Resources for Providers


If you are a surgeon or other medical professional interested in the subject of flat closure, we are so glad you found us! We want to hear from YOU. What do you think of our work? How can we improve? What resources would be helpful to you as a medical professional, to support your interest in flat closure?

Evidence-Based Medicine

At Not Putting on a Shirt, we stick to the facts. We are committed to ensuring that all of the information we provide or promote is medically sound and consistent with the existing body of scientific evidence.

In the case of patient satisfaction with flat closure, there is a distinct lack of data. That’s why we’ve conducted our own pilot studies and are actively promoting larger scale research with validated tools. We will be presenting a poster with the combined results of our two pilot surveys this December at SABCS 2019. You can read our report from the first pilot or take a look at the UCLA flat closure study here:


You may find the following to be useful. Please let us know what we’re missing, too – we want to support providers as much as we want to support patients!

Flat Is Beautiful
SOURCE: Djohan et. al., The Breast Journal, 2019

Informational Videos

Drs. Tiwari and Kocak at Midwest Breast & Aesthetic Surgery in Gahanna, Ohio have put together a series of informational videos on technical subtopics concerning flat closure – both explanting to flat and going flat at initial mastectomy. Take a look below. For more videos, check out MWB’s YouTube channel!

What is a flat closure after mastectomy?
Do you consider a flat closure to be a reconstruction?
Should a plastic surgeon always be involved with a flat closure?
What are the 3 reconstruction options after mastectomy?
How to address shape and form vs. scar
Can large breasted patients expect to have a good flat closure?
How to address concavity after a flat closure?
Is fat grafting possible to address concavity after a flat closure?
Muscle repair after explant
Why is it important to take out the entire capsule?

Articles on Flat Closure and Decision Making


Coding and Reimbursement

A Note on Language

“Flat Closure”

“Flat closure” is the term we are using to describe the reconstruction of the chest wall contour without breast mounds after mastectomy. This procedure falls squarely under the reconstructive (not cosmetic) category of surgery as it restores a normal anatomic contour – the chest wall.

Read what the plastic surgeons at Midwest Breast & Aesthetic Surgery are saying about flat closure in their clinical practice.

Reconstructive vs. “Reconstruction”

Flat closure is reconstructive. The reason we don’t use terms like flat reconstruction or flat closure reconstruction is that these terms do not identify the anatomic contour being reconstructed (the chest wall). Since the medical community identifies the anatomic contour being restored in the term breast mound reconstruction, it would follow that if we are to use the term reconstruction for a flat procedure, it should similarly identify the anatomic contour. Hence, chest wall reconstruction.

We know that there are limitations to what patient advocates can do on their own to advance the conversation in a productive and sustainable way. That’s why we need your input!

Tell us what you think about the language issue!


You can use the form below to inquire about having your listing added to our Flat Friendly Surgeons Directory, to tell us what you’re thinking about, to learn how to support our work, or to find out how to get involved. You can also email us directly at

Get in Touch



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

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