“We know that surgeons who perform breast surgery are also held accountable by their patients… This is kind of an uncomfortable place for us to be as breast surgeons.”

– Oncoplastic surgeon Dr. Colleen Murphy, speaking at a University of Colorado conference (September 24, 2018)

Word is spreading surprisingly quickly through the surgical community – our advocacy efforts are making a difference! Women who choose to go flat after mastectomy will NOT tolerate being treated as second-class citizens whose bodies, choices, and quality of life are irrelevant, any longer. Thank you to everyone who has participated in Not Putting on a Shirt‘s public protests and to those who have volunteered their time and energy with us.

Not Putting on a Shirt founder Kim Bowles was featured in a University of Colorado oncoplastic surgery presentation on September 24th (just published mid-October).  Oncoplastic surgery is cancer surgery using specialized techniques to improve the cosmetic result.  Watch on YouTube here (Kim is at minute 6:19).

Also of note is the study referenced which showed a clear correlation between post-op asymmetry (i.e., a poor cosmetic result following lumpectomy) and poorer quality of life.  Women who choose to go flat after mastectomy also experience this effect, but we don’t currently have data to quantify that, because until now we have not been able to successfully and publicly articulate as a community that we deserve acceptable cosmetic results just as our sisters who opt for breast mound reconstruction do.    Not Putting on a Shirt‘s (non-scientific) 2018 survey‘s preliminary results show that most surgeons treat their flat patients ethically.  But it’s that small minority of surgeons who are willing to cross the line and perpetrate flat denial, who must be held accountable for their actions.

Dr. Murphy’s characterization of the reception of this message by surgeons as one of discomfort is both unsurprising and deserved.  It should be uncomfortable to acknowledge that it’s apparently common practice to override the clear directives of mastectomy patients who decide against reconstruction.

Women who choose to go flat deserve acceptable cosmetic results.  Surgeons must be held accountable for treating us with the same honesty, dignity, and respect afforded to our sisters who choose to reconstruct.  Let’s be clear that there are two types of flat denial:

1. Flat denial through lack of skill can be fixed with simple HONESTY – if a surgeon can’t produce a decent flat result, it’s hir duty to be forthright about that fact, and bring on a competent plastic surgeon or refer the patient.
2. Flat denial through lack of will (intentional disregard) will require stronger accountability measures because this behavior isn’t just carelessness, it’s malicious and predatory.  Intentionally violating the patient’s consent is never acceptable.

No one expects perfection, but there’s no question that patients should be able to expect to be treated in good faith by the medical professionals that care for them.  Hospital administrators and conscientious surgeons must stand up and speak out to protect their patients – they must acknowledge that flat denial is happening, that it’s unacceptable, and that it requires action on their part.  Women are being traumatized by this.  It needs to stop.