Pioneers in Flat Advocacy: Sara Bartosiewicz-Hamilton


Pioneers in Flat Advocacy

A blog series designed to highlight and amplify the voices of the flat advocates who blazed the trail and laid the foundation for those that followed.


Sara Bartosiewicz-Hamilton

Together with her late friend Barbie Ritzco, Sara Bartosiewicz-Hamilton founded Flat & Fabulous, a nonprofit organization committed to empowering, advocating and providing support for those who are living post-mastectomy without reconstruction. When Sara and Barbie first started their Flat & Fabulous Facebook support group in 2014, they had no idea how quickly it would take off. As of January 2020, the group has over 8,500 members and is still growing.


When you were making your reconstructive choice, how did you end up choosing flat?

“I actually didn’t choose flat. I had a prophylactic mastectomy at 29 and did expander reconstruction. My body did not get along with implants – I tried silicone and saline. I developed burning pain and, at the same time, was dealing with autoimmune issues. At that time, my doctors did not have an answer whether or not the implants were the issue, they all supported my decision to remove them to see if it would help. Almost 6 years after my PBM [prophylactic bilateral mastectomy], I made the decision to have my implants removed.”

How has your surgical result affected your healing process moving forward?

“Because I was sick when my implants were removed, my surgeon wanted to do so with as little risk as possible. He cut open my mx scars 1-2” and removed the implants. Therefore, I am not flat. I have lumps and bumps. I debate whether or not I want revision – I always come back to not wanting to spend anymore of my life down for the count because of my mx. I’ve realized by being involved in our community, healing isn’t a given – there are serious risks to undergoing surgery. I don’t want to risk my quality of life for a shot at being completely flat. Maybe someday, not today.”

How did you decide that you wanted to be an advocate?

“Shortly after becoming flat, I was planning a vacation for my family. It dawned on me, I had no idea what to do about a swimsuit. I was involved in HBOC communities but needed advice from women who knew because they were living flat. It was then I asked Barbie if we should create a group – three weeks after becoming flat, Flat & Fabulous was born. By the way, I ended up wearing the same suit I wore with rock hard implants😂”

What is your proudest accomplishment as an advocate?

“Barbie really wanted to go viral. When Barbie told me she was dealing with recurrence, I felt entirely helpless. It was the only thing I could think of to do for her to bring one small ray of sunshine to her. The smile she gave me when I told her she did it is something I will never forget. I have talked to Facebook, reporters, surgeons, app creators – I still am most moved when I talk with a woman who was made to feel outcast or abnormal because she is deciding not to have reconstruction. In the early days, 90% or more of our members literally had no idea someone else had chosen to be flat, let alone the vast community we know exists today. I am proud our community successfully delivered the message ‘you are not alone’.”

What has been your biggest challenge as an advocate?

“There is not enough time in the day or energy available to finish the work. I have had life happen in big ways the last few years and have realized I need to step away. It’s difficult to step away from a community I love and helped build. But it’s part of living wholeheartedly.”

What have you learned as an advocate that you would like other advocates to know?

“We all choose how to apply our passion. Advocacy in general can be heartbreaking and stressful. We need to give each other the room to make mistakes and accomplish our goals for our own visions. We need to remember the common goal and understand there are many ways to achieve it, and we may all take different and necessary paths to obtain it. I am grateful for the support system I have with other advocates. We help support and inspire each other. I literally would not have been able to keep our support group running without my team. In the early days, they stepped up and helped me reach goals when all I wanted to do was grieve Barbie. Find your team, and don’t waste time and energy criticizing other advocates.”

What is your vision for flat advocacy generally? What do you want the future to look like for women going flat?

“What do you want the future to look like for women going flat? I am excited to see the landscape of surgical results change. I believe this will become the rule rather than an exception shortly. I know many of us have the ears of surgeons – I am very hopeful they will begin providing flat results during the first operation.

“I believe women need to be presented flat as an option when they are discussing mastectomy I’ve heard from many women who did not voice the thought of going flat for fear of being criticized. Choosing to have a mastectomy is a highly vulnerable time – I did what my surgeons recommended, no questions asked. So changing the conversation and including all viable choices will give each individual a greater opportunity to determine what feels right for them. This takes the continued building of relationships with our medical field and helping them understand why this is so important.

“I believe we need to be allowed to have frank conversations on how these surgeries and treatments impact us as women. I was healthy when I had my pbm – I still find my journey traumatizing. Women who wanted reconstruction and were told it wasn’t an option – they are traumatized. Women who are having treatment for cancer – they are traumatized. The women who can’t heal, the women who are burned from radiation. Those of us who have hysterectomies. We all have experienced trauma.

“Part of our collective healing is sharing this with the general population. They need us to be strong, move on and be victorious warriors. I think it is important for the human population to understand the reality – perhaps this will help humanity – heal, understand each other, grow. We need our moms, sisters, aunts and friends to get better healthcare options. We need women of color to be heard and receive the same level of care. We need better treatment options. For me, the risk of pink washing is that it further perpetuates this rosy outlook on cancer and ‘beating’ it.

“Within the last two months, three active members of our group died. I am part of the SCAR Project – including Barbie, at least six of our sisters have passed. It’s not slowing down – it’s women of all ages. Our community has accomplished so much in a short amount of time, I strongly believe we can use our passion and drive to change the general conversation and landscape  of cancer as well.”


A pioneer may start as a lone voice in the wilderness, but their passion for and commitment to their cause inspires others to join them. This has led to exponential growth in the field of flat advocacy over the last decade or so. In 2020, we have flat photography projects, full length memoirs, nonprofit organizations, communities on social media, and even gatherings across the world… all made possible by the work of the advocates who blazed the trail.

If you know of a pioneer in flat advocacy that you’d like to see featured, please let us know!


Disclaimer: Any and all information published by Not Putting on a Shirt (NPOAS) on behalf of a third party is for informational purposes only and should not be taken as a substitute for medical or legal advice from a licensed professional. Views expressed and claims made by third parties do not necessarily represent the views of NPOAS.


Published by Not Putting on a Shirt

Founder of Not Putting on a Shirt, a mastectomy patients' rights organization that advocates for optimal surgical outcomes for patients going flat.

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