48-year-old female with stage two left breast cancer elects to proceed with bilateral mastectomy and aesthetic flat closure. She is morbidly obese with a history of gastric bypass, and despite this, she has an excellent result after surgery. The most challenging portion of these procedures is insuring a flat lateral contour with no step off between the mastectomy incision in the front and her sides where she had significant excess fat. Her lower mastectomy incisions are placed in the breast crease and her fatty pre axillary areas  require debulking to obtain a flat closure.  Doctor Schwartz has published and been invited to lecture on an innovative technique to achieve excellent outcomes in obese patients who desire aesthetic flat closure. She is shown four months after her bilateral mastectomy and aesthetic flat closure.