Flat is Beautiful (Video)

A new resource is up on the website – the Flat is Beautiful video presentation, featuring many amazing flat advocates and advocacy projects. This 6 minute video is an introduction to going flat as a valid, beautiful mastectomy choice. Narrated by Kim Bowles of NPOAS. Transcript below the video.


Hi, this is Kim Bowles, founder of Not Putting on a Shirt. I’m here to talk to you all about going flat – a legitimate and beautiful reconstructive option for women facing mastectomy.

Losing your breasts isn’t fun. And it’s not really a choice for most women – cancer made that call for us. I myself faced this situation in 2016 – I’ll talk about my own story a little later.

For women facing mastectomy, the only choice is… do I try to reconstruct my breasts, or not? It’s a very personal choice. Women consider:

  • Is it important to me to maintain a breasted appearance?
  • How much surgery am I willing to undergo to achieve breast mounds?
  • Are the risks of implants or autologous reconstruction, worth it in my case?

Before the 1990’s, breast reconstruction was largely considered to be “cosmetic” – not necessary. Many women who wanted reconstruction could not afford it because it was not covered by health insurance. For these women, going flat was not their first choice – it was just what they had to live with.

Patient advocates changed this situation by partnering with provider organizations and lobbying to pass the Women’s Health and Cancer Rights Act of 1998. This legislation required most insurance companies to cover the cost of breast reconstruction.

Reconstruction rates skyrocketed in the decades following. Yes, it’s been decades since the 90’s.

Other things have changed since the 90’s as well. Women’s perception of our own worth and of how we define “beauty” is changing… and with it, so is the way we view breast reconstruction.

The WHCRA advocates’ goal was to ensure women could access ALL reconstructive options.

Now we have come full circle.

For many woman today, flat is where it’s at. We have looked at all of our options, and flat is our affirmative choice.

All reconstructive choices are valid.

And they are all beautiful in their own way.

A woman’s aesthetic choice after mastectomy represents her new body moving forward in her life. This is who she is now.

This is her body and her choice.

For some women, reconstructing their breasts does help them to feel whole again. Living flat does not appeal to them at all. That’s their perspective, and that’s ok. That’s the beauty of choice. Women who choose to go flat, on the other hand, have a different perspective – we feel that we are already whole. Many of us simply don’t desire the appearance of breasts, and for others, the price of reconstructing our breasts – to our time, and to our health – is just too high. Many women who initially choose implant reconstruction later decide to explant and go flat for this reason.

For some of us who were diagnosed at a young age, our priority is to get back to life with our kids. We feel that cancer treatment has taken us away for too long already. And we also want to show our daughters that we are not defined by our breasts. This is who we are. It’s ok to be breastless. It’s ok to have scars. We are whole!

Going flat can be a way to take back ownership over your new body after breast cancer. For some of us, it’s reminiscent of when we were kids – we were breastless then too. Breast reconstruction doesn’t give us back what we lost. Facsimiles of breasts may be important to other women, but not to us. Our breasts are gone… but WE are still here.

And we are proud of our scars!

There are many ways to reclaim our bodies after mastectomy. Reconstructing breast mounds is one way… but a smooth, flat chest can be a great blank canvas for individual artistic expression. Mastectomy tattoos play a big role in some women’s healing process. We’ve even heard from women who knew exactly what they wanted their chest tattoo to look like immediately after learning they needed the surgery!

Over the last decade, patient advocates have developed extensive resources for women considering going flat.

From online support groups, to photography projects to magazine articles, to podcasts, to full length memoirs. And there are nonprofit advocacy organizations as well – in the US and the United Kingdom as well – that are working to promote flat as a legitimate reconstructive choice.

It’s all freely available online.

FLAT resources online continue to grow and expand as women learn more about the benefits of this reconstructive choice. There’s even an annual day of celebration every October 7th – “International FLAT Day”. You can find the Flat is Beautiful brochure at InternationalFLATDay.com. It has a list of resources as well as detailed information about going flat and questions to ask your surgeon.

So we’re coming back now to my personal story.

It’s an unfortunate reality that not everyone believes that women can be whole without breasts. And surgeons are no exception.

I’m here today because my surgeon intentionally disregarded my clear directive and left “pockets for implants” remaining on my chest. He thought I would “change my mind” about getting implants. You can visit my website to see my whole story.

To ensure that women recieve full and fair disclosure of ALL of our reconstructive options, and to ensure that our informed consent respected, EVERY TIME, women must speak out. That’s why I’m here talking to you. Education is a big part of the solution, but it’s not the whole picture.

You can learn more about my work at Not Putting on a Shirt.org

I’ll leave you with this lovely photograph that we saw earlier – this is from a photography project called The Breast and the Sea. It’s a collaboration between Miana Jun, a photographer, and patient advocates.

Whether you choose flat, breast reconstruction, whether you’re a unicorn (that’s half flat)… all reconstructive choices are valid, and all are beautiful in their own way.

Thanks for listening.

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.

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