Stacey Sigman, a woman at the forefront of the movement, speaks up.
While women often choose to have breast reconstruction after a mastectomy, some feel that this is a procedure which falls flat–so they instead choose to “go flat.”
The official term for this–as adopted by the National Cancer Institute in 2020–is aesthetic flat closure (AFC). When survivors pick this option, they have the extra skin, tissue and fat in the breast area removed. What’s left of the chest is then tightened and smoothened to issue permanently flat. An expert on this subject is Stacey Sigman, founder of the Flat Retreat which is a community-supported organization that hosts retreats and cultural events for women who choose AFC. And, in this position, she’s been made privy to the many reasons why women choose this procedure.
Sigman said that breast cancer can strip individuals of their sense of control over their bodies. Choosing to go flat, she claimed, is a way to regain that control. It allows survivors to define their beauty standards and embrace their bodies as they are, scars and all.
But AFC also has practical advantages. Breast cancer reconstruction can be complex as it often requires multiple surgeries and a lengthy recovery period. Going flat, on the other hand, is a simpler, less invasive option. It eliminates the discomfort and potential complications associated with breast implants. It also offers a more straightforward path to recovery.
Furthermore, choosing to go flat avoids the risks of breast reconstruction surgery. These include infection, implant rupture, and even the need for additional surgeries to correct complications.
Sigman had her own reasons for going flat. After being diagnosed with breast cancer in 1997, she opted for a single mastectomy followed by chemotherapy. She got diagnosed again in 2013, so she decided to follow the same game plan that she had during her first battle with breast cancer.
“Like most, I followed protocols and listened to my doctors,” she shared. However, her decision to go flat was clear from the start. “I had no desire to create a breast mound that I could not feel,” she said. “I received pushback from my surgeon and plastic surgeon, who thought I would regret it. Regret was never my experience.”
Eventually, Sigman went on social media and found that there were a lot of women who felt the way she did. And, among them, she found not just a community she eventually took part in nurturing.
The Rise of the Flat Retreat
The flat community is a group of women who have chosen AFC after mastectomy. It has deep historical roots, encompassing courageous women like Betty Ford, Audre Lorde, Shirley Temple, and Deena Metzger—women who chose to go flat and proudly share their stories long before the era of social media. Nowadays, the flat community–which Sigman has become a part of–is a diverse collective of patients, advocates, activists, doctors, grassroots nonprofits, and supporters who come together to share their personal experiences related to mastectomy.
The group is present in various public and private social media platforms. But, Sigman decided that they should expand beyond cyberspace. Ergo, the Flat Retreat was created.
Conceived in 2019, the Flat Retreat was created to provide a physical gathering for women who chose AFC. The inaugural retreat brought 40 women from across the United States and Canada to a desert location in Palm Springs, California. During the event, the group participated in a local breast cancer walk that went viral after Flat Retreat participants took off their shirts during the march.
Since the Flat Retreat’s inception, the aim has been to create gatherings that would honor and destigmatize living flat. It was also made for its members to share experiences that foster support, and advocate for improved standards of care for women with breast cancer.
“Flat Retreat values the truth about breast-implant illness, challenges bias in the medical community to include non-shaming practices, and promotes patient consent for AFC as an equal option,” Sigman shared.
Flat Retreat’s events have created a culture of acceptance and empowerment within the flat community. They showcase influencers, create their fun, celebrate successes, and support organizations challenging biased medical practices.
In 2020, the organization held its first Annual Flat Visibility Awards, broadcasted live on several social media platforms. Subsequently, they hosted formal Flattie Balls, fashion shows, weekend retreats, virtual workshops, and meetups. They co-hosted International Flat Day with Christy Avila. They also directed and edited a short film of patient interviews for the AFC advocacy group Not Putting On A Shirt; this was used for the latter’s patient advocate table at the National Plastic Surgeon Conference in Las Vegas. These events energized the movement, leading to significant achievements.
Aside from the National Cancer Institute’s adoption of the term “aesthetic flat closure,” which provides patients and doctors with the language to discuss going flat, another feat includes the New York State Legislature passing SB S7881 in 2021. This requires insurance to cover the cost of AFC.
Currently, Flat Retreat aims to continue advocating for similar legislation across all states. It also aims to amend the Women’s Health and Cancer Rights Act. But in order to push for these changes, the flat community needed to overcome a few speed bumps.
Shirts off
In the journey of the flat community, one highlight, Sigman shared, was the birth of Stand Tall AFC (STAFC). This national campaign began in response to Flat Retreat’s refusal to sponsor a table at the Palm Springs Breast Cancer Walk after organizers asked participants to keep their shirts on.
“Hearing this washed over me with a deep silence that I will never forget,” she said. “At that moment, I would allow myself to feel what it was like for others to see me without my breasts, how disturbing it might be, and I started to feel shame. How could women choose this?” This incident therefore led her and others in the movement to focus on the importance of visibility and education.
STAFC, co-founded by Sigman and advocate Renee Ridgeley, took the movement to the streets, organizing hundreds of women from the flat community and their supporters to be ambassadors at local breast cancer walks. What they wanted was simple: body positivity and for AFC to be recognized as an equal option after mastectomy.
According to Sigman, the decision to go flat is not a rejection of femininity or beauty, but rather a redefinition of those terms. AFC challenges societal norms and expectations surrounding women’s bodies and beauty standards. As more survivors choose AFC, the narrative of what it means to be beautiful and whole is shifting. The growing movement to normalize this option empowers women to make choices that align with their values and comfort.And, while it is an ongoing journey that may hit a few bumps along the way, many of the prominent people behind it have proven that such challenges tend to push them to forward.