Dr. de Boer’s assistance was invaluable in getting our 2018 and 2019 Survey data presented at the San Antonio Breast Cancer Symposium in December 2019, and she has also assisted in reviewing information we provide on this website. Thank you, Dr. dr Boer, for your help as we work together to #putflatonthemenu!

Tell us about your work and how aesthetic flat closure came on your radar screen.

“I am the Chief Medical Officer of MAPS PBC, a Public Benefit Corporation that is working on healing and well-being through psychedelic drug development and therapist training programs. We are currently developing MDMA-assisted psychotherapy for PTSD. Flat closure came on my radar screen in 2015 when I was diagnosed with early stage breast cancer and chose that option. My female surgeon honored that decision but it came to my attention through social media and the work that Kim is doing that is not the case in other parts of the country.”

What do you think patients facing breast cancer surgery should know about “going flat”?

“Patients facing breast cancer surgery should know that “going flat” is a valid option that should be given to each and every person. If the provider seems hesitant to discuss that option, it is best to go for a second opinion. After the surgery, the chest could feel a bit tight (the “iron bra”) and that could improve over time and there are options such as self massage with Bio-Oil. The chest area could be less sensitive to touch but that is not always the case (e.g. I personally never lost sensitivity).

“Lastly, and that’s not discussed often, losing your breast may have an effect on your sex life; however, that also takes time and overall the relief of being done with any surgeries and having faced the diagnosis of breast cancer is with a good outcome, at least in my personal opinion takes the big positive prize. A friend in a same sex relationship told me that prior and I still think it is good to at least mention. Of course, one’s sex life is very personal and I don’t want to open the can of worms that women are not female without our breast as that is not the case and I feel very comfortable being flat (and preferable to DD physically).”

What do you think providers should know about aesthetic flat closure?

“Providers should discuss the pros and cons of each option for breast cancer surgery clearly and without any bias. If a provider personally favors one option over the other, they should refer that patient to a colleague who may not have that bias. I also think it would be great if there is  e.g. a folder with all the options included that a patient can take home. Such a folder should have all options included (with pictures) and preferably a phone number where a patient could talk with breast cancer survivors who choose the option mentioned. I am thinking of a phone number for NPOAS where someone could talk to a patient who went flat and shares his/her experience and answers questions. You already do that and to avoid bias, preferably there would be a phone number for a patient to talk to representatives who choose any of the other options.

“Patient need to have time to digest the information and then make an informed decision about their choice.”

In your view, what are the most important barriers to parity for aesthetic flat closure and how should we address them?

“The most important barriers to parity for aesthetic flat closure is the fact that not all providers are aware of that option; plastic surgeons are generally more into “beautifying” their patients and unless they have heard the stories of patients like yourself and others in the community, are not aware of the problem. So getting out the information, as early as possible in medical school and residency training, and providing all clinics who are seeing breast cancer surgery patients with a folder explaining what aesthetic flat closure is from both the technical perspective and the patient perspective would be great.

“More scientific papers about the topic would be helpful, e.g. setting up a study where patients would fill out questionnaires prior and after their surgery and Patient Reported Outcomes (PRO) about satisfaction with the results using a Likert scale may be an option.”

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.

Rep. Fegard is a long-time strong supporter and strategist in her work with NPOAS. She spearheaded the 2019 legislation in Vermont that would require stakeholders to convene and ensure insurance coverage for revision surgery. Thank you, Rep. Fegard, for your help as we work together to #putflatonthemenu!

Tell us about your work and how aesthetic flat closure came on your radar screen.

“I have so many different types of jobs, from Civil Service work in Haz-Mat/Environmental Compliance on overseas military bases, administrative work, registered childcare, professional landscaping and cleaning, outreach and education and technical assistance to schools and businesses around Indoor Air Quality and waste diversion. But 2019-2020 I have been a House Representative in Vermont’s Legislature. I was diagnosed BRCA-1 positive and had a prophylactic bilateral mastectomy in 2016. I knew from the moment of my test results that I was committed to limiting surgical injury and risk of complication and infection by not having reconstruction. I was lucky. My breast surgeon was skilled in patient education and surgery. My results were excellent. Later, I learned of other women choosing flat and that many were not as lucky as I was.”

What do you think patients facing breast cancer surgery should know about “going flat”?

“Breast cancer patients deserve to know all their options in unbiased, full disclosure. Patients should be made aware of the stark differences in surgery time, in-patient hospitalization time, pain medication expectations and general recovery time between the different reconstructions and aesthetic flat closure. Their surgeon should also be upfront about their skill in flat closure.”

What do you think providers should know about aesthetic flat closure?

“Providers need to know that AFC is a valuable medical treatment that, when done well, allows women to minimize their surgical injury, feel authentic and quickly get back to living their lives with dignity in a body that is fully functional.”

In your view, what are the most important barriers to parity for aesthetic flat closure and how should we address them?

“Lack of patient education, lack of support by medical staff play roles in dissuading patients from choosing AFC. This is true for women facing mastectomy as well as women who want to explant their breast implants from problematic reconstruction. After the initial surgery, if the surgical outcome is unsatisfactory, providers need to educate patients about clean-up options. Sometimes insurers may balk at the clean up procedure and miscode it as ‘cosmetic’ instead of reconstructive.”

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.