Legal Milestone in the Fight Against Flat Denial
In a first-ever legal victory for the flat advocacy movement, a woman in California has successfully held her surgeon accountable after she experienced what is known as flat denial—being left with excess skin after a mastectomy despite having clearly chosen to go flat.
The case was resolved through arbitration, where the arbitrator found in her favor and awarded her a financial settlement. While the terms of the arbitration are confidential, this outcome marks a powerful affirmation of a patient’s right to bodily autonomy and informed consent.
What is Flat Denial?
Flat denial occurs when a patient explicitly chooses to go flat after mastectomy, but their surgeon disregards that choice—often leaving excess skin “just in case you change your mind about reconstruction.” This practice is not only unethical, it is a violation of informed consent. Our survey from 2019 suggested that roughly 3-4 in 20 women going flat experience this kind of surgical betrayal (either intentional or negligent flat denial). Further larger scale research is needed to confirm these figures.
This legal win sends a strong message:
To patients: You do have legal recourse if your wishes are not honored.
To surgeons: Patient autonomy is not optional. Violating it has consequences.
To advocates and allies: Change is possible, and accountability is critical.
Statement from the Woman in California
“In 2006, I was diagnosed with an aggressive, rare form of breast cancer. I was terrified—but also relieved that reconstruction would be covered by my insurance. That hadn’t been the case for my mother. She had two radical mastectomies in the 80s with no reconstruction options. Her marriage didn’t survive, and tragically, neither did she. She passed away at just 50. I was 30 when I lost her.
So when I was offered immediate reconstruction after my double mastectomy, I was grateful. My plastic surgeon reassured me that silicone implants were safe and monitored under a case study. I believed her. I just wanted to get through treatment and go back to my life.
But soon after, my health declined. I had unexplained rashes, muscle spasms, neuropathy, memory loss, and chronic fatigue—yet no one thought to link it to my implants. Years later, in 2018, I found a lump under my arm. It turned out my implant had silently ruptured. Silicone had spread throughout my body.
I had the implants removed—but again, under pressure from my surgeon, I agreed to have them replaced. That surgery wrecked me physically and emotionally. The new implant never looked right and caused pain. I begged for them to be removed for good. I made it clear I wanted a smooth, flat closure—but I woke up disfigured and devastated. After my surgery, my surgeon avoided seeing me for weeks. It wasn’t until I insisted that she finally saw me—three weeks later. To my disbelief, she actually asked if I wanted my implants put back in. I was in complete shock. In that moment, it became painfully clear to me: she had never truly supported my decision to explant. It felt like removing the implants was an insult to her professional pride, and she had never intended to honor my wishes from the start.
I looked mutilated. My self-esteem crumbled. My marriage suffered. After 40+ years together, my husband and I were no longer intimate. I questioned if he still loved me. The toll was heartbreaking.
That’s when I found a support group of women who had gone through the same thing. Their strength gave me courage. In 2019, I found a compassionate surgeon who gave me the closure I had originally wanted—one that restored not just my chest, but my sense of self.
I also found a lawyer—something that’s not easy to do in cases like mine. I was fortunate. I had documentation, emails, and photos to support what had happened. I sued my plastic surgeon for medical battery, and my husband sued for how our marriage had suffered. The surgeon’s attorney tried to blame me, saying I had “consented” to the outcome. But I hadn’t. I had trusted her. That trust was betrayed. Thankfully, I won my case—it could have gone either way, but justice was served.
Years later, I’m still healing. My physical scars are faded, but the emotional ones—especially in my marriage—run deep. But I refuse to let this break me. I now advocate for other women, helping them find doctors who truly listen and respect their choices.
Breasts—or no breasts—should never define who we are. We deserve dignity. We deserve to be heard.”
We Are Grateful
We are grateful to this brave woman for pursuing justice and helping to advance protections for others. Her courage has created an opportunity for other victims of flat denial to seek redress, and for ethical surgeons to speak out against this unacceptable practice within their field.
NPOAS will continue to work toward a medical culture that respects flat as a valid and equal post-mastectomy option.
