Not Putting on a Shirt is a 501(c)(3) organization advocating for optimal surgical outcomes for women who choose to go flat after mastectomy.

It’s About Full Disclosure and Informed Consent.

Women who choose to go flat after mastectomy deserve full disclosure of ALL of their reconstructive options, and to have their informed consent respected.

Core Values

Clear Language

Flat closure is reconstruction of the chest wall contour.

Flat denial is when a surgeon disregards the patient’s consent and fails to perform the agreed upon flat closure.

Full Disclosure

Women must be given full and accurate information about ALL of their reconstructive options, including flat closure.

Shared Decision Making

The decision making process must center the patient’s values and priorities from start to finish for optimal surgical outcomes.

Evidence-Based Medicine

An optimal, evidence-based standard of care must be developed for flat closure in order to ensure women consistently receive acceptable surgical outcomes.


Respect for women’s informed consent is non-negotiable. Surgeons who intentionally disregard a woman’s reconstructive choice must be held accountable.

Fair Reimbursement

Surgeons deserve to be fairly reimbursed for flat closure and revision services, as flat closure is a truly reconstructive, NOT cosmetic, procedure.

Systemic Parity

Achieving parity for flat closure requires systematic legislative and regulatory change. Both the NCI and WHCRA’s definitions of “breast reconstruction” as well as the NAPBC’s reconstructive consult protocol must all be amended to explicitly include flat closure.

Patients speak out

“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

“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.”

― Anon. Victim of Flat Denial

Flat closureis chest wall reconstruction.

FLAT Stats


Of all mastectomy patients choose to go flat.



Three of every four patients going flat are satisfied with their cosmetic outcome.

NPOAS Survey 2018

1 in 20

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 at the hands of an unethical provider.

NPOAS Surveys 2018-19

Why Does Flat Denial Happen?

How did we get to a place where women are being routinely denied their reconstructive choice, in 2019, the year of #metoo … and no one is held accountable?

The problem is multifaceted, with many contributing factors that must be addressed in order to ensure that a woman’s choice to go flat is respected, every time. Paternalism, protectionism, lack of a defined standard of care, sub-optimal oncoplastic training for general surgeons, and an off-kilter reimbursement system are all pieces of the puzzle.

Work We Support

About Us

Not Putting on a Shirt is a 501(c)(3) organization advocating for optimal surgical outcomes for women who choose to go flat after mastectomy.


This site contains copyrighted material. Not Putting on a Shirt’s educational materials and resources on this site are freely available for “fair use” (Title 17 U.S.C. Section 107) in accordance with our mission to advocate for optimal outcomes for those who choose to go flat after mastectomy.  The copyrighted material on this site is distributed for educational purposes without profit – all donations to Not Putting on a Shirt directly fund our advocacy work. If you wish to use copyrighted material from this site for purposes that go beyond “fair use”, you must first obtain explicit permission from the copyright owner. Please direct requests or questions to NotPuttingonaShirt@gmail.com.

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