Background <p>Understanding the psychosocial impact of mastectomy is crucial for guiding patient decisions on breast reconstruction. The BREAST-Q survey has been instrumental in assessing patient satisfaction. This study examines patient-reported outcomes and experiences with post-mastectomy flat closure, aiming to refine decision-making support for this option.</p> Methods <p>A retrospective review analyzed flat closure outcomes post-mastectomy, examining patient demographics, surgical details, and complications. Following consent, patients completed the BREAST-Q survey, rating satisfaction and factors influencing their choice for flat closure. The study also included qualitative analysis from patient emails, employing an inductive, triangulated approach to extract themes and provide a multifaceted understanding of the post-surgical experience.</p> Results <p>Overall, 252 patients underwent flat closure post-mastectomy. The overall postoperative complication rate was 17.5% (<i>n</i>&#xa0;=&#xa0;44); 19.8% (<i>n</i>&#xa0;=&#xa0;50) completed the BREAST-Q survey, reporting high satisfaction with their surgeons, moderate satisfaction with their breasts, and high physical well-being. Survey results illuminated reasons for choosing flat closure, such as lower complication rates and avoidance of foreign objects. Furthermore, qualitative feedback from 15 email correspondents revealed some limitations of the survey’s relevance and language, highlighting emotional impacts and a desire to improve future surveys.</p> Conclusions <p>This study distills the flat closure experience post-mastectomy, highlighting its viability and alignment with patient preferences for fewer complications and quicker recovery. It reveals the BREAST-Q’s limitations in fully capturing patients’ nuanced experiences, underscoring the necessity for more tailored data collection methods. Future research must refine patient-reported outcome measures (PROMs) and ensure flat closure is a routinely discussed option in post-mastectomy care.</p>