{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T18:36:20Z","timestamp":1780079780123,"version":"3.54.0"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Over 14,000 UK women undergo mastectomy annually, 70% of whom do not undergo breast reconstruction. These women are often left with suboptimal scars.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to explore the attitudes of women towards their mastectomy scars, particular the aesthetic outcomes, and to raise awareness of the importance of achieving aesthetic flat closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Semi\u2010structured interviews with women who had undergone mastectomy without reconstruction were recruited from a single UK teaching hospital. Thematic analysis was performed using the Framework Approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty women aged 47\u201391\u00a0years old were interviewed in 2024. Themes identified: satisfaction with scar cosmesis, physical impacts of scars, attitude towards flat mastectomy scars, body image and confidence, pre\u2010operative counselling and scar revision surgery. There was widespread patient dissatisfaction with mastectomy scar cosmesis, although attitudes and emotional responses varied. Women viewed their scars as a necessity. Physical symptoms included discomfort from dog ears chafing on bra straps, or scar tightness restricting arm or shoulder mobility. Most women were interested in scar revision surgery, with some requesting more information, or referrals. Those who had scar revision surgery or chose contralateral symmetrising mastectomy displayed more positive attitudes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study found considerable patient dissatisfaction with mastectomy scar cosmesis and demonstrated the profound impacts of poor cosmetic outcomes, highlighting the importance of optimising aesthetic outcomes and the need for scar revision surgery to help women achieve aesthetic flat closure. These findings demonstrate the importance of careful pre\u2010operative planning and good surgical technique with more time allocated to manage expectations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70436","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T04:14:13Z","timestamp":1774584853000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Insights Into \u2018Living Flat\u2019: A Qualitative Study of Patients Who Have Mastectomy Without Reconstruction"],"prefix":"10.1002","volume":"35","author":[{"given":"Laura","family":"Lyons","sequence":"first","affiliation":[{"name":"Division of Clinical Medicine University of Sheffield Medical School  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0988-0353","authenticated-orcid":false,"given":"Charlene","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Clinical Medicine University of Sheffield Medical School  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynda","family":"Wyld","sequence":"additional","affiliation":[{"name":"Division of Clinical Medicine University of Sheffield Medical School  Sheffield UK"},{"name":"Doncaster and Bassetlaw Teaching Hospitals NHS Trust Jasmine Center Doncaster Royal Infirmary  Doncaster UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"King","sequence":"additional","affiliation":[{"name":"Flat Friends UK  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Brunsden","sequence":"additional","affiliation":[{"name":"Flat Friends UK  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5337-5581","authenticated-orcid":false,"given":"Jenna","family":"Morgan","sequence":"additional","affiliation":[{"name":"Division of Clinical Medicine University of Sheffield Medical School  Sheffield UK"},{"name":"Doncaster and Bassetlaw Teaching Hospitals NHS Trust Jasmine Center Doncaster Royal Infirmary  Doncaster UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Cancer Research UK. \u201cBreast Cancer Statistics \u201d : [Online] accessed September 16 2022 https:\/\/www.cancerresearchuk.org\/health\u2010professional\/cancer\u2010statistics\/statistics\u2010by\u2010cancer\u2010type\/breast\u2010cancer#heading\u2010Zero."},{"key":"e_1_2_12_3_1","unstructured":"R.Jeevan D.Cromwell J.Browne et\u00a0al. National Mastectomy and Breast Reconstruction Audit 2011 (2011)."},{"key":"e_1_2_12_4_1","unstructured":"F.MacNeill C.Lead T.Irvine et\u00a0al. Breast Surgery GIRFT Programme National Specialty Report\u2019 Getting it Right First Time (2021) accessed November 11 2025 https:\/\/gettingitrightfirsttime.co.uk\/wp\u2010content\/uploads\/2021\/09\/BreastSurgeryReport\u2010Jul21p.pdf."},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/JAMASURG.2014.548"},{"issue":"3","key":"e_1_2_12_6_1","first-page":"409","article-title":"Immediate Breast Reconstruction After Mastectomy\u2010\u2010Why Do Women Choose This Option?","volume":"9","author":"Shameem H.","year":"2008","journal-title":"Asian Pacific Journal of Cancer Prevention"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004272.PUB3"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bodyim.2023.07.009"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/gox.0000000000004327"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpra.2025.08.024"},{"key":"e_1_2_12_11_1","unstructured":"National Cancer Institute. \u201cDictionary of Cancer Terms Aesthetic Flat Closure \u201d https:\/\/www.cancer.gov\/publications\/dictionaries\/cancer\u2010terms\/def\/aesthetic\u2010flat\u2010closure#:~:text=A%20type%20of%20surgery%20that used%20to%20restore%20breast%20shape."},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.13781"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010020\u201009448\u20109"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/nuf.12714"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549\u2010022\u201006756\u20104"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2025.109878"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2022.11.173"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u201013\u2010117"},{"key":"e_1_2_12_19_1","first-page":"295","volume-title":"Qualitative Research Practice a Guide for Social Science Students & Researchers","author":"Spencer L.","year":"2003"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203413081_chapter_9"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyt176"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010020\u201000926\u20103"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/03630242.2017.1310169"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/0361684310395606"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002820\u2010200306000\u201000002"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.4103\/apjon.apjon_25_17"},{"key":"e_1_2_12_27_1","unstructured":"Not Putting on a Shirt. \u201cGoing Flat After Mastectomy Survey 2018 \u2010 Report 2019 \u201d https:\/\/notputtingonashirt.org\/2019\/04\/20\/npoas\u2010survey\u20102018\u2010report\/."},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1053\/otgn.2002.35344"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2015.12.068"},{"key":"e_1_2_12_30_1","unstructured":"A.Ketley C.Martin L.Wyld N.King S.Brunsden andJ.Morgan \u201cWhat Makes a \u2018Good\u2019 Mastectomy? \u2013 A National Qualitative Study of Health Care Professionals Opinions on Mastectomy Without Reconstruction \u201d ."},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2021.08.017"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010023\u201014294\u20106"},{"key":"e_1_2_12_33_1","unstructured":"SDM NICE NICE. \u201cShared Decision Making NICE Guideline \u201d (2021): [Online] www.nice.org.uk\/guidance\/ng197."},{"key":"e_1_2_12_34_1","unstructured":"NICE. \u201cPatient Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult NHS Services Clinical Guideline \u201d (2012): [Online] www.nice.org.uk\/guidance\/cg138."},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnr.2019.03.002"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549\u2010023\u201007240\u20103"},{"key":"e_1_2_12_37_1","article-title":"Oncoplastic Breast Reconstruction Guidelines for Best Practice","author":"Rainsbury D.","year":"2012","journal-title":"Association Breast Surgery"},{"key":"e_1_2_12_38_1","unstructured":"J.Pereira R.Jeevan D. 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