Contact Your Legislators

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Want to take action to make a difference for women going flat?

Contact your legislators.

Women going flat need our elected representatives – both at the federal and state levels – to pass legislation that requires:


Health insurance companies must cover aesthetic flat closure and revision services just like they cover conventional reconstruction.


An evidence-based standard of care for aesthetic flat closure must be developed and adhered to.


Providers must give equal time to the option of aesthetic flat closure as they do conventional reconstruction education.

It all starts with you.

Legislators listen to their constituents. Make your voice heard!

STATE – Encourage your state legislators to sponsor a bill modeled on the Vermont revision legislation.

Download the materials, find your state legislators, and call their office.

1. Download the Materials – Factsheet, Bill, & Visual Aid

You’ll need these to email to your legislators after you call their office.

2. Find Your State Legislators

Thanks to Open States for providing this free service!

3. Call their Office and Offer to Send Materials

Ask to speak to their healthcare aid. Be concise and polite. You can use our script:

“Hi, my name is [name]. I am a constituent from [your locality]. I’m calling to ask if [rep’s name] will sponsor a bill requiring insurance coverage for revision surgery for mastectomy patients. Right now patients are struggling, and we need your help. Vermont’s legislature is considering such a bill right now. May I email you more information?”

Questions? Contact us!

FEDERAL – Sign our WHCRA petition online, and use our template to mail a personalized letter to your federal legislators.

[1] SIGN the Petition

Click below to navigate to the Care2 Petition. We will be hand-delivering this petition to Congress in the coming months.

After you sign, please consider sharing!

[2] WRITE a Letter

It’s easy! Find your federal legislators, then use our template to personalize your letter. Print, sign and mail it out!

1. Find Your Legislators
2. Draft Your Letter

NOTE: Select File > Make a Copy, then make your edits

3. Print and Mail

Stay tuned for updates!

June 20, 2020 – National Cancer Institute defines “aesthetic flat closure” as a unique reconstructive procedure.

April 19, 2020 – The Oncoplastic Breast Consortium adds “optimal flat closure” to its mission.

April 20, 2020 – H.686 Factsheet now available for download.

Jan. 12, 2020 – Vermont State Representative Charen Fegard introduces an historic bill requiring insurance coverage for revision surgery.

This bill will serve as a model for legislation in other states, and will put flat closure on the radar at the federal level as well. That will facilitate getting the WHCRA amended. It’s time!

State Legislation Progress Tracker




Jan. 2020






in committee

Questions? Need Help?

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Find out more!

Why do we need to amend the WHCRA legislation?

To ensure insurance coverage for flat closure and revision services… so that women going flat don’t have to worry about fighting their insurance companies.

Going flat at initial mastectomy instantly saves your health insurance company thousands if not tens of thousands of dollars. And most often, going flat means you’re “one and done.” However, sometimes a patient will require additional “revision” surgery to produce an aesthetic result that they can live with.

Revision can involve removing excess tissue and/or other contouring procedures to produce a smooth result. This can be required after initial mastectomy, or after removal of implant reconstruction (explant) to go flat.

Insurance companies often refuse to cover revision surgeries, stating that they are “cosmetic” rather than reconstructive, and therefore are not covered by the Women’s Health and Cancer Rights Act (WHCRA, 1998).

Women end up having to spend their limited time and energy fighting their insurance company while recovering from major surgery, just to get the care that they need to move on with their lives.

Too often, if the option to go flat is mentioned at all, it’s cast as a choice that’s “less than.” And in terms of getting a result they can live with, many women don’t have the ability to fight their insurance company during their surgical recovery – so they are forced to live with a “mangled” chest. Whereas their sisters who choose breast reconstruction have their two, three, even up to nine or more surgeries covered by insurance without any suggestion that their surgeries are “cosmetic”.

The original intent of the WHCRA was to ensure that women facing breast cancer surgery were able to achieve aesthetic results they could live with. Who could have forseen that helping women who choose breast reconstruction would end up harming the rest who choose to go flat? Without corrective action, this disparity will endure.

Flat closure does not rebuild the shape of the breast, but it DOES correct a deformity caused by the mastectomy – it restores the normal anatomic contour of the chest wall (hence, “chest wall reconstruction”) – and therefore it is truly reconstructive (NOT cosmetic) and should be covered by the WHCRA, in order to fulfill that legislation’s original intent.

It’s clear, from a reading of the WHCRA text, why flat closure is often interpreted as being excluded from coverage. However, this is an easy thing to fix – we simply need to change “breast” reconstruction in the legislation to “breast or chest wall” reconstruction. It’s that simple!

“… who elects either breast or chest wall reconstruction in connection with such mastectomy, coverage for—
all stages of reconstruction of the breast or chest wall on which the mastectomy has been performed;
surgery and reconstruction of the other breast or chest wall to produce a symmetrical appearance…”

Women’s Health and Cancer Rights Act of 1998

One in eight women will face a breast cancer diagnosis in their lifetime. And four out of five women over the age of 60 who have mastectomies, decide to go flat. That’s a lot of women potentially facing suboptimal care and additional hardship at one of the most vulnerable times in their lives.

According to Not Putting on a Shirt’s research, which was presented at the San Antonio Breast Cancer Symposium this December, one in four women going flat receives an unsatisfactory aesthetic result, and 1 in 20 are intentionally denied by a surgeon who believes they will “change their mind” about implant reconstruction and so disregards their consent. There is a lot of room for improvement here.

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.

Questions? Comments? Want to do more to help?



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