How to Ensure You Get an Acceptable Surgical Result: Guidelines for Patients

Not Putting on a Shirt has created an informational brochure (UPDATED!) for patients who have chosen to go flat after mastectomy, to help patients protect themselves from flat denial.  Every patient deserves to have the cosmetic result that they choose following mastectomy, and to have that done in one surgery whenever possible.  Since right now it’s a gamble whether or not the surgeon that a patient first encounters will respect their wishes, patients must educate ourselves and support each other.  That’s why we’re here!

This printable trifold brochure describes why women choose to go flat, the current risky situation patients face, how to evaluate whether your surgeon will respect your wishes and produce a flat result, and specific steps you can take to protect yourself.  It also includes images of acceptable and unacceptable surgical results from patients who asked to be flat after mastectomy, so that patients can show their surgeons exactly what they expect.  Brochure highlights and images below:

Going Flat After Mastectomy?

How to Ensure You Get an Acceptable Surgical Result: Guidelines for Patients

  • Going Flat: Your Body, Your Decision
    • There are many reasons a woman may choose to opt out of breast reconstruction, or “go flat,” following mastectomy.  It’s your decision.
  • Expectations: Patients vs. Surgeons
    • Choosing to go flat does NOT mean that the woman doesn’t care about the way she looks, or that she simply hasn’t decided to reconstruct yet, but will do so eventually.
    • Patients expect a flat result when they decide against reconstruction – they don’t anticipate a surgeon simply removing the breast and not prioritizing a truly flat contour. But, all too often, that is exactly what happens – flat denial.
  • Why Does Flat Denial Happen?

A gap in early between patient and surgeon, lack of training for breast surgeons, and paternalism.

  • How to Ensure You Get a Good Flat Result
    • Communicate your decision and your expectations. Be speciric – you want a flat contour in one surgery.
    • Evaluate your surgeon’s response – if you get pushback, consider a new surgeon.
    • Consider bringing on a plastic surgeon for the closure
  • Questions to Ask Your Surgeon

Have they performed flat closures for previous patients? Ask to see pictures.

Will they be able to complete the job in one surgery?

How will they address any challenges like large breasts or obesity?

Should you expect concavity, and how will this be addressed?

How will they avoid “dog ears”? How far back on the lateral chest will the incisions extend?

A single straightsincision may be insufficient to create a flat contour. What incision pattern will your surgeon use, and why?

How will they account for gravity’s? Will they mark you in a sitting position either before or during surgery?

  • Protect Yourself:  Documenting Your Wishes
    • Bring a witness to your surgical consults
    • Put your decision to go flat in writing
    • Show your surgeon pictures of your desired outcome Screenshot (15)
      • Ask your surgeon confirm to the mutually agreed upon goal – a flat contour –  in writing
      • Ask if your surgical consent form can specify “flat”
      • Trust your intuition! If you feel uncertain about your surgeon’s commitment or competence, you should seek a second opinion with another surgeon.

If you have questions or comments, or if you would like to have the brochure sent to you directly either via email or the postal service, please email us at

To access our curated list of “flat-friendly” surgeons, please send us an email.

Together, we WILL put an end to flat denial!

Published by Not Putting on a Shirt

Founder of Not Putting on a Shirt, a mastectomy patients' rights organization that advocates for optimal surgical outcomes for patients going flat.

2 thoughts on “How to Ensure You Get an Acceptable Surgical Result: Guidelines for Patients

  1. Hi,
    I wonder if you might send me a list of “Flat Friendly” surgeons in Southern California.
    Thank you so much!

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