NPOAS Exhibiting at ASBRS Conference 2022

History is going to be made at the American Society of Breast Surgeons annual conference in Spring 2022 in Las Vegas. The NPOAS Board will be attending this conference with an exhibitor’s booth to advocate for aesthetic flat closure. We will be engaging providers one on one, providing brochures for surgeons to take back home and use in their practices, learning about and supporting coding and oncoplastic training, and engaging with researchers and other stakeholders.

The conference provides unique advocacy opportunities to:

  • Engage providers in one-on-one discussion about aesthetic flat closure
  • Give interested providers brochures to take back and use in their practice
  • Network with other stakeholders – including the NAPBC – to promote our mission
  • Learn about the latest research in oncoplastic breast surgery
  • Offer a flat closure patient’s perspective during debates
  • Engage with researchers to promote further studies to support an improved, evidence-based standard of care for aesthetic flat closure

Learn more, and find out how you can help, at the Event Page!

Kourtnii’s Story: I Struggled to Get the Flat Surgery I Chose


Kourtnii was faced with a DCIS diagnosis at the age of 26. She wanted a double mastectomy without reconstruction but repeatedly received intense, paternalistic pushback from the surgeons she consulted. Ultimately she had to have two separate mastectomy surgeries and didn’t get the aesthetic outcome she wanted. She does not regret her decision to stay flat.


I was 26 when breast cancer entered my life. I was prepared, though. After having family members with their own breast cancer stories, I had already decided I had wanted a double mastectomy. I didn’t even realize at the time that my surgeons wouldn’t listen to my wishes and instead choose to follow their own agenda.

In 2019, I found a lump in the bath and it felt big. I had just started seeing someone and I called him in to show him. The next day I went to the doctors and it was only weeks before we had answers. A biopsy on April Fools’ Day came back positive for high grade DCIS. The next few weeks were a blur of appointments. Surgeons kept pushing me to have a lumpectomy and “save my breasts” but this lump was 3.5cm – it would take most of my breast. I asked a few times for a double mastectomy. The surgeons refused! They told me to think about my new relationship and told me that having a double mastectomy would affect my relationship and that my partner could leave me.

I asked a few times for a double mastectomy. The surgeons refused!

I continued to push. I had a meeting a week before surgery where the nurse told me the surgeon now recommended a mastectomy because of the size of the tumor. I told her great, let’s do that. Could you take both breasts in the same surgery? Again I was told no. The next week I saw the surgeon for the final consultation before surgery. I should have walked away then. He asked me what I had decided, and I replied, “Well, after our meeting with the nurse last week I have decided to go with your recommendation of a single mastectomy. I really do want a double mastectomy though.”

“Mastectomy?!? I never recommended that for 9mm of DCIS.”

My partner and I both stare at the surgeon. “Doctor, my DCIS has never been measured at 9mm, it’s last measurement was 35mm.” The surgeon then continued on and said well then what will we do for reconstruction? Will I get the nurses to place you on the waitlist for expanders to implants? I told him no, I really wanted some time to think about that decision.

My mastectomy went off without a hitch, the surgeon boasted about how beautiful my incision was, and continued to ask about what reconstruction I wanted. He kept on telling me how his beautiful incision would be hidden perfectly by my new reconstructed breasts. He seemed angry when I asked to be sent to another hospital for a second opinion. After weeks of back and forth I was finally placed on the waitlist to have my other breast removed. I waited 10 months for my next surgery, and after consulting with a bigger hospital flat was just a step in the process to let my body heal.

He seemed angry when I asked to be sent to another hospital for a second opinion.

I went in for my second single mastectomy. I remember seeing the surgeon and telling him please make my scars match. He confirmed that he would. In the operating room, a young female surgeon came in and asked about what’s being done. I pull my gown open and told her, “We’re taking the other breast. See my scar? Please make the new one match.”

Surgery happened late in the afternoon. The next morning they came to check on me. The young female surgeon comes in smiling and perky. “So everything went pretty well. You had a bleed but we put that pressure dressing on to stop it. Your incision is beautiful and straight!”

Straight?! I thought I had asked for my scars to match. The young surgeon walked out. Only minutes later the main male surgeon arrived, ripped open the pressure dressing to reveal an almost perfectly straight incision on my chest. I burst into tears. The surgeon sid something about plastics being able to fix it and walked out, leaving my dressing half ripped off.

After that experience I decided that flat was the only option for me. I didn’t want breast implants and was concerned about BII and other compilations associated with breast implants. My new plastic surgeon has been super supportive of my decision to stay flat which has changed everything for me.

And that person I was seeing? They haven’t gone anywhere. They are my biggest supporter in my decision to opt of reconstruction surgery. So the surgeon was wrong about that too.


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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.

Charen’s Story: Authenticity & Health


Charen, a legislator in New England, made an informed choice to go flat after her prophylactic bilateral mastectomy for BRCA-1. She prioritized her health and function as well as having a short surgery and recovery period. Her surgeon respected her wishes. Two weeks after surgery, Charen was back to hiking and living her life!


Due to family and personal health history, I was diagnosed with the BRCA-1 gene mutation in 2016. When I knew my path was prophylactic mastectomy, I met with my surgeon. She insisted I listen to all the options, which included going flat, implant reconstruction, or DIEP flap reconstruction. After asking questions related to health, function and recovery, I chose to go flat for the following reasons.

  • I could have my mastectomy and ovary removal all in one OR session instead of enduring additional risk of infection or injury from anesthesia.
  • I was outpatient instead of spending 1+ days in ICU.
  • I needed a small fraction of the pain management.
  • My recovery time was 1/4 to 1/3 as long.
  • I maintained full use of my arms and shoulders instead of having my pectoral muscle or abdominal tissue mutilated.
  • Reconstruction could not give me back what I lost. Implant reconstruction looks like a war injury and they are cold and numb. DIEP Flap leaves huge scars on the abdomen for numb, scarred “mounds”.
  • I am not ashamed of losing my breasts, nor do I need to make people believe that I have breasts in order to have professional or personal relationships built on respect, trust and common goals.

I was very lucky. I had an excellent breast surgeon who explained everything to me clearly, respected my wishes, and who had the skill to give me an aesthetic flat closure in one procedure. It healed quickly and well. Two weeks later I was on a gentle hike and a month after that, I was on a wilderness canoe trip. Going flat allowed me to have a life built on authenticity and health. It was the best choice for me to achieve personal and professional goals from outdoor or farming activities to better advocating for mastectomy patients in the state legislature.

And honestly, nobody has ever noticed unless I brought the topic up.

It is crucial for the dignity of mastectomy patients that they are fully informed of the medical choices and risks and that their wishes for an aesthetic flat closure be respected and fully carried out.


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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.

Dee’s Story: I Wish I Opted Not to Reconstruct

Mastectomy tattoo technicolor octopus iconic flat aesthetic flat closure

After her breast cancer diagnosis, Dee reconstructed with textured implants and had them for twelve years before one ruptured, resulting in multiple complications. She learned about BIA-ALCL and breast implant illness after the fact, and explanted only to have her surgeon intentionally deny her the agreed upon flat closure. Dee suffered greatly because of her surgical outcome and was able to have a revision surgery to fix it the following year. She now advocates for breast implant safety and aesthetic flat closure.


When I was diagnosed with a very aggressive and rare breast cancer back in 2006, I was relieved to learn that breast reconstruction would be covered by my health insurance because when my mother was diagnosed in the early 80’s it was not an option for her. She had two separate radical mastectomies, 5 years apart from each other and by two different surgeons and I remember feeling very sorry for her because to me, it appeared that her doctors didn’t even try to make her look aesthetically appealing. I know she was very self-conscious about how she ended up looking and the saddest part is her marriage did not survive the turmoil that she had to endure, nor did she. My parents ended up divorcing after 32 years of marriage and the disease took her from us at the very young age of 50. I was 30 years old when she died. She ended up moving in with us during her last 2 years so that I could take care of her. I witnessed the worst of the disease and prayed it wouldn’t happen to me, but unfortunately it got me too. 

So, in 2006 when Dr. G gave me the option for a double mastectomy with immediate reconstruction, I was very thankful that I would not look as hideous as my mother did. Dr. G was the plastic surgeon that my general surgeon highly recommended. In her words, Dr. G was an “artiste” because she was known for her specialty in breast construction. At my first consultation with her, she gave me the typical different reconstruction options but since I was not overweight at the time she said having the DIEP Flap reconstruction surgery, where they remove a portion on the belly fat and move it to the chest area would not be a good option for me, but she he told me I was very lucky because I qualified to have silicone breast implants put in instead since only breast cancer patients at that time were the only ones allowed to have them put in. They had been taken off the market in 1992 due to safety concerns. She reassured me that they were now safe and that she would closely monitor me because I would be in a 5 year case study, so I had nothing to worry about.

Side note: During the 5 year case study, I was told I would be monitored which I was not, after we discovered that one of the implants had ruptured, I asked Dr. G about it. She said that I did in fact finish the study but after reviewing my medical notes, the last time I had seen her was in April of 2011 and the implants were put in 4 years before that so the study did not monitor me for a full 5 years.

Had anyone looked at my medical history they should have questioned the implants because according to the FDA’s website, “the FDA recommends that people with silicone implants get regular screenings to detect silent ruptures”, but it was never recommended to me. Maybe if it had, I wouldn’t have silicone laden lymph nodes with silicone migrating throughout my whole body now!

During my breast cancer treatment, I was trying to be the best patient, I never questioned anything like I should have, I just wanted to get it all over with as soon as possible. I had a double mastectomy on March 15, 2006 and at the same time, I had tissue expanders also put in, so after each of my chemotherapy sessions I would go in to see Dr. G to have the expanders filled with saline to make my skin stretch to make room for the implants. I finally finished my aggressive chemotherapy treatment in August of that same year. Dr. Mattson Gates implanted me with the Mentor textured silicone implants in September so that I was able to go back to work late that September. Later she also recreated areolas and nipples and she tattooed them to look as natural as possible. I was very happy with the outcome but I was not warned of any side effects the implants may have on me in the near future.

It wasn’t long after they were implanted that I started experiencing allergies, weakness in my legs, muscle spasms, neuropathy, memory loss, vertigo, heart and breathing issues to name a few. I never associated any of these problems with my implants and none of my doctors thought to connect the dots either. I had many diagnostic tests performed but my doctors were never able to determine the causes, so I just lived with all of the issues. 

Early spring of 2018, I discovered a large lump under my left armpit and of course thought that my breast cancer had returned but instead it was determined through ultrasound and MRI that my left implant had silently ruptured and I had silicone laden lymph nodes EVERYWHERE! I was happy to find out that both of my original surgeons were still working at Kaiser so I scheduled both Dr. N, my general surgeon and Dr. G, my plastic surgeon to tag team again and perform the surgery to remove the 13 year old implants and remove as much silicone from my body. I had that surgery on April 19, 2018. 

At my pre-op appointment with Dr. G, I told her I was considering not replacing the implants, that I didn’t feel like I needed them but she told me in a very matter of fact way that, yes, I did want them and that I would be very unhappy without them so I agreed to have them replaced. I wish at that time that I opted not to reconstruct and just live my life flat with no regrets but I thought it was just too daring to go there so I just went along with her advice again. 

That surgery was very hard on me, harder than my original mastectomies. My body did not recover as easily this time. Not only was I having trouble physically, my emotional state was shaken to the core! My husband told me that Dr. G came out to speak to him right after my surgery, she said it took longer than expected because the implant had disintegrated, she had to scrape the “goo” from my rib cage and that the implants I had were the kind that had been known to cause Breast Implant Associated Anaplastic Large Cell Lymphoma or BIA-ALCL. She told him that it looked very suspicious to her so she was going to have my tissue tested for it. 

I had never heard of BIA-ALCL before so when I researched it I learned that I had every symptom. (Side note: in my medical notes, Dr. G wrote that she informed me of the risk, and that is not true! She never mentioned it to me until after my surgery.) Even though my test results were negative I could not stop thinking they missed something, especially when I was able to finally lift my left arm up, I discovered the same large lump I originally found was still there! I ended up seeing 3 different surgeons and they all said they didn’t feel that the risk to remove the silicone in my lymph node would outweigh the risk of possibly losing the ability to use my arm, but I couldn’t let go of the fear that that lymph node was not sent in for a biopsy. Once that thought was there, I couldn’t let it go. I must have had PTSD because it was very worrisome to me to say the least! 

About a week later after my implant exchange surgery, a friend called me to tell me she heard about what happened and she asked if I heard about breast implant illness, I told her no, I had never heard about it, and after researching it I honestly thought it was a bunch of women that were making exaggerating claims that their implants were making them sick. Since I had just 

had the new ones placed I just wanted to feel better to get my life back on track again so really didn’t want to open any can of worms on this. But not long after my recovery I started noticing I was feeling better than I had in years! There was a time when I was very scared because I was having severe memory loss and feared it was Alzheimer’s. I was forgetting important things at work and my co-worker’s were getting very frustrated with me, not to mention my family always making comments about how forgetful I was. All my medical tests came back normal but once my ruptured implants were replaced, I noticed how clear headed I was, I no longer felt like I was in a fog! That’s when I remembered about breast implant illness and thought maybe it really was true after all. 

After that surgery, my left breast drooped drastically lower than my right breast. When I asked Dr. G about it she said it was because she had to scrape out everything and the pocket was much larger so she replaced the implant with a 700cc implant, a larger size than my original was without consulting me on the size difference. I also found out that she left my right capsule intact, even though she knew of my high risk of BIA-ALCL. The right breast implant was lifted high and tight but the left just hung there. She said I could have it repaired once I healed because she knew I was not happy with the outcome, plus the implant would occasionally flip over and I would have to manually move it back in place. 

About 4 months later I asked her if I could have the revision surgery because I was about to start a new job and didn’t want to take any time off after I started it. She agreed to do it on September 14, 2018. She was only able to correct the drooping a little bit, it was still lower than the right but not as drastic. Unfortunately, there wasn’t anything else she said she could do for me, she said she tacked the implant so that it should not flip over any more. 

On Christmas morning 2018, my great dane jumped on me while I was sleeping. He somehow managed to flip the left implant over but this time it pulled something internally. I thought he broke my rib, that’s how much pain I was in. I was able to get in to see Dr. G on December 27, she had X-rays performed and thankfully I did not fracture any ribs. She said the pain was from internal bruising, said it was not from the implants even though I could feel that it was, I remembered her telling me that she tacked it down and it felt like it ripped away. She told me to take 800mg ibuprofen twice a day but the pain did not go away. I emailed her many times asking her to please remove the implants because I was not able to get comfortable, I wasn’t sleeping well and I just wanted them out. With my persistence I finally got her to agree to remove them but I was put on an elective surgical list. I emailed her again, begging her to please help me, this was not an elective, this was urgent. She finally wrote back and said they would schedule me soon. I could tell she was not happy to help me but at that point I was in too much pain to care. 

I reached out to a private Facebook group of women that had their implants removed after having a mastectomy because I was very worried about how I would look. The memories of how my Mom looked still haunted me but I knew I needed them out. Many ladies reassured me there were surgical options to make it look smooth, one lady sent me a picture of her after her revision with a description of what her surgeon did using a technique where she used her 

excess skin flaps and made a cushion underneath so she did not look concave. I emailed Dr. G the picture and the description of what her surgeon did for her, I asked her if she was comfortable doing the same for me and if I was a good candidate for the same outcome, her answer was “We can certainly leave skin flaps, how thick they are depends on how thick your mastectomy skin flaps are now.” 

I felt very confident that I communicated as clearly as possible to her on what I wanted. My explant surgery was on Valentine’s Day 2019, almost 2 months from when my dog hurt me. I felt like having my implants removed on Valentine’s Day was an appropriate day to have it done because I knew it was the best self-care I could do for myself. I was looking forward to getting my life and my health back. After I woke up from that surgery, she did not come in to check on me to let me know how it went, she didn’t even come out to talk to my husband to let him know either. My post op appointment was scheduled to only see her nurse. I was running a low grade fever that day and had yellow discharge coming from my incisions. The nurse asked me if I was taking any antibiotics but I told her on the morning of my surgery Dr. G instructed me not to take them when she came in to draw on me, so I hadn’t taken them yet. The nurse said she wanted another surgeon to see me because she knew it looked terrible.

I knew it looked very bad but I was hoping it was just excess swelling. My incisions looked like Frankenstein! I couldn’t believe someone that specialized in breast reconstruction would be proud of this outcome and I’m convinced that is why Dr. G would not see me for any of my post-op rechecks. On February 27, 2019 I brought my aunt to come with me to see the physician assistant and because I needed someone to advocate for me. At this point, my husband Tom was not very supportive, but looking back I understand why he didn’t want to see my hideous incisions because I looked so repulsive, I would hide from him when I got undressed!

At this appointment, we asked the PA if he felt this was an acceptable outcome, what would he do if his wife looked like this. I asked him if Dr. G was in the office and she was, so I insisted she come in to finally see me, this was the first time I saw her since my surgery 2 weeks prior. She was not very empathetic, when I asked her what the excess skin was, she said it was fat and if I lost some weight it would look better. She even had the nerve to ask me if I wanted the implants back in! I firmly told her NO! 

During all my other surgeries and breast cancer treatments, my husband Tom was always there for me and he was very supportive. Before this surgery, I emailed Dr. G, telling her my main concern was for Tom and how I wanted to be sure the outcome would be presentable for my husband because I knew going flat would be an extreme adjustment for us. I had hoped she would want to help Tom just as much as she would be helping me. I can honestly say in the 42 years of our relationship this was by far the hardest for us to go through! I looked mauled 

and disfigured, I was a complete turn off! Even though I couldn’t blame him, I questioned whether Tom still loved me, and as much as I hate to admit it, divorce was even discussed. I know he’s ashamed to admit his true feelings, there are things you just can’t fake and not being attracted to someone that now repulses you isn’t hard to hide, his lack of affection was very apparent. 

I’m normally a very optimistic person, I can find the positive in almost every situation… except this one. Even Dr. G told me I was depressed and that I needed to talk to my primary physician about it. I’ve never been diagnosed as depressed before but I know I was not enjoying life as I should, I had to rely on my close friends and family to get me through this. I was shocked to find out there are other women just like me, that their surgeons denied them of a clean, flat closure after their mastectomy and left them grossly disfigured too. The surgeons took it upon themselves to save the excess skin just in case their patients changed their minds and wanted implants again, how dare they! 

I recently began to advocate for these women and to inform others about breast implant safety. Having breasts or lack of them should not be the defining factor of who we are to ourselves or to others. Helping others has taken the focus off of my hardship and has really helped me heal. Thankfully I fought for what I knew I deserved, I found a very skilled Plastic Surgeon, Dr. Sendia Kim (Ed.: Dr. Kim is on the Flat Friendly Directory) from Kaiser in Woodland Hills, CA. I drove 2 ½ hours to each visit to see her and had my last revision surgery on August 14, 2019. 

Tom and I are still working through this, my physical scars may be fading but our marital scars are still healing. The deep emotional pain I still endure has been traumatic for me so I know it will take some time but I refuse to allow it to ruin me. I also don’t want my story to end the same way my parents did because of her surgeon’s lack of care and concern. If anything, it makes me want to fight even harder for my marriage.


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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.

Samantha’s Story: She Wears Her Scars Like a Warrior


Samantha was only 31 with a young family when she was diagnosed with breast cancer. She deliberated carefully and decided on a bilateral mastectomy with aesthetic flat closure. Her surgeon did an amazing job. Samantha wants women to feel empowered to make the right choice for them, whatever that choice may be.


“She wears her scars like a warrior for they are a reminder she’s alive.”

When I was diagnosed with stage 2 breast cancer at the age of 31 it seemed like my entire world had crashed down on me. I never really knew much about breast cancer other than the pink ribbons seen in October every year. With three kids and a family that needed me, I knew I would fight this beast with everything I had. After the treacherous journey through chemotherapy, I was then given an option of a single mastectomy or a lumpectomy.

I remember being so confused at first. After some research and support from a fb page of women who had gone flat, I knew what I wanted. I went to my surgeon and said, “Can you just take them both off?” She looked at me kind of puzzled and replied, “Absolutely!” My way of preparing was to purchase “foobs” a bra with some stuffed breasts in it. I also tried to find every shirt I could that would hide my flat chest.

The day of surgery came and while having a quick chat with my surgeon before hand, I said, “Please make sure it’s a nice flat closure… I’m terrified to have skin hanging everywhere.” She reassured me and said she would do the absolute best she could. I remember waking up from surgery and feeling like my chest was so tight. The healing was easier than I thought… seven days later I went to have my drains checked and bandages removed. When I looked down I cried. I was very pleased with the outcome and how perfect my incisions were but it was a shock.

My breasts were part of me. Not to mention my hair which was still gone from chemo. The first few times looking in the mirror were tough. I felt like a 12 year old boy. No hair and no boobs. It took a while… but today… I am so proud of my scars. I seen a quote that just fit so well: “She wears her scars like a warrior for they are a reminder she’s alive.” I had it tattooed on my ribs to always remind myself what I’ve overcome.

I found a new me. A stronger me.

I knew I didn’t want implants or expanders. I knew my body had been through so much and going flat was the best option for me. I found a new me. A stronger me. I encourage any woman facing this hard decision to do what feels right to YOU. There is no right or wrong way to navigate thru this journey. Regardless of the outcome it takes time. Time to learn and accept the new you… I cried many times just trying to find a shirt that I felt pretty in… or a bathing suit that I felt comfortable in. With time, though…. you will look at your scars with the mentality of a warrior and know you overcame and conquered.


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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.

Lori’s Story: I Chose AFC for Quality of Life


Lori leads an active lifestyle and chose to go flat ten years ago, before “aesthetic flat closure” was on the books. Her surgeon pushed back because of her age, but ultimately respected her wishes, and Lori is happy with her choice.


I chose aesthetic flat closure 10 years ago before it had a name. I had read about what to expect if I reconstructed, and asked my surgeon questions for an hour prior to making that decision. After our discussion, I told her I wanted to be flat with symmetrical scars. She thought I was too young (46), but was willing to do as I requested. She was impressed with how quickly I healed. She caught me riding my bike the day after surgery on our local trail and asked me if I thought it wise. I laughed and told her I had great balance and exercise promoted healing, to which she couldn’t argue. I was able to get my drain tubes out 4 days after surgery and the skin had already attached to the tubes, as that hole really wanted to close.

I chose to be flat for many reasons, but primarily quality of life.

I chose to be flat for many reasons, but primarily quality of life. I didn’t want reconstruction to mess with my passions by messing with muscles used for golfing and kayaking. I also didn’t want tattooing every few years or having to redo construction every 10 years or so, (which they knew even back then). I had read stories of implants gone bad, and couldn’t understand why more women weren’t choosing the healthiest option. I remember sitting around a campfire having to explain to several friends why I was making that choice, and none of them could understand. Society sends us a different message which makes this decision difficult for some people.

I am thankful that my surgeon took the time to answer all my questions, so I could arrive at the decision that was right for me. I was able to return to the activities I love at the same level within a week. My husband has always been my biggest supporter, and didn’t want me to suffer endless surgeries just so I could have artificial breasts. My old friends accept me as I am. I usually end up saying something about it to new friends and they always say they didn’t even notice.

I wanted to be an advocate for going flat with the cancer society. They had a group of volunteers that talked to women facing those decisions, but 10 years ago that was a message they didn’t want to send. I am thankful there are groups like this one getting the word out to women.


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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.

Support AFC Legislation in New York State!


NY State Assembly Bill A08537 – Insurance Coverage for Aesthetic Flat Closure After Mastectomy


Following direct talks with NPOAS leadership in October, Rep. Stacey Pheffer Amato of NY District 23 has introduced a bill in the New York State Assembly to protect mastectomy patients seeking aesthetic flat closure by ensuring their surgery is covered by insurance.


Why We Need This Bill Now

All women with breast cancer deserve to have insurance cover their surgery. After a mastectomy for breast cancer, there are two types of reconstructive surgeries available – but only one is guaranteed by law to be covered by insurance.

Women who forgo breast reconstruction are most often done in one surgery, but about one in four will require revision to produce an acceptable aesthetic result (an aesthetic flat closure, or AFC). Too often, these women are told that their revision surgery is “cosmetic” and therefore will not be covered by insurance. How would you feel if this (right) was you or your loved one?

An important step in solving this problem is to require insurance companies to pay for AFC surgeries just like they are required to pay for conventional reconstruction. Assembly Bill A08537 does exactly that.


What’s in the Bill?

New York State law contains a word for word excerpt from the federal Women’s Health & Cancer Rights Act (WHCRA) which requires most insurance companies to cover the costs of breast reconstruction. Wherever the NY law says “breast reconstruction”, Bill A08537 simply amends it to say “breast or chest wall reconstruction.” It’s that simple! The bill also mentions aesthetic flat closure as defined by the National Cancer Institute as specifically included in “chest wall reconstruction.”

This will ensure that patients are not denied necessary care simply because they chose to forgo breast reconstruction in favor of a flat closure.


Take Action! Sign the Petition

Let’s ensure mastectomy patients in New York state get the care they need and deserve!

Our Thanks

Our thanks to the flat advocacy community members whose participation contributed to the creation of this historic bill! Stand Tall AFC, organized by Renee Ridgley of Less Than Two Breasts and Stacey Sigman of Flat Retreat, was instrumental with boots on the ground and direct engagement with local civil leadership bridging key relationships to advocate for this bill. Jo Ann Shapiro Amato introduced the team, including Melissa Eppard (Melissa Eppard Coaching) and NPOAS leaders Christy Avila and Kim Bowles, to Rep. Pheffer Amato for talks. Working in concert during the Stand Tall Campaign, Flat Retreat NY members Meg Haney Krause, Susan Derwin, Allyson Skikas & Cindy McCord coordinated community turnout. Putting FLAT on the menu is truly a team effort!


More information at:

NotPuttingonaShirt.org/NYBill   ~   info@notputtingonashirt.org



Melinda’s Story: Intentional Flat Denial 10yrs Ago


Melinda was 60 years old when she learned she had breast cancer for the second time, and decided to have a bilateral mastectomy with no reconstruction. However, her surgeon had other ideas and said that going flat was “a bad idea.” Melinda was never satisfied with her closure. Ten years later her dermatologist confirmed that her surgeon left extra skin “in case you change your mind.” She had revision surgery to fix it. Melinda’s original surgeon later became a gender confirmation specialist and Melinda hopes that she has learned from her mistake.


“Looks like someone wanted to leave skin in case you wanted reconstruction.”

January 2010 I was diagnosed with breast cancer and soon found out I had three tumors in one breast.

I was 60 years old and a high school teacher with three adult daughters. I did my research in a hurry and as I had had a lumpectomy 5 years before in the other breast I decided to say goodbye to them both. A surgeon, Dr. W., was recommended to me and I met with her. I told her I wanted to go flat- no reconstruction, and wanted both breasts removed. She said that that was a bad idea. We discussed our different opinions. I listened politely to her but told her that this is what I wanted. I left her office really afraid as I wondered if she would sabotage me and not follow my wishes. And what about the cancer? I was really afraid. Three days before surgery I saw the anesthesiologist who said, “One breast and reconstruction, right?”

Ah no, not right. She made some calls and came in rather frustrated with me making it CLEAR that this was on ME and NOT Dr. W’s wishes. Now I am scared times 100!! So, surgery is done, I never see her again, have chemo, and try to go forward with my life. My chest looks like SHIT but, hey, no cancer right, so I should not be complaining.

Ten years later I asked my dermatologist – look at my chest. What’s your opinion? He says, “Looks like someone wanted to leave skin in case you wanted reconstruction.” Yep – that’s what I think. So, I see a plastic surgeon and he says, “Yep, we can fix this.” So, surgery occurs and after 6 weeks I resume life. Chest looks a hell of a lot better, not perfect but better. So, when I see Dr. W.’s name as a potential good surgeon, I can only hope she changed her thinking and decided that her patient’s opinions mattered. I know people learn from their mistakes and I hope she did.

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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.

Fiona’s Story: I Instantly Knew I Would Stay Flat


Even though Fiona knew immediately that she wanted to stay flat after her mastectomy, she met with pushback at every turn.  Her surgeon required that she have a psychological consultation before agreeing to remove her “healthy” breast. She was treated as “less than” because of her decision to go flat. She was not given an aesthetic flat closure and still struggles with acceptance, using art to process her feelings.


I live in the UK, where I had my first mastectomy in 2014, aged 46. I was told I would not be able to have immediate reconstruction because I would need radiotherapy. That was fine by me – I instantly knew I would stay flat. My second mastectomy was elective, and took place in 2016. I had to have a session with a psychologist before the surgeon agreed, because it involved removing healthy tissue. I was really angry about this – had I wanted reconstruction, I could have gone straight ahead with surgery, no mental health checks needed, even if I went for extensive surgery to remove healthy tissue from elsewhere to use in the reconstruction. I felt that my choice to go flat put me right on the outer limits of acceptability. Every time I saw a nurse of doctor, that choice was questioned, and I was told countless times that I might change my mind. I knew I wouldn’t. Anyway, the second mastectomy didn’t go so well. I got a huge, breast-sized hematoma. I was told it would probably go down over the next few years. The reactions from the medical staff implied that I didn’t deserve any help to rectify this.

I felt that my choice to go flat put me right on the outer limits of acceptability.

I have no regrets about not going for reconstruction. I do have regrets that I didn’t know how to ask for aesthetic flat closure, or convey to the surgeons that I was totally certain aI have no regrets about not going for reconstruction. I do have regrets that I didn’t know how to convey to the surgeons that I was totally certain about my decision not to reconstruct, now or in the future. Looking at your website brings tears to my eyes, even 5 years on, knowing that I have a very visible hematoma mound on one side, uneven, ugly, scars, and big bulges under both my arms.’

The day before my first surgery I took photos of my right breast. The day before the second mastectomy I memorialised my one remaining breast by painting it and pressing against paper to make a print. I have put these on a website I’ve started, where I begin to explore my emotions around this, and how it makes me feel so closely connected to my mum who also had a mastectomy. The site is here: https://www.palimpsest.space/

I’m grateful to Not Putting on a Shirt for your advocacy work, and hope things will change so that women’s decisions and preferences are better respected in future, and others are able to get the flat closure they want. Thank you for your initiative.


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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.

Ara’s Story: No Regrets


Ara was diagnosed with locally advanced breast cancer and chose to have a bilateral mastectomy after her initial lumpectomy failed to remove all of the disease. Ara’s surgeon was very supportive of her choice to go flat, and she has never regretted her decision.


I chose double mastectomy and no reconstruction in 2000 when my stage 3B breast cancer in the left breast was not completely removed by lumpectomy. Fortunately my surgeon, Rebecca Yang, did not question my choice and she did a nice job.

I have never regretted my choice. No more bouncing boobs, no hot sweaty bras, no painful mammograms, I can sleep on my stomach in comfort now, and most importantly, I am symmetrical. There are no reminders of the terrifying trauma of the breast cancer diagnosis (I thought hard about breast cancer daily for 5 years. ) I can move, I am strong, I can use all my muscles because they are still where they are supposed to be, and I don’t have odd temperature or tightness sensations in “fake” boobs caused by transplanting tissue there, which happened to some women I knew who had reconstruction.

Fortunately my husband (still the same one) cared more about me than my boobs. I am authentic, there is nothing fake or cosmetic about me. This is fundamental to who I am. Thank you, Rebecca Yang.

I have never regretted my choice.

In 2017 while grieving the death of my mother (who moved up and stayed with me through my surgery and much of my chemo) I had a recurrence in my armpit – some forgotten cell put to sleep by the treatments woke up in response to my grief-compromised immune system. I went through everything all over again, (surgery, chemo, radiation, hormone therapy) EXCEPT the trauma. In fact, once I got done with radiation, I got back to my busy life and quickly forgot that I had had a recurrence. When a co-worker reminded me what I had gone through in 2017-2018, I was surprised at how thoroughly I had forgotten about it. If I had one breast intact and a prosthesis (moving muscle and fat from other parts of my body to create a fake breast was out of the question) I would still be reminded daily of breast cancer. Rather not!


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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.