Not Putting on a Shirt

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Not Putting on a Shirt

Not Putting on a Shirt is a 501(c)(3) organization advocating for optimal aesthetic flat closure

01/25/2026

Huge win for German flat advocates!!!! Their national in evidence-based guidelines for breast cancer treatment (similar to the NCCN in the US) now include aesthetic flat closure!

01/17/2026

We just learned that last year, the state of Arkansas passed Act 424, requiring insurance coverage for chest wall reconstruction to include aesthetic flat closure! 👏👏👏 The primary sponsors were Senator Josh Bryant and Rep. Kendra Moore, and it was signed into law in April by Gov. Sarah Huckabee Sanders! Way to go, Arkansas!

https://www.billtrack50.com/billdetail/1794653

01/01/2026

Happy New Year! Here's to 2026! 🥂🍾🎊🎉🥳

12/24/2025

Happy Holidays to you and yours, from all of us at NPOAS! Here's to 2026! ❄️❤️

12/15/2025

Who is most at risk for flat denial? Some characteristics including age, BMI, and type of surgeon are all associated with an increased prevalence of flat denial. As is the presence of push back from your provider during your consultation.

Protect your choice. Ask your surgeon for an "aesthetic flat closure" as defined by the NCI, to ensure they understand exactly what you want: a smooth, flat chest with no "dog ears" and no extra skin at all. And make sure it's in your medical record!

Learn more at NotPuttingonaShirt.org/WhatisFlatDenial

12/14/2025

When interviewing your surgeon about getting your mastectomy with aesthetic flat closure (AFC), be sure to ask specific questions about HOW they will achieve an AFC in YOUR specific situation. More at NotPuttingonaShirt.org/GoingFlat

12/13/2025

Going flat? Let's be clear. Ask your surgeon for an "aesthetic flat closure" as defined by the National Cancer Institute, so they know you want a smooth, flat chest with no extra skin. And make sure it's in your medical record!

Spread the word - aesthetic flat closure!

12/12/2025

If you or a loved one is considering going flat after mastectomy, you should know that there are many ways to produce an "aesthetic flat closure" (as defined by the National Cancer Institute). This is your body, and your choice. Talk to your breast surgeon about their specific plan to achieve an AFC for you!

More at NotPuttingonaShirt.org/GoingFlat

12/11/2025

Providers, we have a FREE patient education tool just for you!

NPOAS ships over 4,000 My Choice: AFC educational brochures to clinics and advocates nationwide (and beyond!) annually free of charge thanks to support from our generous donors.

Every brochure shipped represents another mastectomy patient educated about the option to go flat, and empowered to advocate for their choice!

Order brochures: www.NotPuttingonaShirt.org/Publications

Donate: www.NotPuttingonaShirt.org/Donate

12/10/2025

A new systematic review of AFC surgical techniques, patient reported outcomes, and patient perspectives has just been published in the journal Aesthetic Plastic Surgery by researchers out of Georgetown University! Research is how we establish AFC as the standard of care for patients going flat after mastectomy 💪. Read more at the blog:

12/07/2025

Advocacy Opportunity!

Our legislative advocacy team is currently lobbying lawmakers to add the NCI-defined term "aesthetic flat closure" to landmark federal legislation (H.R.5813) that was recently submitted in the House of Representatives.

As it stands, the legislation references "flat closure" which is an undefined term - this could lead to insurance companies continuing to deny coverage for patients to get decent aesthetic outcomes. Surgeons deserve to be properly paid for their work, and patients deserve AESTHETIC flat closure.

This is where YOU come in! In order to effectively lobby lawmakers, our team has put together a petition where you can express your support for adding "aesthetic flat closure" to the legislation. The more people who sign, the more powerful the petition becomes!

You can find the petition on our website at NotPuttingonaShirt.org/Petition

THANK YOU FOR YOUR SUPPORT!

Together, we will ensure parity for aesthetic flat closure and make for a better experience for the next generation of women facing mastectomy.

12/05/2025

"Aesthetic flat closure" is defined by the National Cancer Institute and specifically refers to the removal of excess skin and fat after the breast tissue is removed during a mastectomy, to create an aesthetically pleasing flat chest wall.

Prior to its inclusion in the NCI Dictionary in 2020, patients going flat struggled to communicate their wishes with their surgeons. Now, we have clear language. Thank you, NCI!

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Pittsburgh, PA

Telephone

+14124075997

Website

http://www.NotPuttingonaShirt.org/

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Why aren’t we putting on a shirt?

Not Putting on a Shirt is a grassroots movement started by Kim Bowles, a Pittsburgh scientist, artist, wife, mother, cancer survivor, and topless protester. Her activism here is inspired by her own unsatisfactory cosmetic outcome following mastectomy.

Kim had simply wanted to get back to life after just one surgery; now she has to choose whether to live with a cosmetic effect that she finds abhorrent, or to take on additional risk--and sacrifice energy, money, and precious time with her family--just to get a cosmetic result she feels she can live with.

Kim went through all the proper channels, and even consulted an attorney, to attempt to get Cleveland Clinic to acknowledge that her plastic surgeon, Dr. Steven L. Bernard, understood that Kim wanted a "smooth flat result," yet intentionally left pockets for implants, instead.

All Kim asked for was acknowledgment, from the surgeon and hospital, of the wrong that had been done, and a commitment to prevent this from happening to future patients. But her pleas fell on deaf ears. So, Kim has chosen to invest herself in helping future mastectomy patients across the US and beyond--especially those who wanted to save precious time by forgoing reconstruction: those who choose to "go flat."