The pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis

Many women with breast cancer are electing to undergo a mastectomy with flat closure as their treatment of choice. This reconstructive procedure creates a smooth flat chest wall after breast removal. The lack of studies on women’s flat closure experiences were striking, sparking the need for additional research. To address this concern, this study sought to describe and explore the pre and post-mastectomy experiences of women choosing a bilateral mastectomy with flat closure after a breast cancer diagnosis. Women’s decision-making, mirror-viewing, and flat closure experiences were examined. Using purposeful sampling, 19 women were interviewed for this qualitative study. The study’s philosophical and methodological foundation was guided by Ricoeur’s hermeneutic phenomenology and included a structural analysis and phenomenological interpretation. The structural analysis revealed two salient elements within which the flat closure experience existed: (a) healthcare clinicians: flat-out denial to overwhelming support and (b) family, friends, society: abandonment to embracement. The phenomenological interpretation uncovered five themes: (a) my body, my choice, (b) fulfilled or shattered expectations, (c) the pendulum of comfort, (d) overcoming a new reality: body acceptance, and (e) moving forward. The study findings highlighted how women felt pressured by family, friends, and clinicians to consider reconstructive surgeries despite their desire to go flat. Many women described their shattered expectations and the raw emotions that surfaced upon viewing their suboptimal flat closure outcomes in the mirror. These experiences led to mirror avoidance, psychological distress, and body image disturbances for some of the women. In learning to accept their new reality, the women discovered various ways to feel comfortable with their bodies at home and in public. Despite resistance from others, decision satisfaction was high among the women. Body image improved with time and flat closure revision surgery. The importance of patient advocacy and support for women choosing flat closure cannot be understated. Nurses can enhance women’s flat closure experiences by offering education that includes flat closure handouts, photo galleries, and resources. Providing supportive environments and addressing expectations can enhance women’s decision-making and mirror-viewing experiences and assist women as they adapt to their new flat bodies.