Please share suggestions for any and all things related to BCO

Get rid of the “Waiting for Test Results” forum in “Not Diagnosed But Concerned”. When that forum got added all the new folks who already posted in “Not Diagnosed But Worried” decided they should start additional new thread(s) after their mammograms, biopsie, etc. instead of continuing with their results in their original thread. If they are “Not Diagnosed but Worried” it is already pretty much a given that they are waiting on test results.

I agree with Buttonsmachine. "Aesthetic Flat Closure" is ONE type of surgery. I had unaesthetic or regular old shitty closure so I wouldn't belong. I think "flat" has to be a broader topic.

Totally agree! I'm glad that "aesthetic flat closure" is now recognized enough by the medical community to warrant getting an official name. That really needed to happen.

Let's change it! As someone who went flat after finding what was appealing online and not in a surgeon's office or website (curved incisions along the pectoral muscles) , I think Aesthetic Flat Closure as new language in the NAtional Cancer Institute is hugely important. It will give patients and surgeons much needed language. It's so crappy to have to ask for "no reconstruction" - a choice literally defined by a rejection of mound reconstruction as MT1 pointed out. As for the women whose heath would be compromised by removing excess tissue on their chest (not due to delayed recon) at time of MX, I would think requesting the best "aesthetic flat closure" result possible would still be a desire. Indeed many women choose flat because it is the choice with lowest risk and easiest recovery. I have NEVER heard of anyone requesting to be left with bumpy rolls of skin on their chest. That seems to be from poor surgical skills, or the surgeon deciding "no recon" means the patient will change her mind (completely offensive). Moderators, aesthetic flat closure is on the menu:)

I agree with Abelian that this is a tricky issue.

I want to emphasize that some of us are not even candidates for "aesthetic flat closure." Some of us just had to be patched up in any way we could. Some people are very concave because part of the chest wall had to be removed, some people had skin grafts, and some people have other lumps or bumps due to infection or any number of other reasons when our diagnoses became more complicated.

I totally support the recognition and increased visibility of "aesthetic flat closure" for people who chose and are candidates for that. But does that really mean that those of us with unaesthetic flat closure are not allowed to participate on that forum anymore? I don't think that makes sense.

In my opinion, it would be best to start an "aesthetic flat closure" specific forum for those who are interested in that as a reconstructive choice.

The Breast Reconstruction forum is one forum for all types of reconstruction, and for discussion about all issues related to reconstruction. The Living Without Reconstruction After A Mastectomy forum has up to now been the same thing for those who have had a MX with no breast replacement reconstruction, i.e. a place to discuss any and all issues related to this surgical option and living flat. Personally I think this board already has too many forums and I don't see the benefit in breaking the Living Without Reconstruction forum into two.

Why not just a pinned thread at the top of the forum for discussion of Aesthetic Flat Closure? And perhaps a reference to that option in the description/option under the main forum name. The subject will get more attention if it is in a forum that everyone going flat participates in. And perhaps the forum name should be changed to "Living Flat After A Mastectomy", in recognition that aesthetic flat closure is a type of reconstruction.

We now have a new word for 'flat' and an NCI dictionary reference to boot.

The word, 'reconstruction', as we now know it, implies 'breast mound' surgery. Prior to this moment, choosing 'flat' could easily be confused with 'skin sparing mastectomy'. But now, with the NCI's clarity, it also includes, 'aesthetic flat closure'. At one point, no one knew what a Diep Flap surgery was, but we learned about it and incorporated the idea into our lexicon, just as we are doing this this new term.

Those who choose 'flat', are NOT choosing skin sparing procedures, nor breast mound surgeries, but they are asking for an aesthetically pleasing appearance. Choosing 'aesthetic flat closure' has nothing to do with whether you have chosen unilateral of bilateral 'aesthetic flat closure'. Under the WHCRA, anyone who needs 'reconstruction' can choose to have surgery to their contralateral breast for reasons of symmetry, or not. But when flat is not acknowledged as 'reconstruction', skin sparing surgeries, paternalism and lack of skill, can and does run rampant.

My insurance refused to pay for my surgery because they deemed my contralateral choice of symmetry unnecessary. 20K

People who choose flat need doctors and insurance companies to up their game, gain skills and loose their bias to breast mound surgery. Once this occurs, we can discuss financial parity for those doctors who work to increase their skill and listen to the needs of the women who choose flat closure.

I do not want to define my choice as 'no reconstruction', because my body was most certainly 'reconstructed'. Names are important. Definition is important.

I do understand that not all people who choose 'aesthetic flat closure', 'go flat'. We have options! We can wear any size prosthetic we want. We can forgo their use at home. We can 'go flat' on the daily. 'Going Flat' is a colloquialism.

"Prior to this moment, choosing 'flat' could easily be confused with 'skin sparing mastectomy'."

Uh, no. A skin sparing mastectomy leaves as much of the breast skin as possible, specifically so that a "breast", be it implant or transferred body fat, can be created to fill the skin. A skin sparing mastectomy is generally contraindicated for those who are not having reconstruction. I realize that there are cases where a skin-sparing mastectomy may be done to optimize the amount of skin left to provide a better aesthetic result when going flat, but that is not the usual definition or role of a skin sparing mastectomy.

It seems that there are two different points being made. MT1, I don't think anyone disagrees about the importance of having the NCI identify "aesthetic flat closure" as a surgical procedure. Until your posts, I was not aware of the term or that it is a specific surgical procedure, and as someone who has had reconstruction but often posts to newbies who are struggling with their decision on whether or not to have a MX and if so, whether or not to have reconstruction, this is important information that I will add into my posts going forward.

But the point being made by many others who've posted here is that "aesthetic flat closure" is a surgical procedure and is not a term that represents the entire experience and all the issues related to living flat. Up until now, the Living Without Reconstruction has represented this broader experience. Similarly, the Reconstruction Forum represents all types of reconstruction and all issues related to living with reconstruction. It's not called the DIEP Forum.

Is there a name that you suggest to replace "Living Without Reconstruction After a Mastectomy"? Your point about not defining those who choose to go flat as having "no reconstruction" makes sense. A few posts up in this thread I suggested "Living Flat After A Mastectomy" but it sounds as though you don't like the word "flat" ("'Going Flat' is a colloquialism."). So what's better to represent the full experience, from the decision-making process through the surgery to living one's life with one or both sides flat?

Wrenn, you and me both!

What about "Cosmetic Flat Closure"? In a college journalism class I was taught that newspapers do not use vocabulary above a six grade level (sad, I know), and "aesthetic" qualifies. MT1, I do understand your position but I think if you want women to investigate all their options, the name of the forum matters. As a side note, it is unconscionable that you had to pay out of pocket to achieve the symmetry that you desired. I had lived with 1 ½ breasts for almost twenty years, but if one was going, the half was going too!

I can't tell you the number of women who've told me, "I did not realize that I could choose not to have reconstruction." I think the real point here is to present the options so women investigating can weigh them all and feel they made an educated decision, the best for them.

While I had not heard the term "aesthetic flat closure" prior to this discussion, that is exactly what I wanted. I brought photos of what I wanted (let's be honest, they make women into men these days, so it can be done). I got a PS to close, and my surgeon, who by this point was like a friend because he'd done my Phyllodes surgery in 1997 . . . he said he chose the best PS MD Anderson has. Either the PS did not believe me that I would not change my mind or doesn't know what an "aesthetic flat closure" is when she sees a photo of it. I've come to wonder whether an "aesthetic flat closure" can be accomplished in one surgery, which is one of the reasons I chose it in the first place—to avoid multiple surgeries.

i think we have all made really good points. However, I still don't see why the forum name needs to be changed to something that most people are not familiar with. Changing the forum name isn't going to magically force all doctors to change their surgical methods.

I think the point here is to educate and inform patients that they have this option available to them and they can then ensure that their surgeon understands their desires. To that end, a thread that stays pinned at the top would be much more helpful.

I wear prosthetics every day and even in my bra look just as I did before--it's remarkable, honestly. I am not in denial about the real state of my body but want clothes to fit as they did and don't find wearing forms burdensome in the least. I did not get the aesthetic flat closure I requested and was planning to investigate going to a "makeover your body type of PS" to get it fixed because I know it can be (now that enough time has passed since radiation). Right when I could do it, the world as we knew it came to a grinding halt due to a microscopic virus. I really wanted to avoid that second surgery.

This conversation has been educational for me, though, and while some here may feel frustrated over it, I searched "aesthetic flat closure," and boy, I learned a lot. I showed my PS photos of an AFC, but did not use the term. Would it have helped? I am not entirely certain.

MT1, I think you came up with a great name for the thread in question: Flat closure -is- reconstruction.

Dear Mods and fellow members, it looks like the number of active topics has been declining for some time. This would indicate fewer active members and less interest in BCO on behalf of the general public.

I think there are multiple factors contributing to this unfortunate trend. I am sure we can come up with ideas if the owners and moderators are interested

Moderators, let us know!

What I don't see is how many people are now in the Zoom get togethers instead of posting here.

Mods??? Any feed back?

I was able to update my dx yesterday- it would be nice if you could skip any question. Some, I don't have the answer or don't apply (due to de novo dx), so I just have to pick a random response to move forward.

Also, once I'm logged in and in the Community, it would be nice if Dashboard and My Favorites were always available in the drop down list. As it is, I have to go to Active topics, and then I can see the other options in the drop down list. (Note - I view in portrait mode on my tablet, which resolves the excessive white space issue, but changes the appearance of some of my menus)