Living Flat

Full color collage of happy women living flat after mastectomy with aesthetic flat closure

Disclaimer: Any and all information provided by Not Putting on a Shirt and its representatives is for informational purposes only and should not to be considered as medical or legal advice. This information is not intended to diagnose, prescribe, treat, or cure any medical condition. Statements should not be taken as a substitute for medical advice from a licensed physician. In using the communications, documents, forms and other information from Not Putting on a Shirt, you accept the terms and conditions of this disclaimer. Note: NPOAS is not affiliated with these groups or projects, unless specifically noted.


Introduction to Living Flat

There is beauty in simplicity.

Going flat and living flat is a journey, not a destination. You will adjust, you will grow, and you will make peace with your new body – but it will take time. Now is the time to give yourself space, and grace. Your physical healing is just the beginning.

“Flat can lead to freedom! I don’t miss having my boobs flopping around while trying to exercise, or the agony of trying to find a good fit in a swimsuit. The first time I went topless on at the beach and felt the sun on my chest, I felt like my authentic self. Nothing was missing, I was whole.” Amy Middleton (Fierce, Flat, Forward)

“Be gentle with yourself both physically and emotionally. I think we are too hard on ourselves and demand perfection from ourselves too often. We give care to others but when it comes to ourselves as women we demand too much of ourselves. So my advice would be: be gentle with yourself.” Kathy Ruscher (Fierce, Flat, Forward)

“Some people ask why so many photos of shirtless women who are flat? We show our scars because: we are both brave and beautiful, women of any age and stage of life can be diagnosed with breast cancer, we want to be the stepping stones of hope for those who come after us on this challenging journey.” Kathy Ritz (Fierce, Flat, Forward)

MORE Click to read more from women who are happily living flat.

“I knew I wanted to be flat. I read a lot of scary articles about women who were ‘botched’ which worried me… She did an amazing beautiful meticulous job. I love being flat. Love the freedom. Love the feeling. Love the look.” Anonymous (2018 Survey)

“After my explant surgery, I finally feel well and at home in my body. Removing the implants has allowed me the space, literally and figuratively, to heal from prior surgeries and medical experiences. I feel embodied and whole. I am strong and well. I finally feel like myself.” Sam Paige (Last Cut Project)

” I wore a prosthetic breast form for many years… When I stopped wearing the breast form, to my surprise, my confidence increased. My surgeon gave me a very flat result for which I’m grateful.” April Stearns (Wildfire Magazine)

“… the first time I saw my flat chest after removing the bandages and never looked back. I was happy. I felt just as sexy and feline as ever without bulky breasts weighing me down… Now, with my new [reconstructed] breasts, I feel equally as sexy and feminine… the bottom line, I think, is that you have to feel good about whatever choice you make, and that feeling good is critical for having and maintaining quality of life.” Beth Fairchild (Metavivor)

“When I first saw my chest after surgery, I felt relieved. I thought I looked fine, even beautiful. Although I choose to wear breast forms when I’m out and about, I feel totally comfortable with my breast-free self.” Barbara Kriss (BreastFree.org)

“[Going flat] was the best decision that I made for my body and eliminated all of the discomfort from previously having an implant.” Jersi Baker (Angel in Disguise, Inc.)

“Love yourself. Trust yourself, show yourself. This is your best life!” Pseud. Madonna (Fierce, Flat, Forward)

“I specifically requested a ‘gull-wing’ scar pattern (you can make such requests!) because I find its curviness aesthetically pleasing, and because I can wear lower-cut shirts without showing my scars if I feel like being sassy but not too sassy, lol… I am very pleased with my results.” Anonymous (read her story)


Community & Support

When you’re new to living flat, it can be a relief to find a community of like-minded women who have been through this transition. Share your experience, get support and advice, and crowd-source information and resources using one (or more) of the many Facebook groups founded for women like you!

Cover for Facebook support group for women going flat after mastectomy - Fierce, Flat, Forward
Fierce, Flat, Forward

Fierce, Flat, Forward 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.

Founded and run by Christy Avila, NPOAS Board member
Cover for Facebook support group for women going flat after mastectomy - Breatless & Beautiful
Breastless & Beautiful

We are living life Flat after Mastectomy due to breast cancer. Together, we are a network; supporting and exploring, considering and expressing a new body normal, together.

Founded and run by BethAnne King, NPOAS Board member
Cover for Facebook support group for women going flat after mastectomy - Fabulously Flat (Unreconstructed Breast Cancer Survivors)
Fabulously Flat (Unreconstructed Breast Cancer Survivors)

Support group for fabulous women who are considering or have elected not to have breast reconstruction following breast cancer.

Something missing? Add your group to this page!

You can also find community support on forums like BreastCancer.org on the web, or #BCSM on Twitter. National organizations like SHARE Cancer Support and the Breast Cancer Resource Center offer phone & video conferencing support groups. You can also find local resources with Triage Cancer’s search toolCancer Care’s search tool, or contact your national cancer society [American Cancer Society] [Canadian Cancer Society].

If you find yourself struggling, don’t be afraid to reach out for professional support. Ask your oncologist, oncology social worker or nurse navigator for a referral to a psychologist or therapist who can help you manage your feelings in a healthy way. Hester Schnipper LICSW, BCD, OSW-C (Healing Garden Cancer Support) has written a great article on how to find a cancer therapist here. You can also call Cancer Care’s Hopeline, or search for an oncology social worker near you using the Association of Oncology Social Work’s online tool.


Flat Fashion

Full color collage of happy women living flat after mastectomy with aesthetic flat closure - mastectomy with no reconstruction fashion tips

Dressing your post-mastectomy body is all about YOU – what you feel comfortable in, what you like and don’t like, and your personal sense of style. Some women living flat wear form fitting clothes that draw attention to their flat chest, while others prefer to wear clothing that distracts from or conceals the chest contour. And of course, there’s always the option to wear prosthetics.

There are several flat-specific fashion projects, groups and blogs online where you can find fashion tips, community, support and inspiration:

MORE Click here to see more flat fashion resources
Cover for Instagram flat fashion: The Flattie Closet
The Flattie Closet
(IG @theflattiecloset)
Casey is a BRCA1+ previvor embracing life & style as a flattie
Cover for Instagram flat fashion: Flattie Trip Mom
Flattie Trip Mom
(IG @flattie_mom)
Flattie fashion + mom life
Cover for Instagram flat fashion: Denise Archer
Denise Archer (IG)
Sewer, writer, embroiderer

Cover for Instagram flat fashion: @thebooblesswonder
@thebooblesswonder (IG)
Editor, writer, maker, BRCA2+ flattie living without breast reconstruction

Body Image & Sexuality

Full color collage of happy women living flat after mastectomy with aesthetic flat closure - mastectomy with no reconstruction body image and sexuality
Photos from AnaOno (far left) and The Grace Project (far right).
Body Image

No matter what your reconstructive choice, when you wake up from your mastectomy, your body will be forever changed – and it can be a big adjustment. Even when you’ve seen photos of flat closures and tried to prepare yourself for the “big reveal,” it can be a shock to see your flat chest the first time. Rest assured, it won’t always be this difficult (source). Be gentle with yourself and allow yourself to experience the grieving process – and don’t hesitate to seek out the support you need and deserve.

Some women experience positive benefits from being breast-free, particularly women who had large breasts. Many of these women report feeling “slimmer,” “lighter,” and “free,” especially when running and swimming. Even when you’re feeling less than confident, you can try to appreciate your body for what it can do rather than what it looks like. It can be challenging to shift your focus like this, but you may discover that you’re more resilient than you ever thought possible.

For body-positive inspiration, check out the flat visibility movement on social media, and the professional photography projects that serve to support women facing breast cancer:

Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Linkage Beauty Movement
Linkage Beauty Movement
Here to stand firm in Beauty, Confidence, Acceptance and Strength. Guiding women into positive body ownership and appreciation for what we are chosen to bear.
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Less Than Two Breasts
Less Than Two Breasts
An IG advocacy campaign to normalize bodies after breast cancer and to rethink cultural concepts of femininity. 
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Tout Aussi Femme
Tout aussi femme
Marie-Claude Belzile’s flat advocacy project on social media in Quebec (Facebook)
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: International FLAT Day
International FLAT Day
Celebrating FLAT as a worthy and beautiful reconstructive choice! (Facebook)
MORE Click here to see more flat & body-positive projects
Cover for breast cancer photography with and without breast reconstruction: The Grace Project
The Grace Project
Charise Isis’ beauty through mastectomy photography project (registered nonprofit)
Cover for breast cancer photography with and without breast reconstruction: The Scar Project
The Scar Project
David Jay’s beautiful professional portraits of young women with breast cancer
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: @feminine_phenom
@feminine_phenom
Navy veteran, figure competitor and breast cancer survivor Amber Dawn Rice
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: @whatcancernaija
@whatcancernaija
Ngozi Ejedimu’s breast cancer advocacy from Nigeria
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: @charitysade
Charity Sadé
(@charitysade) is a comedian, writer, activist, teacher and breast cancer advocate living flat in D.C.
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: @not_in_the_pink
@not_in_the_pink
Tina Martel is an artist, author, educator, and two time breast cancer survivor living the flat life and promoting body positivity.
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Juliet Fitzpatrick
Juliet Fitzpatrick
(@julietkfp)
Living flat & advocate for choice after mastectomy.
Cover for body positive flat imagery - with and without breast reconstruction: Wildfire Magazine
Wildfire Magazine
“Too young” for breast cancer, fighting nonetheless.
Cover for flat podcast - Flat Is Where It's At - living flat after mastectomy with aesthetic flat closure
FLAT is where it’s at
(Instagram) Stephanie Astalos-Jones’ on all things flat!
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Completement Femme
Complètement FEMME
Daring to be whole after mastectomy (L’audace d’être entière après une mastectomie)
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: AMSOB Germany
Ablatio mammae – Selbstbewusst ohne Brust e. V. – AMSOB
(@selbstbewusstohnebrust) AMSOB ist ein Verein der sich für Frauen nach Brustkrebs oder prophylaktischer Operation (#BRCA 1&2) ohne Rekonstruktion stark macht.
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Marianne DuQuette Cuozzo, Artist
Marianne DuQuette Cuozzo
Artist, mother, 3x cancer survivor and dreamer….
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: @statisticaloddity
@statisticaloddity
Laurie Ratliff is a long time stage IV BC survivor and audo-visual artist and advocate.
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Samantha Paige
Samantha Paige
@samantha__paige__
Sam is an artist, author, teacher
and creator of @lastcutproject
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Flat Closure NOW
Flat Closure NOW
Promoting self-love, and body positivity, creating community, providing support, and educating with a focus on advocating through visual arts.
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Rebecca Pine, The Breast and the Sea
Rebecca Pine
Speaker, Survivor, Workshop Facilitator, Transformation Coach, Co-Founder of The Breast and the Sea- Empowering Through Healing Our Inner Scars
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Spero Hope, LLC Jamie Lee
Jamie Lee (Spero Hope, LLC)
(@spero_hope_llc_)
Jamie Lee is a Christian, wife, Mom, and breast cancer survivor.
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Christina Belding
Christina Belding
Artist, baker, cat lover, movie fan, gym rat and world traveler
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Lisabeth Live Aloha
Lisabeth 🌺Live Aloha!🍍 (IG @ocr_wahine)
FireWife+DogMom • Run+OCR
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: @frameshiftflat
@frameshiftflat
A young physical therapist & BRCA2 previvor living flat
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: Rocki The Flat Chick
Rocki • That Flat Chick
@livingflatoutloud (IG)
Thriver/Survivor BC 2012, Melanoma, Chronic Illness
Silly/Serious
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: @mscarlahill
@mscarlahill (IG)
TV host, model, & breast cancer and kidney transplant survivor
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: @the_way_i_am_now
@the_way_i_am_now
Free To Be Imperfect
Showing that choosing no reconstruction is a valid choice.
Cover for body positive flat imagery - aesthetic flat closure after mastectomy: @plattnormen
@plattnormen (IG)
Sweden’s flat advocacy nonprofit PlattNormen – supporting freedom of choice in mastectomy

Questions or concerns? Something missing? Add your project/resource to this page!

Sexuality & Intimacy

Mastectomy will invariably impact a woman’s sex life, because it impacts the body she inhabits. To the extent that your natural breasts were a source of sexual pleasure for you, you will have adjustments to make as you get used to your post-mastectomy chest. Beyond the change in appearance, you will notice that you no longer have the same level of sensation there that you had with your natural breasts. Remember that the loss of sensation is not due to going flat – it’s a result of the mastectomy itself. Some women retain some sensation, while others are completely numb – and this can change over time as well.

Your sense of yourself as a sexual being, and a sexually attractive woman, may be impacted by your mastectomy as well. Since this is so individual and variable, and your relationship with your partner is as well, the most helpful strategy is to focus on communication.

“The key is communication – the biggest sexual tool with your partner is to talk to them. Tell them what you want, what you don’t want, what’s different and to try to explore different issues… the key issue in developing a positive sex life after cancer is communication.”

Professor Jane Ussher, Western Sydney University

The Australian charity Cancer Council NSW has the following excellent tips for resuming intimacy after mastectomy:

  • Be gentle with yourself and acknowledge how you are feeling.
  • Look at and touch your scars so you get used to the changes.
  • Give yourself time to get used to any physical changes. Some changes may be temporary and will improve with time.
  • Focus on yourself as a whole person and not just the part of you that has changed.
  • Remember that sexual attraction is based on a mix of emotional and physical factors, not on a single body part or another physical characteristic.
  • Dim the lights and/or wear a comfortable top when you have sex until you feel more confident about your body.

In addition to the impacts on your sex life from the mastectomy, you may also be dealing with changes to your body from chemotherapy, radiation, and/or hormone therapy which negatively affect your sexual anatomy and libido. Early menopause, in particular, can present a major challenge, especially because its associated physical and emotional changes can be sudden and drastic.

Talk to your medical oncologist about your symptoms. Don’t be shy – be specific, and advocate for yourself. Your sexual well-being is important for your quality of life! Your oncologist may be able to refer you to a women’s sexual health specialist, or recommend products or treatments tailored to your situation. And you can find a wealth of information and resources on sexuality after cancer online at the American Cancer Society and the Cancer Council NSW.


Prosthetics (Breast Forms)

Color photo collage of prosthetic breast forms for mastectomy

“Living flat” usually means that after your mastectomy with flat closure, you don’t wear prosthetics which are external accessories that are worn under clothing to give the appearance of breasts. But many women who choose flat closure do wear prosthetics, some or all of the time. Your preferences about prosthetics can change over time, too – many women wear them at first, then find that they wear them less often as time goes on and they feel more at ease with their breastless body. One of the benefits of flat closure is you can choose to appear flat or breasted at will!

You should know that prosthetics are almost never medically necessary, for posture or any other functional reasons. Unless you are single-breasted and your remaining breast is very large, you’re unlikely to benefit physically from wearing a prosthetic. It’s an issue of aesthetics – how you want to look, both for your own self-image and confidence and for presenting yourself to the world in a way you feel comfortable with.

Prosthetics can be purchased prefabricated from many different retailers, in different shapes, sizes and materials. From traditional silicone prosthetics which are fairly heavy (Amoena and others), to special swim prosthetics, to lightweight foam alternatives (Athleta Empower Pads, AnaOno’s F(oo)Bs), to knitted/crocheted products (Knitted Knockers, Awesome Breast Forms), to integrated products (Busted Tank) – there’s a prosthetic available for everyone and every occasion. Prosthetics can also be custom-made for your body.

Insurance generally does cover the cost of prostheses, but not always, and you may need a prescription. Visit BreastFree.org, BreastCancer.org, or the American Cancer Society for more detailed information about prosthetics.


Mastectomy Tattoos

Full color collage of  mastectomy tattoos - mastectomy with aesthetic flat closure decorative tattoo art
Mastectomy Tattoo Art by Amy Black, Stupenka Tattoo, Roxx, and Shane Wallin (More)

Mastectomy Tattoo: a tattoo that is drawn on top of the mastectomy site, usually to cover mastectomy scars – includes both restorative tattoos (restoring the nipple/areola) and decorative pieces (non-anatomic).

Tattoos can be an important component of healing for many women following their mastectomy surgery – both those who chose to reconstruct their breasts AND those who chose to go flat. Tattooing can be a way for women to take back ownership over their bodies, having had so little control during breast cancer treatment.

For some, tattoos can restore the appearance of their lost nipple/areola (restorative, or reconstructive tattoos). Others choose mastectomy tattoos that are decorative (also called artistic, or “scar covering”) rather than anatomic, and that hold special meaning for them – flowers, vines, words, and designs of every shape and color. Women going flat typically choose decorative tattoos rather than restorative tattoos, but both are an option.

Unfortunately, many insurance companies do not provide coverage for mastectomy tattoos. Those that do, only cover restorative (not decorative) tattooing as part of the “breast reconstruction” process. However, there are at least two nonprofit organizations that provide financial assistance to mastectomy patients to cover part or all of the cost of their desired tattoo: Personal Ink and Pink Ink Fund.

Patients considering mastectomy tattoos should also be aware that not all tattoo artists will produce optimal artwork, because tattooing is a largely unregulated field, and particularly for restorative tattoos should seek out a licensed artist specializing in this area who can display a portfolio of previous work.

(More about mastectomy tattoo logistics and risks.)


What If I Change My Mind?

Some women who initially reconstruct end up going flat later on, either because their reconstruction failed or because of serious medical complications or dissatisfaction with cosmesis (appearance). Some of these women choose to pursue a different type of breast mound reconstruction instead of going flat. And some women who initially choose to go flat end up reconsidering reconstruction later on.

It’s ok to re-evaluate your initial decision.

It’s ok to re-evaluate your initial decision. None of us can know with perfect certainty how we will feel living with our initial reconstructive choice – or how our initial surgery will pan out. In the United States, the federal legislation requiring insurance companies to cover breast reconstruction doesn’t impose time limits on your right to seek reconstruction (or “deconstruction” – explant, etc.).

Keep in mind that after a mastectomy, no matter what your surgical outcome, there will be an adjustment period. Losing your natural breasts due to breast cancer is a loss, and most women grieve that loss – a process that can take some time and may look different for different individuals.

If after living flat for some time, you feel you are ready to re-evaluate your reconstructive options, the next step is to find a qualified plastic surgeon who will assist you through the process. A good overview of how to find a surgeon can be found at BreastCancer.org. You can also use a decision aid like the Breast Advocate App to help you think through your options before your consult.

Remember, this is your body and your choice. You deserve to have a surgical outcome that supports your emotional and physical well-being!


More Resources

Publications
Cover for body positive flat imagery - with and without breast reconstruction: Wildfire Magazine
MAGAZINE: Wildfire
The only magazine for the women “too young” for breast cancer. Includes a “Body Issue” that is always flat-positive
Cover for going flat book: FLAT Reclaiming my body from breast cancer, by Catherine Guthrie
FLAT: Reclaiming my body from breast cancer
Catherine Guthrie
The compelling narrative of a young, queer woman pressed up against a life-threatening illness and cultural expectations of femininity.
Podcasts
Cover for flat podcast - Flat Is Where It's At - living flat after mastectomy with aesthetic flat closure
PODCAST: FLAT is where it’s at
A podcast about all things flat, with Stephanie Astalos-Jones
Cover for flat podcast - Oben Ohne?! by AMSOB Germany - living flat after mastectomy with aesthetic flat closure
PODCAST: Oben Ohne?!
Host Kerstin Grotelüschen, speaks with guests about various aspects of “breastlessness”
“Going Flat” Articles, Videos and Blog Posts
News & Magazine Articles

Videos
Podcasts & Podcast Episodes

FLAT is where it’s at (Stephanie Astalos-Jones)

Oben Ohne?! (AMSOB, Germany – first episode in English)

Not Putting on a Shirt, with Devorah Vester” (Guest Devorah Vester) MindBloom, 2020

Flat Closure Zoom with Kim & Stacie-Rae: Informed Consent and Advocacy” (Guest Kim Bowles) Stacie-Rae Weir, 2020

Aesthetic Flat Closure” (Guest Melanie Testa) The Healthqueer Advocate, 2020

Blog Posts

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