Peer Support: Fierce, FLAT, Forward

Fierce, FLAT, Forward is a Facebook support group for women at different points of their breast cancer journey who are either flat, going flat, or wanting to research/explore “living the FLAT life”—whether or not they choose to present as such in their daily lives.

It is for the survivor, the previvor, and for the newly diagnosed. It is for the “reconstructed” and then DE-reconstructed, the implanted and then explanted, the revisioned and revised, and the re-re-revised.

Ultimately, and by design, it is a group for the FIERCE, the FLAT, and the ever moving FORWARD! #TheFLATRevolutionIsNOW

Fierce, FLAT, Forward was founded in 2019 by Christy Avila, NPOAS VP, and now has over 9,700 members and growing.

To join, click here or scan the QR Code

Support NPOAS by ordering your own FFF shirt!


Group Management Policy

Fierce, FLAT, Forward – Facebook Support Group Management Policy

  1. Purpose of Policy

The purpose of this policy is to clearly delineate the manner of operation of, and to provide governance direction to leadership of, the private Facebook support group, Fierce, FLAT, Forward (“FFF”). As an official entity (program) of Not Putting on a Shirt (“NPOAS”), a registered 501(c)(3) charity, FFF shall be managed in accordance with our mission statement and core values:

“Our mission is to advocate for satisfactory aesthetic outcomes – as agreed upon by the mastectomy patient and surgeon(s) – for those who choose to go flat. We inform and support patients, demand increased accountability for medical professionals and institutions, and collaborate with patients and the surgeons who care for them to establish resources and protocols that will make a difference.”

Clear Language

Flat closure is reconstruction of the chest wall contour.

Flat denial is when a surgeon disregards the patient’s consent and fails to perform the agreed upon flat closure.

Full Disclosure

Women must be given full and accurate information about ALL of their reconstructive options, including flat closure.

Shared Decision Making

The decision making process must center the patient’s values and priorities from start to finish for optimal surgical outcomes.

Evidence-Based Medicine

An optimal, evidence-based standard of care must be developed for aesthetic flat closure in order to ensure women consistently receive acceptable surgical outcomes.


Respect for women’s informed consent is non-negotiable. Surgeons who intentionally disregard a woman’s reconstructive choice must be held accountable.

Fair Reimbursement

Surgeons deserve to be fairly reimbursed for aesthetic flat closure and revision services, as aesthetic flat closure is a truly reconstructive, NOT cosmetic, procedure.

Systemic Parity

Achieving parity for aesthetic flat closure requires systematic legislative and regulatory change. Both the NCI and WHCRA’s definitions of “breast reconstruction” as well as the NAPBC’s reconstructive consult protocol must all be amended to explicitly include aesthetic flat closure.

  1. Group Description

FFF is a support group for women at different points of their breast cancer journey who are either flat, going flat, or wanting to research/explore “living the FLAT life”—whether or not they choose to present as such in their daily lives. FFF helps patients self-advocate for satisfactory aesthetic flat closure by informing and supporting them before, during and after their experiences with mastectomy and explant.

  1. Group Governance

Group Leader. FFF shall be overseen by a single Group Leader, who shall be an NPOAS Board member. The first Group Leader shall be FFF group founder and NPOAS Vice President Christy Avila. The standing Group Leader shall have the power to appoint her successor when leaving the office. The Group Leader may also appoint an interim Group Leader in the event of personal leave or absence, at her sole discretion.

Administrator Team. The daily business of FFF shall be managed by a team of administrators (“admins”) recruited by the Group Leader from within the group’s membership, under the direction of the Group Leader. Admins shall be members in good standing who have consistently demonstrated sound judgment and are capable of upholding and enforcing the group rules and expectations delineated in Section 5 of this policy.

Relationship to NPOAS Board. FFF operates as an independent program under the direction of one person, the Group Leader. The NPOAS Board does not have oversight over the daily business of the group, but changes to this policy must be approved by the NPOAS Board.

  1. Membership Criteria

Members admitted to FFF must be considering going, or have already gone, flat after mastectomy or explant. Medical professionals who are not themselves mastectomy patients are not allowed in the group.

  1. Group Rules and Expectations

Be kind and courteous. We’re all in this together to create a welcoming environment. Let’s treat everyone with respect. Healthy debates are natural, but kindness is required.

Respect group members’ confidentiality. What is shared in the group is to stay in the group. Please do not share or disclose conversations or photos from the private group. Do not share any private information or screenshots from the group, outside the group.

No hate speech or bullying. Make sure everyone feels safe. Bullying of any kind isn’t allowed, and degrading comments about things like race, religion, culture, sexual orientation, gender or identity will not be tolerated.In addition denigrating an administrator will be an automatic removal from the group

Any promotions must be on topic and admin approved. We expect content to be relevant to our members, so any business or for-profit promotions should be on topic – i.e., related to going flat, living flat, breast implant illness and/or breast cancer – and should be pre-approved by an admin.

  1. Post & Comments Management Guidelines

Prohibited Content

It is NPOAS’ policy to maintain vigilance on content quality in order to protect the integrity and safety of the community that we serve, and to maintain respectful discourse within the group. Therefore, all posts to FFF require prior moderator approval. Posts are approved at the discretion of the moderators as we seek an overall balance in flat related content. Posts should not be approved if they meet any of the following criteria, and comments that meet any of the following criteria should be removed:

  • Contain spam (irrelevant content that adds no value to and/or distracts from the discourse).
  • Are defamatory of any person, deceive others, are egregiously obscene, offensive, threatening, abusive, hateful, inflammatory or promote sexually explicit material or violence.
  • Promote discrimination based on race, sex, religion, nationality, disability, sexual orientation, or age.
  • Are off-topic, irrelevant or unintelligible.
  • Contain any advertising or promote any services unrelated to the group’s mission.
  • Contain explicit or implicit medical or legal advice. Note: discussion of personal experience with medical treatment is allowed.
  • Contain debunked information or “alternative medicine” which may have the effect of discouraging members from adhering to their oncologists’ medical advice. Note: information about complimentary therapies is allowed and encouraged.
  • Breach any of Facebook’s own terms and conditions.
  1. Conflict Resolution

Administrators shall maintain a personable and professional tone when managing conflict between group members. In the event of a conflict, admins shall use good judgment to de-escalate the situation and ensure that all significant parties are properly notified that the situation is being handled. Conflict should be handled promptly and transparently. Post and/or comment deletion is left to the discretion of the admin handling the situation; situations that present with significant uncertainty about proper handling should be brought to the attention of the admin team via group Facebook chat.

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