Aesthetic Flat Closure For Obese Women Bilateral Mastectomy

Posted by srobinet @srobinet, Feb 27 6:24pm

I would like to hear from anyone who had a high BMI and chose Aesthetic Flat closure. My BMI mine is like 42-43. I am 5'3 and current weight is 223. I have a large chest 44D. I have been dieting but it is a slow process but down 14 lbs since mid January.

My surgeon has told me that she can't do anything about what she calls dog ears. She has promised that she will take a great deal of time while I'm under trying to give me the best outcome possible. I realize that my BMI is my own fault so no fault to the surgeon. My size is not making it easy for her. I was just curious about how other's surgery might have turned out.

I'm so ready to be done with this. My surgery is in 11 days.

Interested in more discussions like this? Go to the Breast Cancer Support Group.

tillymack | @tillymack | Feb 27 9:50pm

I'm interested in Aesthetic Flat closure as well. Have you searched online? I did so recently and found a very helpful site, but unfortunately I don't remember the terms I used...

Rubyslippers | @triciaot | Feb 27 10:06pm

An oncology surgeon may not have the skill to eliminate dog ears, but a plastic surgeon should regardless of weight, IMHO. My BMI is 22 and there was still an issue with getting the skin to lay flat. The plastic surgeon cut an extra horizontal line, about 2” long on each side, runs around my rib cage. Without that, I would have had puckering, like dog ears. I didn’t know he was going to need to do it beforehand, but the extra sutures didn’t matter to me because eventually they become almost unnoticeable. In my case, I did not have a mastectomy. I had a lumpectomy with a re-arrangement of the breast tissue to hide that area, and surgery on the other breast to match size.

I went looking for an answer because it just bugs me that a doctor does not have enough concern to figure out a solution! Just consider what a plastic surgeon can do on faces and necks!
Here’s an article about closure of aesthetic flat closure without dog ears, for all body types.
“We describe a new versatile technique, the double S mastectomy technique which provides superior access to axillary tissue and allows the resection of variable amounts of excessive tissue at the medial and lateral ends. The double S mastectomy also offers superior exposure without necessity for extension of the incision when broad access to the axillary compartment is sought. The lateral dog ear will effectively be prevented without further scars. In addition, the double S incision can be adapted to the tumor localization when eccentric skin resection is required. It is an easy technique to reproduce with good cosmetic results if planned properly.”

Caution, it does have before/after photos in the article.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8862225/

srobinet | @srobinet | Feb 27 10:27pm

I have insurance through the VA. I unfortunately do not have time to go through all the hoops to get a new referral and then wait for a consult appointment. This could add weeks to my treatment timeline. I received my diagnosis in early January with DX mammogram in December 2025. I have a grade 3 cancer which is aggressive. I I will go ahead with my 3/10/25 surgery date. I am going to hope for the best. My surgeon is a woman so I'm sure she will try everything she can. She said that they have techniques that they can use to minimize the extra skin.

Since breast reconstruction is covered by insurance I am hoping a revision might be as well. I did not want implants and the other option would be using some of my own skin but that carries much more of a risk due to infection and my size.

cmb93 | @cmb93 | Feb 28 10:54am

Being 5’3 and obese with BC diagnosis I knew exactly what I wanted after reading this article. https://cancerblog.mayoclinic.org/2024/01/11/goldilocks-surgery-finding-the-perfect-balance-in-breast-cancer-reconstruction/ Absolutely loved the outcome. May not be for everyone but just wanted to share that the Goldilocks was a great option for me. Prayers and blessings for you on this journey.

srobinet | @srobinet | Feb 28 5:28pm

In reply to @cmb93 "Being 5’3 and obese with BC diagnosis I knew exactly what I wanted after reading this..." + (show)

@cmb93 I did see the Goldilocks option while doing research. The surgeons in my area from what I could find out do not do this type of reconstruction. I will double check though with my surgeon.

anatomary | @anatomary | Mar 1 7:54am

I wanted the Goldilocks, but I was too thin! Can we ever win? Anyway, I went with the flat closure- and I'm very happy with my results. I am about eight months out and I have a Chihuahua ear on my right side. I have been told that can be corrected by liposuction or a resection of the tissues; many report the resection (small surgery to remove skin and extra fatty tissue) can be done in the office under local anesthetic. Here are a couple of other websites where you can explore and ask person's opinions. https://notputtingonashirt.org/

Facebook group - Fierce, Flat, Forward. This is a private group so you have to ask to join; I think I had access within a day or two https://facebook.com/groups/1445398828930324/

Good luck with your journey- and best wishes for your desired outcome!