2019 Archive

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Coding for Flat Closure

November 25, 2019

There’s no clear pathway to code for for flat closure and revision services. As a result, quite often providers will simply tell the patient they can’t or won’t do the procedure at all. So women are denied services and left with “mangled” chest walls while they’re dealing with breast cancer treatment.

That’s why we are working to facilitate the development of a standard coding protocol, or pathway, for providers to seek reimbursement for flat closure and revision services.

Image: AHRQ

November 21, 2019

At its core, SDM is about returning agency to the patient in the healthcare decision making process against a historical backdrop of paternalism in medicine. In SDM, the process is truly shared between the patient and the provider – the patient brings their individual needs and preferences to the table, the provider brings their medical expertise, and together they come to an optimal decision. This optimal decision serves both the patient’s specific personal needs and preferences, AND their medical needs.

Demand Parity for Flat Closure – Amend the WHCRA

November 18, 2019

The Women’s Health and Cancer Rights Act (WHCRA) is national legislation passed in 1998 which required most insurance companies to cover breast mound reconstruction (BMR) after mastectomy… But there’s a catch… What the WHCRA didn’t cover, was flat closure.

Amending the WHCRA to include insurance coverage for flat closure (chest wall reconstruction) will be a critical step in ensuring these women receive the care they deserve.

Cleveland Clinic Researchers Publish Paper on Aesthetic Flat Closure

October 29, 2019

Beyond the technical impact of this research… the fact that researchers are actively pursuing this means that flat advocacy is making an impact. We are being heard. The medical community is realizing that women going flat expect better – we expect our choice to be honored, and we expect the same respect and consideration for our aesthetic result that women who choose breast mound recon are afforded.

FDA Issues Landmark Recommendations for Implant Manufacturers

October 29, 2019

This is about full disclose of a woman’s reconstructive options (this MUST include flat closure) as well as full information about the risks associated with each of those options. We applaud FDA for taking this important step and we extend our sincere gratitude to the explant advocates who have worked tirelessly at their own expense to be a voice for women on this issue.

NPOAS Will Have a Poster Presentation at SABCS 2019

October 29, 2019

Big news! NPOAS will be presenting a research poster at the San Antonio Breast Cancer Symposium this year, December 10th – 14th. The poster is entitled “Flat closure after mastectomy: are your patients satisfied with the results?”

This poster will weave together results from both of our ad-hoc surveys, and will be a springboard for encouraging researchers in the field to do larger-scale studies with validated tools.

Plastic Surgeons Are NOT Required to Discuss Aesthetic Flat Closure

October 29, 2019

Christy Avila of Fierce, Flat, Forward was just interviewed by patient safety watchdog blog MedTruth about going flat. Christy makes the excellent point that plastic surgeons are not required to discuss flat closure during the reconstructive consult – so oftentimes women don’t realize that going flat is even an option. She’s spot on!

Behind the Pink Ribbon Podcast with NPOAS Founder Kim Bowles

October 29, 2019

Now you can listen to NPOAS founder Kim Bowles’ interview with Behind the Pink Ribbon, a new breast cancer podcast by author Melissa Adams. Kim speaks about her diagnosis and treatment experience as well as her flat denial and advocacy work since. (PODCAST)

Midwest Breast & Aesthetic Surgery Publishes Videos on Flat Closure

October 29, 2019

Flat closure to produce a smooth, breastless chest wall contour is a reconstructive procedure. Listen to Dr. Pankaj Tiwari at Midwest Breast & Aesthetic Surgery discuss the issue on MWB’s YouTube channel (VIDEO)

Hand sketching Online Survey Concept with black marker on transparent wipe board.

UCLA Researcher Launches Flat Closure Survey

October 29, 2019

We are so excited to share this news with our community. Dr. Deanna J. Attai, former President of the American Society of Breast Surgeons and breast cancer researcher at UCLA, has just launched her new study on flat closure! She is making history!

This is how we develop a standard of care for flat closure.

October 13th is Metastatic Breast Cancer Awareness Day

October 29, 2019

Metastatic breast cancer (MBC) is the only breast cancer that kills, and up to 1/3 of patients diagnosed with early stage disease will die of MBC. Hard truths.

Women who choose flat get MBC also. Women with breast cancer don’t have time to waste, and often, women who choose flat do so because they don’t want to spend another minute of their lives on non-essential medical procedures.

Flat Closure is Reconstructive, NOT Cosmetic

October 29, 2019

In the world of plastic surgery, reconstructive procedures are usually covered by insurance while cosmetic procedures are usually not covered. The question is, does the procedure restore (reconstructive), or enhance (cosmetic)?

International FLAT Day is October 7th!

October 29, 2019

“International FLAT Day” was created to celebrate going flat – to promote breast reconstruction awareness, to promote flat closure (breastless, chest wall reconstruction after mastectomy), to promote flat reconstruction as a valid choice, and to bring together the flat community in sisterhood! October is breast cancer awareness month, and the 7th is the “Day of Maat” – the Egyptian Goddess who represents TRUTH and JUSTICE.

FLAT Is Where It’s At Interviews Metro Surgical Associates

October 29, 2019

For her mid-September episode of the podcast, Stephanie sat down with the esteemed Drs. Yara Robertson and Rogsbert Phillips-Reed of Metro Surgical Associates in Atlanta, Georgia, to discuss flat closure. This pair of accomplished breast surgeons worked as a team to perform Stephanie’s own revision surgery.

Now Online – Flat Friendly Surgeons Directory

October 23, 2019

Great news for women going flat! Our 150+ strong, international Flat Friendly Surgeons Directory is now online, searchable and easy to use. Find a patient-recommended flat closure surgeon specializing in mastectomy, revision or explant near you.


August 23, 2019

NEW! Going Flat After Mastectomy Survey 2019

April 26, 2019

If you have gone flat after mastectomy, please consider participating in this NEW anonymized survey. It’s another great opportunity to contribute to ending flat denial that’s quick and easy. [NOTE: Survey closed June 2019)

NPoaS Survey 2018 Report

April 20, 2019

The data analysis is in from our “Going Flat After Mastectomy Survey 2018.” Many thanks to those who participated in this important work!

The purpose of NPoaS’ 2018 Survey was to gather preliminary data on patient satisfaction with flat mastectomy closure cosmesis, to present to researchers to encourage their interest and eventually lead to a larger scale scientific study using validated tools.

Should I Confront My Surgeon?

April 18, 2019

The choice to confront the surgeon who inflicted flat denial upon you, is a highly personal one. Don’t feel obligated to do so for any reason – put your own physical and emotional health first. Flat denial is a traumatic experience and while there are aspects of healing from the trauma that all victims share, no two victims have exactly the same values and priorities. 

The Middle Way? SWIM

April 5, 2019

As patient demand grows for high quality, aesthetically pleasing flat mastectomy closures, cutting edge surgical techniques will be part of the conversation. Today we discuss a new technique called the “Goldilocks mastectomy,” or SWIM. This option, while not currently available to most patients, focuses specifically on maximizing cosmesis for patients having mastectomies without traditional reconstruction.

Julie – “It Isn’t Right, But It Is My Reality”

February 03, 2019

Editor: Julie H. Rose knew that she wanted to go flat from the moment she was diagnosed. And yet, her medical team – including the female surgeon that she had chosen specifically to try to protect herself from paternalism – made her explain her decision over and over again, as though her choice was invalid. Her concern for a good flat result was dismissed, even though she had very large breasts, which makes flat closure more technically challenging. She asked if she needed to bring on a plastic surgeon and was told, “No, this will be easy.”


January 31, 2019

Last Week to Participate in Our 2018 Survey

January 27, 2019

We are now in the last week of data collection for our 2018 survey.

Finally Flat: Suzie’s Revision Story

January 24, 2019

After explant, there will almost always be significant excess skin remaining, and if the surgeon does not remove it, the patient is left looking “deflated” which for most women is an absolutely unacceptable result. Removing the excess skin takes time and skill. Suzie’s plastic surgeon made no attempt to remove any of her excess skin during the explant surgery, despite Suzie being explicitly clear about wanting to have all excess skin removed and stay flat. She was rightly enraged, and demanded that he fix it – here, she tells her story of persistence and finally getting a good flat result that she can live with.

Aesthetic Results Matter to Male Patients Too

January 23, 2019

Just before the holiday, the BBC published an article featuring a UK man, Peter Bagnall, who was diagnosed with breast cancer and was denied surgery to produce a symmetric aesthetic result, causing him immense emotional distress. Men represent less than 1% of all breast cancer diagnoses, but that number represents thousands of men every year in the US alone. Although they may not talk about their aesthetic result as much as women do, men’s experience matters. The parallels of Peter’s experience with those of the female flat denial survivors featured here on NPoaS are striking.

Source: the Clinical Oncology article

Focus on Flat Closure Techniques

January 20, 2019

Word continues to spread among the surgical community that patients going flat after mastectomy expect their choice to be given the care and consideration it deserves – the same level that is afforded to the choice to reconstruct. Patients going flat expect a high-quality flat closure in one surgery whenever possible.



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