forum were reviewed within Reddit's 1,000 post-and-comment visibility limit. AI-assisted thematic analysis was used to identify recurring discussion themes. TikTok was searched using the terms "going flat," "going flat mastectomy," and "aesthetic flat closure." A total of 370 Reddit posts and 74 TikTok posts met inclusion criteria for relevance to AFC. Posts were most often neutral in tone; however negative sentiment was nearly three times more common on Reddit than TikTok (28.9% vs. 11%). On Reddit, the most common area of discussion was comparison of AFC with other post-mastectomy reconstructive options. "Flat denial," defined as neglecting to perform a true AFC either intentionally or inadvertently, appeared more frequently on Reddit (8.4% vs. 4.0%). AI analysis identified recurring themes including flat denial, inadequate counseling, and misinformation regarding AFC. While discussions surrounding AFC were often neutral or positive, concerns regarding inadequate information, patient counseling, and flat denial persist. These findings highlight the need for greater surgeon familiarity with AFC and more comprehensive patient education on post-mastectomy options.