Patient outcomes and experiences of going flat

Expert Guidelines

NCCN has outlined principles of breast reconstruction or going flat following mastectomy surgery.  These include the following:

• All patients undergoing breast cancer treatment should be educated about breast reconstructive options based on their situation. 
• Selection of reconstruction option is bassed on many factors, including cancer treatment, patient preference, obesity, smoking history, comorbidities and patient concerns.  
• Patients may chose not to have breast reconstruction after mastectomy. The option of mastectomy with no reconstruction and optimized closure (aesthetic flat closure) should be part of the discussion of patients' options after mastectomy.  
• Breast reconstruction or going flat should be a shared decision between the patient and their surgeon.

Questions To Ask Your Health Care Provider

• Is going flat an option for me?
• What are the risks and benefits of going flat?
• What are the risks and benefits of having breast reconstruction?
• What are the risks and benefits of having breast-conserving surgery?
• Am I a candidate for an aesthetic flat closure?
• Are there resources that you can recommend if I choose to go flat?
• If I go flat, are breast implants or other reconstructive procedures an option later in life?

Open Clinical Trials

• NCT04491591: Implementing BREASTChoice into Practice. Breast reconstruction after mastectomy is a highly personal decision. A clinical decision support tool, BREASTChoice, with personalized risk information and patient preferences, was created to be used to address these issues. This study is looking at whether the use of BREASTChoice for routine care is more effective than a control website, at improving the quality of reconstruction decisions.

The following are studies related to breast reconstruction or no reconstruction after mastectomy.

• NCT04533373: Sensory Restoration After DIEP Flap Neurotization. The goal of this study is to look at how well a nerve graft works for improving sensation to the reconstructed breast after mastectomy in people undergoing DIEP flap reconstruction. 
• NCT04491591: Implementing BREASTChoice Into Practice. Breast reconstruction after mastectomy is a highly personal decision. A clinical decision support tool, BREASTChoice, with personalized risk information and patient preferences, was created to be used to address these issues. This study will evaluate whether BREASTChoice assists reconstruction decisions.
• NCT04293146: Pre- Versus Sub-pectoral Implant-based Breast Reconstruction After Skin-sparing Mastectomy or Nipple-sparing Mastectomy OPBC-02PREPEC. This study will compare the effect of under-the-muscle versus over-the-muscle reconstruction on quality-of-life outcomes. 

• NCT05020574: Microbiome and Association With Implant Infections. The study is looking at whether people with high amounts of certain types of bacteria are more likely to develop tissue expander-related infections than those with lower amounts of bacteria.