Cancer warriors must have as much information as possible to make informed decisions and find the best approach for their individual situation and body. Unfortunately, many people facing mastectomies aren’t provided a full range of choices. Aesthetic flat closure—also known as “going flat”—is an often-overlooked alternative to options more commonly offered such as breast reconstruction with implants or autologous tissue.
According to the National Cancer Institute’s (NCI) Dictionary of Cancer Terms, “during an aesthetic flat closure, extra skin, fat, and other tissue in the breast area are removed. The remaining tissue is then tightened and smoothed out so that the chest wall appears flat.”
Founded in 2019, nonprofit organization Flat Closure NOW supports mastectomy patients before, during and after a decision to go flat. The organization brings crucial attention to the fact that, in many circumstances, aesthetic flat closure simply isn’t on the menu when surgeons present options to women for their upcoming mastectomies.
In 2020, NCI added “aesthetic flat closure” to its Dictionary of Cancer Terms. With the term now officially defined, the organization hopes “going flat” will be more widely recognized and accepted as a normal and desirable surgery result for many people facing mastectomies.
A key component of the organization’s work is to amplify real-life stories and images. Flat Closure NOW’s website and social media feeds provide a beautiful, honest and informative glimpse into life after going flat with photos from the flat community showing a range of body shapes, sizes and colors. The website also features an FAQ page, a glossary and a brochure with questions to ask surgeons.
“My surgeon presented it to me as: ‘You can have implants, you can rebuild the breast mound or you can do nothing,’” says Flat Closure NOW vice president Emily Hopper, who underwent a bilateral mastectomy for triple negative breast cancer in 2017. But “doing nothing” wasn’t clearly defined, and the ultimate result could vary widely depending on the surgeon’s approach and experience.
Even in situations when forgoing reconstruction is presented as an option, some surgeons may not provide a completely flat result. Flat denial—when a surgeon leaves behind extra tissue and skin after a mastectomy without reconstruction—is unacceptable for patients specifically seeking flat closure. Official recognition of the term aesthetic flat closure and other advocacy efforts help educate the medical community about what result is expected when someone requests it.
Connecting with other breast cancer warriors online during active treatment, Hopper learned more about going flat and ultimately opted for this result. After undergoing months of grueling chemotherapy, she saw going flat as the best option for her to heal as quickly as possible and get back to being present and active in her family life.
“I expected to feel shame, but what actually happened was that I saw my higher self staring back at me,” says Hopper. “I didn’t even notice that my breasts were gone, and I just saw a beautiful soul standing there. My breasts aren’t even here, and I’m still a woman, I’m still feminine, I’m still beautiful.”
After this experience, Hopper felt motivated to spread positive messages about going flat to the wider breast cancer community. She started making “Flat AF” T-shirts and went on to found the “Flatties Unite” Facebook group, which now counts around 3,000 members, and later joined the Flat Closure NOW board of directors.
Flat Closure NOW director Melissa Jansen was diagnosed with breast cancer in 2017. She says she knew almost instantly that going flat was the right choice for her because she didn’t want to further modify her body. It was difficult, however, to convince surgeons of this decision, especially as she opted to go half-flat with a unilateral mastectomy and aesthetic flat closure.
Some doctors attempt to dissuade women from unilateral flat closure with statements about it causing physical pain or negatively impacting their body image and sex life, which Jansen and many others find untrue. By proudly and publicly sharing her experience as a one-breasted thriver on her fashion blog “I Don’t Need Two,” Jansen aims to empower others to be proud of their choice.
When Flat Closure NOW director Melly Testa was diagnosed with breast cancer in 2011, they felt that reconstruction was not the right option for them. Similar to Hopper’s experience, Testa was told that the alternative was to “do nothing.” When they brought up their desire for flat closure, Testa’s doctors asked them to see a psychiatrist to justify this choice.
After personally witnessing a lack of community and support for their decisions and hearing similar stories from others, Testa was inspired to start advocating for flat closure as a valid option for mastectomy patients. “Putting my body out there and saying this is viable, this is OK, was really important to me,” says Testa.
Despite being a fairly new organization, Flat Closure NOW has already made big strides in advocating for and empowering the flat community. Thanks to this important work, more and more women are making the best decisions for their bodies and approaching their surgeries with strength and confidence.
Learn more at flatclosurenow.org.
CORRECTION: An earlier version of this article implied that Flat Closure NOW was directly responsible for NCI adding the term “aesthetic flat closure” to its Dictionary of Cancer Terms. Flat Closure NOW is not the sole party responsible for the term adoption.