Pioneers in Flat Advocacy: Catherine Guthrie


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.


Catherine Guthrie

Catherine Guthrie is a women’s health journalist whose work has appeared in dozens of national magazines from O, The Oprah Magazine to Time Magazine to Good Housekeeping. She was diagnosed with breast cancer at age 38 and elected a double mastectomy, rejecting reconstruction in favor of preserving her physical strength and bodily integrity. Her queer, feminist cancer memoir, FLAT: Reclaiming my body from breast cancer, was published in 2018. Catherine appeared with NPOAS founder Kim Bowles on the Today Show to discuss her exposé on flat denial for Cosmopolitan Magazine. Listen to her NPR interview or visit her website to learn more.


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

“Going flat felt like the least barbaric of my options. Because I have a small frame the only reconstructive choice given to me at the time was the Latissimus dorsi flap, which meant severing my back muscle, tunneling it under my arm, and laying it over a breast implant. My other breast was small, so the surgeon advised me to get an implant on that side too, for symmetry. He said most women just wanted to look normal in clothes.”

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

“I am lucky that my breast surgeon respected my choice to go flat and had the skills to deliver. It sounds naïve, but, 11 years ago when I had my surgery, I never for a minute thought my surgeon wouldn’t respect my choice. It’s depressing as hell that I am grateful not to have been violated.”

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

“For me, becoming an advocate was less of a choice and more of an awakening to the deep roots of misogyny in breast cancer care. Everything about breast cancer care orients to the assumption that a woman without breasts is a travesty. As soon as I started seeing how the male gaze shapes breast cancer care, I couldn’t see anything else. As a women’s health journalist, it was (and is) my responsibility to shine a light on it.”

What is your proudest accomplishment as an advocate?

“My proudest accomplishment has been writing an exposé on flat denial published on Cosmopolitan Magazine’s website. A close runner-up was finding out the article was discussed at length at an international conference of breast surgeons. That level of global impact felt amazing, and it never would have happened without Kim Bowles’ bravery.”

What has been your biggest challenge as an advocate?

“Editors’ eyes glaze over the minute you say breast cancer. Getting past publishing’s gatekeepers is a huge hurdle. My biggest challenge is finding and writing stories that grab an editor’s attention and show them a side of breast cancer they didn’t know existed.”

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

“Never stop telling your truth.”

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

“I want parity. I want surgeons to present the option to go flat with the same energy, acceptance, and enthusiasm that they present reconstruction. I want surgeons to stop assuming they know what women want and what’s best for women.

“No surgeon would ever think it was acceptable to sever the Latissimus dorsi of a young man. It would not be done. But it is done routinely on women. Recently, a doctor told me that without a Latissimus dorsi, a person can’t use a walker when they are old or infirm because that muscle is needed to propel the walker forward. Think about that for a minute.”

PHOTOL: Kayana Szymczak for The New York Times

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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