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 facing mastectomy deserve full disclosure of ALL of their reconstructive options, and to have their informed consent respected.

Our 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 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 closure” is reconstruction of the chest wall contour.

FLAT Stats


Of all mastectomy patients choose to go flat.



Three of every four patients going flat are satisfied with their aesthetic 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 prevalence of oncoplastic training for general surgeons, and an off-kilter reimbursement system are all pieces of the puzzle.

Work We Support

Nonprofit Organizations
Flat Friends UK is dedicated to supporting women who have had single or double mastectomy surgery without breast reconstruction
The NCRH conducts, analyzes, and explains the latest research and works with patients, consumers, and opinion leaders to use that information to improve their own health and to develop better programs, policies, and services.
Working for health justice for all women at risk of and living with breast cancer (including the Think Before You Pink project)
Educating and increasing awareness regarding breast implant safety.
Advocating and support for those living post mastectomy without reconstruction

Young Survival Coalition (YSC) strengthens the community, addresses the unique needs, amplifies the voice and improves the quality of life of young adults affected by breast cancer, locally, nationally and internationally.
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.
Angela (Jersi) Baker’s nonprofit providing complementary services to breast cancer patients in treatment
Shay Sharpe’s organization which grants wishes to young women with MBC
A volunteer-led, non-profit organization that funds vital research to help improve the longevity and quality of life for MBC patients.
Other Advocacy Efforts We Support
Tout aussi femme is Marie-Claude Belzile’s flat advocacy project on social media in Quebec
The Flat Advocate is Katie Fink’s flat visibility on social media project in the US
Catherine Guthrie’s memoir about her experience going flat
Barbara Kriss’ information, advice and support website for women considering going flat as well as those who are living flat
Nancy’s Point
A blog about breast cancer and loss.
Insight and cutting honesty about this terrible disease from author and survivor Nancy Stordahl .
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.
FLAT is where it’s at
Stephanie Astalos Jones
Annual event celebrating FLAT – featuring the Flat is Beautiful brochure
Chiara D’Agostino’s MBC and flat advocacy
The Grace Project
Charise Isis’ beauty through mastectomy photography project
Blooming Cancer
Juliet Fitzpatrick’s visibility and advocacy project in the UK (also on Facebook)
Penser le Sein Feministe
Marie-Claude Belzile’s new book (in French) – deconstructing the cultural narrative about going flat. Purchase your copy here!

Trine Amazon
Denmark’s Magical Uniboob and Queer Ninja’s visibility and advocacy work

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.

Policies and Disclosures



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 info@notputtingonashirt.org.