Media Kit

Aesthetic Flat Closure

Media Kit

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Contact Information


IG: @notputtingonashirt

Twitter: @not_shirt


Phone: (412) 407-5997‪

Mailing Address: Not Putting on a Shirt, Inc.
PO Box #111215
Pittsburgh, PA 15238

Charity ID#: 84-3021062


Not Putting on a Shirt (NPOAS) is a patient-led, all-volunteer 501(c)(3) nonprofit organization advocating for optimal surgical outcomes for women who choose to go flat after mastectomy. NPOAS was founded in July 2018 and incorporated in 2019.

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.


NPOAS curates extensive resources available online and free of charge for both patients and providers interested in aesthetic flat closure, including:


Our grassroots initiatives include stakeholder and public outreach, legislative and regulatory actions, and original research in order to effect cultural and institutional change to protect the interests of women going flat. Our current/recent projects are:

Officers & Directors

Kimberly Bowles, President

Christy Avila, Vice President

Devorah Anne Vester Borenstein, Secretary

Shana Whitehead, Treasurer

Bethanne Lobmiller

Statistics & Fact Sheets

Patients going flat have unique values and priorities.

Patients who choose FLAT

… about 45% of patients

  • want to avoid additional surgery
  • do not consider a breasted appearance to be important
  • worry about health impact of implants and losing muscular strength from breast reconstruction
  • tend to be older (over age 60, 4/5 choose flat

Patients who choose PMBR

… about 55% of patients

  • accept the possibility of needing additional surgery
  • prioritize maintaining a breasted appearance
  • do not want to use prosthetics
  • tend to be younger

There is room for improvement in aesthetic outcomes.

44% of all mastectomy patients choose to go flat.

75% patients going flat are satisfied with their aesthetic outcome.

NPOAS Survey 2018

1 in 20 patients going flat are subjected to intentional flat denial.

NPOAS Survey 2018-19

Certain factors are associated with flat denial and poor aesthetic outcomes.

Factors associated with flat denial:

  • age over 55 years
  • BMI over “normal”
  • use of a general surgeon (vs. breast specialist)
  • presence of pre-operative pushback

Patient factors associated with egregiously poor expectation match include age older than 55 years (left) and higher than “normal” BMI (right). In these figures, red = poor expectation match, green = excellent expectation match.

Note: further studies are needed to confirm and determine the specific nature of these correlations.)

What Is Aesthetic Flat Closure?

Aesthetic flat closure = post-mastectomy chest wall reconstruction

An Alternative to Breast Mound Reconstruction

Aesthetic flat closure is a beautiful, healthy oncoplastic alternative to conventional reconstruction (i.e., implants and autologous flaps) that restores a smooth, flat chest wall contour instead of breast mounds.

Recognized by National Cancer Institute

The mastectomy first removes the glandular tissue of the breast, and the subsequent aesthetic flat closure removes and/or contours any remaining excess fat and skin to restore a smooth, flat chest wall. According to the National Cancer Institute’s definition:

  • aesthetic flat closure is reconstructive (“rebuilding”)
  • aesthetic flat closure requires an aesthetic, or oncoplastic, surgical approach
  • excess tissue removal & contouring are involved
  • aesthetic flat closure may be performed either at the initial mastectomy or at explant (implant removal)
History & Significance

For years, women going flat struggled to be clear with their surgeons, because we didn’t have the language to ask for aesthetic flat closure by name. As a result, surgeons sometimes skip the contouring altogether, leaving a “mess” that required additional surgery to fix. And sometimes, a surgeon will override the patient’s consent and leave extra skin to facilitate implant reconstruction. Our research suggests that 25% of women going flat end up with cosmetic results they are dissatisfied with, and about 5% suffer intentional denial of their choice by a surgeon who thinks they’ll change their mind.

The term “flat closure” entered the patient community’s lexicon only a couple of years ago with the publication of our article about misaligned financial incentives in the mastectomy setting. It was then adopted for general use by patients and providers alike, and in early 2020, the NCI added “aesthetic flat closure” to their Dictionary of Cancer Terms. Now, the ambiguity is gone. And as cancer surgeons’ understanding of their patients’ expectations evolves, it should become commonplace for them to bring on a plastic surgeon to perform aesthetic flat closure – just as they do for breast mound reconstruction.


Board of Directors
Kim Bowles


Kim Bowles is a scientist, artist, mother of two, and founder of Not Putting on a Shirt. She decided to go flat in 2017 as part of her breast cancer treatment plan, but her plastic surgeon intentionally left her with excess tissue to facilitate reconstruction.  Kim went public with her story, and upon realizing that flat denial is a systemic problem requiring institutional change, decided to invest in pursuing parity for flat closure and helping women protect their choice. Kim has been featured in Cosmopolitan magazine, Women and the World, on the Today Show, and more.

Christy Avila

Vice President

Christy Avila is a career educator, mother, and explant and flat closure advocate. She founded Fierce, Flat, Forward, a support and advocacy group that encourages, guides, and educates other breast cancer survivors and previvors on going flat—whether at the time of initial mastectomy or post-explant. She herself chose to “go flat” after discovering breast implant illness (BII) and choosing to explant based on her subsequent research on breast implants as medical devices.

Christy co-founded “International FLAT Day,” (Oct. 7th), an annual event that celebrates FLAT and promotes flat closure and breast reconstruction awareness. In 2019, she testified before the US FDA at their Hearing on Breast Implant Safety in Washington DC, advocating for proper informed consent for breast cancer survivors. Christy serves on the faculty of the Communication Studies Department at San Jose City College where she has taught for over a decade. She looks forward to continuing her advocacy work to promote flat closure, explant, and informed consent.

Devorah Vester Borenstein


Devorah Vester Borenstein is an appellate attorney in Boston who helps persons with mental illness regain their agency, liberty and dignity. In July 2019, she had a double mastectomy after a local recurrence. Devorah always knew she did not want breast reconstruction, and feels fortunate that her breast surgeon – who told her about the flat movement – honored her choice. Devorah’s closely held values of integrity, transparency and individual autonomy make her an incredible asset to the NPOAS Board. Her goal at NPOAS is to bring all parties to the table – doctors, legislators, health insurers and patients – to make certain that in every state a woman’s right to full disclosure and informed consent is protected, and her decision to go flat is respected.

Shana Whitehead


Kim Bowles is a scientist, artist, mother of two, and founder of Not Putting on a Shirt. She decided to go flat in 2017 as part of her breast cancer treatment plan, but her plastic surgeon intentionally left her with excess tissue to facilitate reconstruction.  Kim went public with her story, and upon realizing that flat denial is a systemic problem requiring institutional change, decided to invest in pursuing parity for flat closure and helping women protect their choice. Kim has been featured in Cosmopolitan magazine, Women and the World, on the Today Show, and more.

BethAnne King

Board Member

Hi, I am BethAnne King. My interest in this movement is personal. I was denied the flat surgery I wanted and was inspired to establish Breastless and Beautiful, a social support group for mastectomy survivors. This group’s focus is body acceptance, regardless of surgical results. Members talk about adjusting to their changed bodies and new normal, since breast cancer. The validation and sisterhood there is healing and helpful.

I proudly advocate for informed consent for women who are facing mastectomy due to breast cancer (or risk of). My advocacy work is focused on helping to change laws that increase patient’s opportunities for informed consent so that they receive the surgical outcomes they expect.

My goal is to make changes so that no one else has to suffer this experience. We need to update the policies that restrict insurance coverage of revision procedures for those whose wishes were disregarded, and for those who, with more information, have decided they want to go flat.

Advisory Council
Pankaj Tiwari, MD

Advisor, Plastic & Reconstructive Surgery

Dr. Pankaj Tiwari is a board-certified plastic surgeon who has fellowship training in microvascular surgery and focuses his practice on breast reconstruction after mastectomy. After completing medical school at New York University, plastic surgery residency at the Baylor College of Medicine and fellowship at The MD Anderson Cancer Center, Dr. Tiwari went on to accept a faculty teaching position at The James Cancer Center and The Ohio State University, Wexner Medical Center. While a full time faculty member for seven years, he co-authored numerous publications and book chapters, was awarded the “Microsurgery Case of the Year”, Resident Teaching Award and Best Doctors’ Award and was selected as one of Columbus’ top 40 under 40 professionals. In 2014 he co-founded Midwest Breast and Aesthetic surgery and in 2018 Onyx and Pearl Surgical Suites to provide advanced techniques for reconstructive breast surgery. Beyond microsurgery, Dr. Tiwari has a keen interest in developing practice patterns and standards to help lower the costs of healthcare while providing outstanding quality and safety outcomes. He enjoys spending time with his lovely wife and two daughters, traveling on surgical mission trips and playing the Tabla (Indian Drums).

Ergun Kocak, MD

Advisor, Plastic & Reconstructive Surgery

Dr. Ergun Kocak is a board-certified plastic surgeon specializing in advanced aesthetic and reconstructive surgeries of the breast and body. He is fellowship-trained in microvascular reconstruction and performs over 200 DIEP and other microvascular free flap breast reconstructions yearly. He also specializes in aesthetic operations of the breast including breast reduction, and breast lift (mastopexy). After graduating from the University of Michigan with Honors, Dr. Kocak went on to complete medical school at The Ohio State University College of Medicine. Dr. Kocak continued his training by completing his plastic surgery residency at The Ohio State University Medical Center in Columbus, Ohio. During this time, he completed a Research Fellowship and earned a Masters of Sciences degree in Medical Sciences from The Ohio State University’s Graduate School. After residency, he further specialized by completing a fellowship in reconstructive microsurgery and cancer reconstruction at the esteemed M.D. Anderson Cancer Center in Houston, Texas.

Yara V. Robertson, MD, FACS

Advisor, Breast Surgical Oncology

Yara V. Robertson, MD, FACS, is a board-certified general surgeon and fellowship-trained breast surgical oncologist. Dr. Robertson has been in Atlanta, GA since 2011 providing quality breast cancer care and has been passionate about eliminating disparities in breast cancer treatment, especially in the African American community. She lectures on breast health and participates in numerous health fairs providing free clinical breast exams. She has previously served as Vice-Chairman of Sisters by Choice, a non-profit organization that provides education and free breast health screenings to uninsured women as well as support for women diagnosed with breast cancer.

As a kidney cancer survivor herself, Dr. Robertson is fully aware of the importance of the patient’s role in shared decision making and advocates for patient centered care.  Dr. Robertson believes that women who choose to go flat after a mastectomy deserve a surgical result that is aesthetically pleasing to them and fully supports the mission of Not Putting on a Shirt.

Minas Chrysopoulo, MD FACS

Advisor, Plastic & Reconstructive Surgery, Shared Decision Making

Dr Chrysopoulo (“Dr C”) is a board certified plastic surgeon, breast reconstruction surgeon and microsurgeon, and President of PRMA Plastic Surgery in San Antonio, TX.   He specializes in state-of-the-art breast reconstruction with a particular focus on perforator flap breast reconstruction, nipple-sparing mastectomy, techniques to maximize aesthetic outcomes, and restoring sensation after mastectomy.

Dr C is certified by the American Board of Plastic Surgery, is an active member of several professional societies including the American Society for Reconstructive Microsurgery (ASRM), and the American Society of Plastic Surgeons (ASPS) for which he serves on several educational committees.  He has authored and co-authored several book chapters and scientific articles in peer-reviewed journals, and is routinely an expert speaker at regional, national and international academic meetings.

Dr C has dedicated his professional life to advocating for breast cancer patients.  He strongly believes that shared decision-making between the physician and patient is crucial in achieving the best outcomes and has built his practice on this philosophy.  To empower as many patients as possible to advocate for themselves, Dr C created the Breast Advocate® App, a free app that provides anyone with a breast cancer diagnosis, or at increased risk of developing breast cancer, a much needed voice in their breast cancer treatment planning.

Rep. Charen Fegard (D-VT)

Advisor, Legislative

Charen Fegard of Berkshire, Franklin County, Democrat, was born on Howard Air Force Base in Panama. She lived in many states and countries growing up and through her twenties. Charen earned a Bachelors degree in Biology from the University of NC at Wilmington. She has worked in the Civil Service in Hazardous Materials/ Environmental Compliance on overseas military bases, and has owned and operated a registered home daycare as well as landscaping and cleaning businesses.

Charen worked for a variety of non-profits in Vermont over the years. Before starting the legislative session, she volunteered on the Richford Restorative Justice Panel. Currently, she consults for non-profits and waste municipalities throughout Vermont regarding recycling, composting, and Indoor Air Quality related to cleaning chemicals. She raises meat birds, sheep, laying hens, a lot of vegetables, and enjoys deer hunting with her husband, Russ Ford. They have 4 children in their blended family.

Corine de Boer, MD, PhD

Advisor, Medical & Research

Corine de Boer is a physician, wife and principal of her own consulting company. She was diagnosed with breast cancer in 2015 and opted for a double mastectomy. Her female breast surgeon in Seattle was very supportive of her flat choice and did a great job but Corine has since learned, to her dismay, that this is not the case in other parts of the country. She fully supports the mission of Not Putting on a Shirt so every woman who chooses to go flat after mastectomy has a satisfactory outcome.

Council of International Advocates
Juliet Fitzpatrick

United Kingdom

Blooming Cancer

Juliet has worked as a librarian, researcher, in sports development, is a mother of two adult children and has been married for 30 years. Right now she’s a writer, campaigner, flower grower and flat topless model. She was diagnosed with breast cancer in January 2016 at the age of 54, and had a left mastectomy, chemotherapy and targeted drug therapy. She decided against breast reconstructive surgery despite this being the only post mastectomy treatment option offered to her, and was left with a GG cup right breast. She was very unhappy being a “uniboober” and asked her surgeon over 18 months to remove her right breast so that she could be symmetrical and aesthetically flat. He finally agreed and she’s now very happy living flat, without breasts.

Juliet started to campaign for women to be given all the options post mastectomy so that they can make informed treatment choices. As part of this she did a series of topless photo shoots to increase the visibility of women living flat. This culminated with her working with Dove and her flat topless image being shown globally including on billboards in Times Square & Piccadilly Circus as part of the #ShowUs campaign, and in a prime time television commercial which aired in North America and Europe.  She’s also appeared in the national press, on UK TV and radio, and on numerous podcasts.

Marie-Claude Belzile

Quebec (Canada)

Tout aussi femme

Marie-Claude Belzile is a 33 year old writer, poet and advocate living with her wife and partner of eight years in Montréal (Québec, Canada). She earned her degree in anthropology from the Université de Montréal in 2014 and has written many socio-political articles for the independent journal L’Esprit libre. Her book, Penser le sein féministe, published in 2019, explores the experience of going flat after mastectomy from a feminist perspective. In it, she discusses how pervasive sexist bias affects women throughout their cancer journey, including the pressure to reconstruct their breasts.

Marie-Claude was first diagnosed with early stage breast cancer in 2016, followed by a metastatic diagnosis in 2018. When her ongoing chemotherapy treatment made work untenable, she started to advocate from home under Tout aussi femme (“not less of a woman”) on Facebook. In her spare time, Marie-Claude cares for her extended animal family, draws, and reads to satisfy her lifelong intellectual curiosity.

Abigail Bakan

Ontario (Canada)

University of Toronto

Abigail B. Bakan is Professor in the Department of Social Justice in Education (SJE), at the Ontario Institute for Studies in Education (OISE), University of Toronto, Canada. Her research is in the area of anti-oppression politics, with a focus on intersections of gender, race, class, political economy and citizenship. Her experience with breast cancer, and flat denial, led her to share her story in “Going Flat: Breast Cancer, Mastectomy and the Politics of Choice”, Imaginations: Journal of Cross-Cultural Image Studies, vol. 11, no. 1, May 2020: 39-63. Other publications include: Israel, Palestine and the Politics of Race: Exploring Identity and Power in a Global Context (2020) (with Yasmeen Abu-Laban); Theorizing Anti-Racism: Linkages in Marxism and Critical Race Theories (co-edited with Enakshi Dua); and Negotiating Citizenship: Migrant Women in Canada and the Global System (with Daiva Stasiulis).

Pascale Contrino


Complètement FEMME – l’audace d’être entière après une mastectomie

Pascale Contrino was born in 1972 in Marseille, France. She earned her degree in conservation & restoration of painted works in 1997, and then worked as a painting restorer and artist. In 2017 Pascale was diagnosed with breast cancer, and in 2018 she had a partial mastectomy. She was in treatment until March 2019 – chemotherapy, immunotherapy, hormone therapy, radiotherapy. In April 2019, Pascale created the Facebook page Complètement FEMME – l’audace d’être entière après une mastectomie (“Completely Woman – the audacity to be whole after a mastectomy”).

In June 2019, in partnership with Valerie Blondeau, she founded the nonprofit organization Complètement FEMME to support Amazons and enhance their image. In July 2019, the organization created the first prototypes of Amazon swimwear. The following year, the organization marketed the first sports shirts and bras for Amazons to wear without prosthesis. Pascale is now dedicated to both her artistic work and to the work of Complètement FEMME = find her work online and on social media. Her paintings of Amazons have been featured in art exhibits throughout the world (Tahiti, Switzerland) and are helping transform the narrative about women with mastectomies to one of beauty and positivity.

Kerstin Grotelüschen


Ablatio mammae – Selbstbewusst ohne Brust e. V. – AMSOB

Kerstin learned she had the BRCA1 gene mutation when she was just 28 years old after a genetic test prompted by her extensive family history of cancer. She first decided to have routine MRI scans with the idea that early detection could spare her from unnecessary surgery, but the stress of the testing made her change course. Then she came across Catherine Guthrie’s memoir, “FLAT: reclaiming my body from breast cancer” and made her final decision. Now she’s flat, happy, and living her life free from fear of cancer.

Grit Konrad-Groß


Ablatio mammae – Selbstbewusst ohne Brust e. V. – AMSOB

Grit was diagnosed with triple negative breast cancer in January 2016 and shortly after learned she had the BRCA1 gene mutation, putting her at very high risk for recurrence. During neoadjuvant chemo, her surgeon offered reconstruction as the default and her only choice was what KIND of reconstruction. Her instinct was to reject reconstruction, but everyone around her seemed to expect her to reconstruct. Finally, she had a moment of clarity: “It’s my breasts or NOTHING!” She began searching online for support but found nothing. When she told her surgeon she’d decided to go flat, the surgeon’s response was “You want me to mutilate you?” Luckily, Grit met a flat woman in a BRCA support group who gave her the confidence to stick to her guns, and she has been flat and happy with her decision ever since.

Heike Fangrat


Ablatio mammae – Selbstbewusst ohne Brust e. V. – AMSOB

Heike’s mother and sister were both diagnosed with breast cancer. Her mother wore prostheses religiously, and her sister opted for implant reconstruction before passing away shortly after from metastatic breast cancer. They never spoke about their experience nor showed their scars. Two years after her sister passed away, Heike was diagnosed and discovered she had the BRCA2 gene mutation. As a single mother of a ten year old, she wanted to heal as quickly as possible. And she didn’t want a foreign body inside of her. Heike has never once regretted her decision and accepts her new body. She wears her flat chest proudly to show other women that there is no shame in breast cancer and to honor those whose lives have been taken by the disease.


Promotional Materials

Infographics – Aesthetic Flat Closure
Videos – Aesthetic Flat Closure
Hashtags – Aesthetic Flat Closure
Brochures – Aesthetic Flat Closure

Media Release – Aesthetic Flat Closure

Coming soon



This site contains copyrighted material. Not Putting on a Shirt’s educational materials and resources on this site are freely available for “fair use” (Title 17 U.S.C. Section 107) in accordance with our mission to advocate for optimal outcomes for those who choose to go flat after mastectomy.  The copyrighted material on this site is distributed for educational purposes without profit – all donations to Not Putting on a Shirt directly fund our advocacy work. If you wish to use copyrighted material from this site for purposes that go beyond “fair use”, you must first obtain explicit permission from the copyright owner. Please direct requests or questions to