Cleveland Clinic Researchers Publish Paper on Aesthetic Flat Closure

CREDIT: Djohan et. al. (The Breast Journal)
DOI: 10.1111/tbj.13641
You read that right. Cleveland Clinic researchers, in partnership with the University of Toledo, have been researching flat closure.
Cleveland Clinic y’all.

This week in research to #putflatonthemenu … a collaborative paper from researchers out of the The University of Toledo and Cleveland Clinic just published their aesthetic approach to flat closure in The Breast Journal, entitled “Technical considerations in nonreconstructive mastectomy patients”

“When performing post‐mastectomy closure without reconstruction, attention to tissue excess, medialization of axillary tissue and providing bulk with lateral and caudal tissue allows for an easy, reproducible, and aesthetic closure.”

– (Conclusion) Djohan et. al. 2019
What Does This Mean? We are Being Heard.

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.

Thank you, Cleveland Clinic researchers! Thank you for listening to women going flat, for taking our concerns seriously, and for putting your professional skills to use on our behalf.
Michelle Djohan MS
Rebecca Knackstedt MD, PhD
Tripp Leavitt MD
Risal Djohan MD
Stephen Grobmyer MD

Original version published on NPOAS’ Facebook page on October 27, 2019

FDA Issues Landmark Recommendations for Implant Manufacturers

Hot off the press – FDA is listening to women’s voices on breast implants. Today, FDA issued a recommendation to implant manufacturers that include many of the items that Breast Implant Safety Alliance and others have been pushing for:

  • a black box warning to clearly identify risks (this is the most serious warning labeling the FDA has in its toolkit)
  • a checklist to guide the patient-provider discussion
  • new screening guidelines for possible ruptures
  • clear ingredient information

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.


Original version published on NPOAS’ Facebook page on October 23, 2019

NPOAS Will Have a Poster Presentation at SABCS 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.

We have our eye on the Breast-Q, an outstanding assessment tool developed by Dr. Andrea Pusic, the President of the Plastic Surgery Foundation, the nonprofit arm of the American Society of Plastic Surgeons (ASPS).

Learn more about our work.


Original version published on NPOAS’ Facebook page on October 20, 2019

Plastic Surgeons Are NOT Required to Discuss Aesthetic Flat Closure

It’s true… plastic surgeons are not required to discuss aesthetic flat closure during the reconstructive consult.
Christy Avila on International FLAT Day

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! Click below to read the article.

What can we do about it?

NPOAS is addressing the problem of patients not receiving full disclosure of their options.

Late last year, we published “The Future of NPOAS” which outlined our strategic plan. This plan includes legislative and governmental initiatives to pursue systemic change to promote parity for flat closure, and one of the amendment targets is the NAPBC‘s plastic surgery reconstructive consult requirements protocol (see below).

Flat closure should be REQUIRED to be discussed alongside breast mound reconstructive options!

The National Accreditation Program for Breast Centers’ reconstruction consult requirements can be amended to include aesthetic flat closure at the fourth option.

Watch MedTruth’s interview with Breast Implant Safety Alliance‘s VP Julie Lykins:

Original version published on NPOAS’ Facebook page on October 18, 2019

Behind the Pink Ribbon Podcast with NPOAS Founder Kim Bowles

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.

Original version published on NPOAS’ Facebook page on October 17, 2019

Midwest Breast & Aesthetic Surgery Publishes Videos on Flat Closure

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:

Do you consider flat closure to be a reconstruction?

Should a plastic surgeon always be involved with a flat closure?

Thank you, Dr. Tiwari, for being a voice for women!

Original version published on NPOAS’ Facebook page on October 16, 2019

UCLA Researcher Launches Flat Closure Survey

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.

Thank you, Dr. Attai!


Original version published on NPOAS’ Facebook page on October 15, 2019

October 13th is Metastatic Breast Cancer Awareness Day

October 13th is Metastatic Breast Cancer Awareness Day.

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.

The damage done to a patient in denying her a flat result, is multiplied exponentially for those with MBC.

In memory of our sister Louise Broda.


Learn more at Dr. Deanna Attai’s blog. and at Metavivor.

Original version published on NPOAS’ Facebook page on September 18, 2019

Flat Closure is Reconstructive, NOT Cosmetic

“Reconstructive” vs “Cosmetic”Surgery

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)?

Clearly, flat closure is reconstructive. It restores a smooth, breastless chest wall contour. Simply removing the breast tissue isn’t enough. Women deserve a mastectomy result that we can live with.

If your surgeon tells you that flat closure or revision services aren’t covered by insurance because they are “cosmetic”… consider using a different surgeon!

Original version published on NPOAS’ Facebook page on October 13, 2019

International FLAT Day is October 7th!

“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. The 7 principles of Maat are: Truth, Justice, Harmony, Balance, Order, Reciprocity, and Propriety. These principles really reflect the “heart” of the shared flat movement!

International FLAT Day began as a joint project of flat advocates Christy Avila (Fierce, Flat, Forward), Robyn Towt (Breast Implant Safety Alliance), Devorah Vester Borenstein, Penny Dubbs Dudek, and Kim Bowles (Not Putting on a Shirt). We share a common goal of wanting to #putflatonthemenu by celebrating the flat advocacy community, and enabling “open-source” sharing of resources on going flat developed by our diverse and passionate flat advocacy community.

Learn more about International FLAT Day!
Download the FLAT is Beautiful brochure!

Original version published on NPOAS’ Facebook page on October 03, 2019

Donate $100, Get a T-Shirt!When you donate at the $100 level, we will send you a vintage NPOAS t-shirt as a thank you. Just fill out this form!

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