Flat Denial: Who is Most at Risk?

We’re All at Risk, Right?

Our research, presented last year at the San Antonio Breast Cancer Symposium, has identified several probable factors that patients going flat should be aware of. While all patients going flat face some risk – roughly 2-3 in 20 end up with an egregiously poor cosmetic result and one of those is intentional denial – certain factors are associated with an increased prevalence of flat denial. These factors are: age older than 55 years, higher than normal BMI, use of a general rather than a breast specializing surgical oncologist, and presence of pre-operative pushback from the surgeon.

The Takeaway:
  • Choose a breast surgeon whenever possible rather than a general surgeon. Flat denial rates are tripled for general surgeons.
  • If you have a higher BMI and/or are older than 55, be especially vigilant.
  • If you sense pushback, find a new surgeon.

While there are no guarantees and further studies are needed, these guidelines should help patients secure the aesthetic flat closure they expect and deserve.

Need to Find a Surgeon?

Find a patient recommended flat closure surgeon near you for mastectomy, revision or explant using our Flat Friendly Surgeons Directory. These surgeons:

  • Respected the patient and their wishes to be flat
  • Were technically competent in surgical technique to achieve a flat result, AND
  • Did the best they could do give the patient the results they desired.

No Directory Surgeons in Your Area?

Visit the information pages for Initial Mastectomy, Revision and Explant for tips, tools and more.

Want to Support Our Work?

Spread the word by sharing our work on social media or speaking to your local medical providers about flat closure. Or volunteer or donate!

Kim’s Revision Surgery After Intentional Flat Denial

NPOAS Founder Kim Bowles prepares for revision surgery to remove the “pockets for implants” left behind against her consent by Cleveland Clinic plastic and reconstructive surgeon Dr. Steven Bernard in 2017. (January 14, 2020)
I finally decided to get revision surgery, after almost three years living with “a little extra in case you change your mind.”

I shouldn’t be here, being prepped for revision surgery. I had a plastic surgeon at my mastectomy two years ago solely to do a flat closure. I had pictures, a witness, “smooth flat result” was in my medical record. My choice was to be done in one surgery. It was my choice. And it was stolen from me.

“I’ll leave a little extra in case you change your mind” is an attitude that forces women already traumatized by breast cancer treatment into yet another risky, costly, and anxiety provoking surgery in order to get a surgical result they can live with.

It’s wrong.

I shouldn’t be here.

It’s way past time to #putflatonthemenu, folks.

Surgery on irradiated tissue is always riskier than for healthy tissue, and in Kim’s case the site became severely infected and she was hospitalized for several days (picture is ten days post-op).
Operating on irradiated tissue could have been avoided if my closure surgeon had honored our agreement.

Irradiated skin means surgery is riskier. A big part of my decision to go flat at my initial mastectomy, was to avoid incurring those risks. Unfortunately for me, my closure surgeon at Cleveland Clinic decided to “leave a little extra in case you change your mind [about implants]” willingly and knowingly against my consent.

It took me almost three years to finally get revision surgery to fix what he did to me. I’m at the hospital right now with a severe post-op infection, facing possible inpatient admission for IV antibiotics, when I should be home caring for my children.

This is what flat denial looks like, folks. Dragging women through AVOIDABLE psychological, physical, and financial trauma.

And for what?

I will never stop fighting to put an end to this cruel and abusive practice.

Surgeons, protect your patients.

#flatdenial
#mybodymychoice
#cantstopwontstop
#notputtingonashirt

Kim leading a Board meeting during her post-revision hospitalization. (January 28, 2020)

NPOAS’ Table at the 2019 AHN SABCS Review

Allegheny Health Network sponsored the Pittsburgh 2019 SABCS Review. Kim represented NPOAS to engage providers on the subject of flat closure (and flat denial). (January 24, 2020)
A Great Opportunity for Provider Outreach

Thanks to Allegheny Health Network and San Antonio Breast Cancer Symposium for putting together the 2019 AHN SABCS Review, and for providing for participation from local nonprofits. Kim was there representing NPOAS and spoke to quite a few medical professionals about flat closure, flat denial, our research and our initiatives. We got some hot tips on strategy. And we handed out dozens of International Flat Day’s “Flat is Beautiful” brochures! 

Next year we will be targeting Review sessions across the country to continue to engage providers on this important topic. Stay tuned!

Want to support our work?

Spread the word! Share our work on social media and talk to your medical team about aesthetic flat closure. You can also volunteer with us, or donate to support our initiatives.

#putflatonthemenu
#flatisbeautiful

NPOAS Board of Directors

Not Putting on a Shirt is starting 2020 off with a BANG!

The new year brings a new crew and we are proud to introduce our new Board of Directors.

Kimberly Bowles, President
Christy Avila, Vice President
Devorah Borenstein, Secretary
Shana Whitehead, Treasurer
BethAnne Lobmiller

The expertise, knowledge, and diversity of experiences and talents of our Board of Directors are complemented by that of our growing professional Advisory Council. We are confident and enthusiastic about all that awaits in this new year and beyond, as we continue the important work of protecting the interests of women going flat. Learn more at the Leadership page.

Guest Blog: At the Intersection of My Flat Chest and an Antiquated System of Care

by Melissa Eppard

Melissa Eppard is a certified Life Coach, writer, and breast cancer thriver. Today she’s speaking with us about women’s health, women’s autonomy, explant, and flat closure.

Women everywhere are calling for the standard of surgical breast cancer options to shift and include flat closure. We’re finally positioned culturally and historically to demand autonomy over our health care choices, and how we express our ideas of what is truly healthy and beautiful for ourselves.

Melissa after her explant (removal of breast implants and scar capsules) and flat closure with the technique described here.

Breast cancer has become ground zero, where the intersection of popular culture—music, media and fashion, meets medical device manufacturing, the health and beauty industry, the world of plastics, and what women want for themselves in terms of comfort, health and functionality. We are taking ownership in self-determination, both in our surgical outcomes and self-image, redefining the currency of what makes a woman beautiful. 

We are now poised at this powerful juncture with more women in leadership roles in business and politics than ever before, in the wake of the #MeToo movement, with the surge of the collective feminine voice reaching into every cultural corner. We are gymnasts and yoga teachers, nurses and gardeners, congresswomen and doctors. We are carpenters and professors, actors and MMA fighters, engineers and activists, and so much more. 

“We’re finally positioned culturally and historically to demand autonomy over our health care choices.”

Melissa Eppard

We want the least amount of surgical down time, no extra revisions required, and none of the complications or harmful side effects from breast implants. We want surgeons who make us flat when we ask them to, without scare tactics or chauvinistic comments, wondering how we’ll manage to fill out a swimsuit. We want the truth about breast implants, in plain language, and flat closure to be offered as a valid option from the time of that very first consult. 

We want to be visible to each other and to the world. We are not broken. We are beautiful and strong and whole, and a force to be reckoned with. It is time our health care policies and patient care reflected the evolving needs and demands of 21st century women. 

Melissa Eppard is a certified Life Coach, writer, and breast cancer thriver. She uses her personal and professional experiences to help women get their sexy back after cancer so they can move forward with less fear, make peace with their bodies and reclaim the fullness of life. She uses guided visualization, mindfulness tools, embodiment practices, and EFT Tapping to empower her clients. She lives and works in Kingston, NY and offers long distance sessions as well. 

Disclaimer: Any and all information published by Not Putting on a Shirt (NPOAS) on behalf of a third party is for informational purposes only and should not be taken as a substitute for medical or legal advice from a licensed professional. Views expressed and claims made by third parties do not necessarily represent the views of NPOAS.