Frequently Asked Questions

FAQ for Providers


What is an “aesthetic flat closure?”

Aesthetic flat closure (or “flat closure”) is reconstruction of a smooth chest wall contour post-mastectomy. It involves careful removal of any excess tissue remaining after excision of the glandular tissue, and can also involve contouring of the remaining tissues. The National Cancer Institute recently added aesthetic flat closure to its Dictionary of Cancer Terms.

How is aesthetic flat closure different from a nonreconstructive mastectomy?

Aesthetic flat closure refers specifically to the contouring work that is performed after removal of the breast tissue, whether at the initial surgery or at a later timepoint (i.e., revision or explant), to restore a smooth, flat chest wall contour. Patients who choose to go flat almost universally desire aesthetic flat closure. But until very recently, they have not had clear language with which to express this desire. The language deficit has also presented a problem for providers in managing patient’s expectations. The National Cancer Institute’s definition of aesthetic flat closure should resolve this issue.

Where can I learn more about aesthetic flat closure generally?

You can visit the Provider Resources Page to learn more. This page is continuously updated with the latest news and information about aesthetic flat closure.

What is “flat denial“?

It’s a matter of informed consent. Unfortunately, in the past, a small number of providers have taken advantage of the murky language situation in order to impose their own preferences for breast mound reconstruction on their patients, directly against the patients consent. This is flat denial. Under certain circumstances, we also include egregiously poor aesthetic results resulting from lack of skill or care. You can read some of these patients’ experiences here.

Do patients expect perfect mastectomy closures now?

Minor imperfections are normal and expected and do not constitute flat denial (which involves egregiously poor aesthetic results). We discuss contributing factors to the aesthetic outcome here. We discuss expectations and shared decision making here. We welcome your input on this issue – please do not hesitate to contact us!

Can’t a plastic surgeon do this work at a later date?

Yes, but most patients going flat strongly prioritize being “one and done.” For this reason, if they do not feel they can provide the result the patient expects, some surgical oncologists may elect to bring on a plastic surgeon to perform an aesthetic flat closure after they perform the mastectomy/ies.

Is the information on this website vetted for medical accuracy?

Yes. As a matter of ethics and historic policy, our medical Advisors review all of the information we provide.

How do I get on the Flat Friendly Surgeons Directory?

All of our current listings are from direct patient recommendations, but in the future we do plan to expand the Directory beyond that – please fill out the short form at For Directory Surgeons. You can also contact us directly online or by email to providers@notputtingonashirt.org.

How do I update my Directory listing?

Update your listing online or by email to providers@notputtingonashirt.org. Please send flat closure images directly by email.

How do I get brochures for my clinic?

You can order brochures mailed at no charge, at our Publications Page.

I don’t see my question here.

We are here to help! Please ask your question directly by emailing us at providers@notputtingonashirt.org or by using our contact form.


Contact

Not Putting on a Shirt
P.O. Box #111215
Pittsburgh, PA 15215
USA

Ask Your Question