Patients and Providers for Optimal Aesthetic Flat Closure

Aesthetic flat closure (AFC) is reconstruction of the chest wall contour.

Institutions support AFC.

…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

“Many people think of reconstructive surgery as breast reconstruction with tissue flaps or implants. But aesthetic flat closure — considered to be the gold standard for going flat — is also a form of reconstructive surgery.”


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

“In a total mastectomy with a flat closure, the entire breast, including nipple, extra skin, fat, and other tissue in the breast area are removed. The remaining skin is tightened and sewn together.

National Comprehensive Cancer Network (NCCN) 2022 Patient Guidelines

Medical professionals support AFC.

“Aesthetic flat closure IS a type of reconstruction and is a very powerful choice that deserves just as much care and respect as any other reconstructive surgery.”

Dr. Ron Israeli
Plastic & Reconstructive Surgeon, NYBRA Plastic Surgery

“Patients deserve aesthetic flat closure.”

Drs. Jennifer Baker & Deanna Attai, ASO Author Reflections

“Many women have begun to embrace Flat Closure as a movement and a way of life. Flat Closure is a chance for women to accept their new, post-breast cancer bodies as both beautiful and valid.”

Midwest Breast & Aesthetic Surgery

“I think ‘going flat’ just refers to removal of the breast and no reconstruction, and what it should refer to is removal of the breast, no reconstruction, and the surgeon doing everything they can to make it look nice and neat.”

Dr. Deanna J. Attai for the Breastcancer.org podcast

“We believe patients should be fully informed of all their breast reconstruction options, as well as the option of aesthetic flat closure (no reconstruction with a nicely-contoured, truly flat result). It is only once all the options are fully discussed, that patients can take part in a shared-decision-making conversation with their surgical team.”

Minas Chrysopoulo MD, PRMA Plastic Surgery

Patients expect AFC.

“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

“It’s hard enough to have a double mastectomy due to breast cancer, but to have to fight insurance just to be able to look halfway decent and be somewhat comfortable in your own skin is wrong.”


“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.

“Going Flat” After Mastectomy: Patient-Reported Outcomes by Online Survey” (Baker et. al., 2021)

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

“Going Flat” After Mastectomy: Patient-Reported Outcomes by Online Survey” (Baker et. al., 2021)

Spread the Word!



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)

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) logo
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.
AMSOB Germany Flat Closure
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.
[RETIRED] Flat & Fabulous was a nonprofit organization with a large Facebook support group for women facing surgery, advocating and support for those living post mastectomy without reconstruction. Flat & Fabulous was retired in 2021.

Center for Institutional Courage Dr. Jennifer Freyd’s nonprofit organization dedicated to promoting institutional courage
Other Advocacy Efforts We Support

The Breast Advocate App
a decision aid for patients deciding on reconstruction options
Busting Free
The award-winning self-help book for patients considering, moving through, or recovering from explant.
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
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

GF Made (Formerly, Going Flat: Thrifty Fashion for the Boobless)
Chiara D’Agostino’s MBC and flat advocacy. [RIP Chiara August 04, 2020]
You Do You Sweets - Clothing for Breast Cancer Survivors
You Do You Sweets – Clothing for flat breast cancer survivors & more!
Learn Look Locate
Breast cancer information and inspiration, including Global Flatties!
Global Patient Advocacy Coalition (GPAC)
Breast implant illness advocacy organiation.
“Flat & Happy”
guidebook by Katrin van Dam

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