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)

Patients and Providers for Optimal Flat Closure: It’s About Full Disclosure and Informed Consent.

Aesthetic flat closure is reconstruction of the chest wall contour.

Institutions support flat closure.

…The consortium focuses on oncoplastic breast conserving surgery, nipple/skin sparing mastectomy with immediate reconstruction and optimal flat closure after conventional mastectomy.

Oncoplastic Breast Consortium

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…”

National Cancer Institute, Dictionary of Cancer Terms

Women facing mastectomy deserve full disclosure of all of their reconstructive options, including aesthetic flat closure, and to have their informed consent respected.

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.”

― Anonymous

Flat Denial: Why Does it Happen?

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).



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.

NPOAS Surveys 2018-19

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Work We Support

Nonprofit Organizations
The Grace Project
Charise Isis’ beauty through mastectomy photography project.
The Oncoplastic Breast Consortium ‘s mission is to bring safe and effective oncoplastic breast surgery to routine patient care.
Facing Our Risk of Cancer Empowered (FORCE) provides information and support to individuals and families affected by hereditary breast, ovarian, and related cancers.
Flat Friends UK is dedicated to supporting women who have had single or double mastectomy surgery without breast reconstruction
The NCHR 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.
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.
Ablatio Mammae – selbstbewusst ohne Brust (AMSOB) is an advocacy nonprofit based in Germany that promotes flat as a viable “third option”
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.
Tigerlily Foundation is a national breast cancer foundation providing education, awareness, advocacy and hands-on support to young women (15-45) – before, during and after breast cancer.

Touch, The Black Breast Cancer Alliance, brings stakeholders together to collaborate with accountability to end Black Breast Cancer.
Flat & Fabulous is a nonprofit organization with a large Facebook support group for women facing surgery, advocating and support for those living post mastectomy without reconstruction

Other Advocacy Efforts We Support
Complètement FEMME – l’audace d’être entière après une mastectomie – Pascale Contrino, artist and designer in France
Tout aussi femme is Marie-Claude Belzile’s flat advocacy project on social media in Quebec
Catherine Guthrie’s memoir about her experience going flat
FLAT is where it’s at
Stephanie Astalos Jones
Annual event celebrating FLAT – featuring the Flat is Beautiful brochure
Less Than Two Breasts
An advocacy campaign to normalize bodies after breast cancer and to rethink cultural concepts of femininity. 
Wildfire Magazine
The only magazine for the women “too young” for breast cancer.
Trine Amazon
Denmark’s Magical Uniboob and Queer Ninja’s visibility and advocacy work
Ngozi Ejedimu’s breast cancer awareness, visibility & support in Nigeria
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.
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!

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 .
The Flat Advocate is Katie Fink’s flat visibility on social media project in the US

Chiara D’Agostino’s MBC and flat advocacy. [RIP Chiara August 04, 2020]


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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.

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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.