Institutions support AFC.
"Many people think of reconstructive surgery as breast reconstruction with tissue flaps or implants. But aesthetic flat closure — considered to be the gold standard for going flat — is also a form of reconstructive surgery."
"Discussion of all options, including flat closure, is vital to guide shared decision making and empower patient choice regarding BRRM… Surgeons should elicit the patient’s preference for reconstruction and offer the option of aesthetic fat closure.”
"aesthetic flat closure:
A type of surgery that is done to rebuild the shape of the chest wall after one or both breasts are removed..."
"In a total mastectomy with a flat closure, the entire breast, including nipple, extra skin, fat, and other tissue in the breast area are removed. The remaining skin is tightened and sewn together."
National Comprehensive Cancer Network (NCCN) 2022 Patient Guidelines
Medical professionals support AFC.
“Aesthetic flat closure IS a type of reconstruction and is a very powerful choice that deserves just as much care and respect as any other reconstructive surgery.”
Dr. Ron Israeli
Plastic & Reconstructive Surgeon, NYBRA Plastic Surgery
“Patients deserve aesthetic flat closure.”
Drs. Jennifer Baker & Deanna Attai, ASO Author Reflections
“Many women have begun to embrace Flat Closure as a movement and a way of life. Flat Closure is a chance for women to accept their new, post-breast cancer bodies as both beautiful and valid.”
“I think ‘going flat’ just refers to removal of the breast and no reconstruction, and what it should refer to is removal of the breast, no reconstruction, and the surgeon doing everything they can to make it look nice and neat.”
Dr. Deanna J. Attai for the Breastcancer.org podcast
“We believe patients should be fully informed of all their breast reconstruction options, as well as the option of aesthetic flat closure (no reconstruction with a nicely contoured, truly flat result). It is only once all the options are fully discussed, that patients can take part in a shared decision-making conversation with their surgical team.”
Insurance companies support AFC.
Are group health plans and issuers offering group or individual health insurance coverage that cover mastectomies required to provide coverage for chest wall reconstruction with aesthetic flat closure as a type of breast reconstruction under WHCRA? “Yes… This includes coverage for chest wall reconstruction with aesthetic flat closure… as a required type of reconstruction.”
Patients expect AFC.
“My surgeon gave me a handout on going flat, along with the info about reconstruction, at my first meeting with her… She did a perfect job on my chest.”
― Anonymous
“It’s hard enough to have a double mastectomy due to breast cancer, but to have to fight insurance just to be able to look halfway decent and be somewhat comfortable in your own skin is wrong.”
- April
“I knew I wanted to be flat from the very beginning [but] I was given a skin-sparing mastectomy. I did not consent to that outcome, nor did ever imply that it was anything I wanted. I am devastated.”
― Anonymous
We face multiple cultural and institutional barriers to ensure that a woman’s choice to go flat is respected, every time. We now have clear language – aesthetic flat closure. But paternalism, protectionism, lack of a defined standard of care, sub-optimal prevalence of oncoplastic training for general surgeons, and an off-kilter reimbursement system are all pieces of the puzzle we still need to address.
FLAT Stats
Of all mastectomy patients choose to go flat (aesthetic flat closure).
National Trends in "Going Flat" After Mastectomy (Johnson et. al., 2023)
Three of every four patients going flat are satisfied with their aesthetic outcome.
“Going Flat” After Mastectomy: Patient-Reported Outcomes by Online Survey” (Baker et. al., 2021)
About 1 in 20 patients going flat – that’s a 5% risk for each woman who chooses flat closure – are subjected to intentional flat denial.
“Going Flat” After Mastectomy: Patient-Reported Outcomes by Online Survey” (Baker et. al., 2021)
Shareable Graphics
#aestheticflatclosure
#putflatonthemenu
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#blacklivesmatter
NPOAS stands in full solidarity with the Black community against racism & injustice. The right to bodily integrity is universal and all-encompassing, and there is no greater violation than the taking of an innocent life. (Learn more about BLM)
Work We Support
Facing Our Risk of Cancer Empowered (FORCE) provides information and support to individuals and families affected by hereditary breast, ovarian, and related cancers.
Angela (Jersi) Baker’s nonprofit providing complementary services to breast cancer patients in treatment
Flat Friends UK is dedicated to supporting women who have had single or double mastectomy surgery without breast reconstruction
A volunteer-led, non-profit organization that funds vital research to help improve the longevity and quality of life for MBC patients.
Young Survival Coalition hosts a quarterly virtual hangout on Zoom for flatties and unis to talk about everything that comes with going flat after mastectomy!
National Coalition for Cancer Survivorshop | Cancer Policy & Advocacy Team (CPAT)
CPAT provides cancer survivors and caregivers with tools and training that build upon their personal experiences to become effective advocates to improve cancer care.
Other Advocacy Efforts We Support
Linkage Beauty Movement
We at Linkage Beauty Movement are here to stand firm in Beauty, Confidence, Acceptance and Strength. Guiding women into positive body ownership and appreciation for what we are chosen to bear.
Busting Free
The award-winning self-help book for patients considering, moving through, or recovering from explant.
Less Than Two Breasts
An advocacy campaign to normalize bodies after breast cancer and to rethink cultural concepts of femininity.
Penser le Sein Feministe
Marie-Claude Belzile’s new book (in French) – deconstructing the cultural narrative about going flat. Purchase your copy here!
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