She Went Flat After a Mastectomy — Now She’s Helping Others

When Lisa Taft Sylvester learned she had the BRCA2 gene in 2021 — and that her lifetime risk of developing breast cancer could be as high as 80 percent — getting a preventative double mastectomy was a “no-brainer,” she said.

A tougher decision? Whether to reconstruct her breasts.

Sylvester, then 55 and co-owner of Interrobang Design Collaborative, a graphic design studio in Richmond, weighed her options carefully. At first, she assumed she’d get implants, the saline- or silicone-filled inserts also used in breast augmentations. But reading horror stories about the implants migrating to other parts of the body or rupturing made her feel uneasy. She didn’t know how her body would react, and she worried about complications that could result in needing additional surgeries.

Then Sylvester stumbled upon a photograph of a woman who had chosen to remain breastless after surgery, a choice many breast cancer patients refer to as “going flat.” On social media, she found a community of women who embraced their flat chests, calling themselves “flatties,” and soon got coffee with a woman she met through the Facebook group Fiercely Flat Vermont.

That conversation gave Sylvester the confidence to seek out a surgeon who would perform what’s known as “aesthetic flat closure,” in which extra tissue is removed and the chest cavity is leveled for a smooth look. Four years later, she couldn’t be happier with her decision. She often goes braless, jogs without uncomfortable bouncing, sleeps on her stomach with ease and likes to garden in her yard topless.

Now Sylvester supports other women who choose aesthetic flat closure post-mastectomy through her advocacy project, Still. Last September, she hosted a photoshoot in Worcester, Mass., capturing 12 topless “flatties” flaunting their smooth chests. Sylvester turned those photos into a 132-page photo book and 32-page compendium, which she distributed to 45 medical centers across 21 states — including the University of Vermont Cancer Center. Last week, she promoted those projects through her booth at the American Society of Breast Surgeons‘ annual meeting in Las Vegas.

Such educational efforts are necessary, Sylvester said, because surgeons don’t always present aesthetic flat closure as a viable option for women. Even when women request to go flat, some report waking up from surgery with extra tissue left behind against their wishes — a phenomenon patient advocacy groups dub “flat denial.” This happens despite research showing flat closure often leads to fewer complications, a faster recovery and no significant differences in quality of life, body image or sexual outcomes compared to breast reconstruction. Sylvester argues that some surgeons’ apprehension isn’t based in science but rather outdated notions of what it means to be a woman.

“Society really draws a strong correlation between breasts and femininity and beauty,” Sylvester said. “There’s this perception that women need to have breasts.”

Yet going flat is more common than not. A study published in the Annals of Surgical Oncology found that between 2004 and 2019, about 60 percent of mastectomy patients chose to go flat. Once taboo to be openly breastless, “flatties” are increasingly showing their pride.

Last May, Sylvester walked topless through Lowell, Mass., as part of the Lowell General Hospital TeamWalk for CancerCare. While walking, one of the other participants remarked that she wished there were a billboard to help normalize aesthetic flat closure. Sylvester didn’t want to do a billboard — after all, she’s from Vermont, where billboards are banned. But she liked the concept of improving the visibility of “flatties.” She decided to host a photoshoot instead, using connections she had from her day job.

Soon, she had assembled a team of creatives willing to donate their services, including photographer Bob Packert, executive producer Kristie Raymond, and wardrobe, hair and makeup stylists. A casting call posted to Instagram drew 45 submissions. Sylvester wanted the final group of 12 to reflect a wide range of experiences, including cancer survivors, women who had preventative mastectomies, and those who had either gone flat immediately or had implants removed. The final lineup hailed from Connecticut to California and ranged in age from 31 to 70.

In January, Sylvester self-published the anthology and compendium, which CW Creative in Barre printed free of charge. The books, available for purchase on the Still website, feature black-and-white portraits of the topless women striking defiant poses — a hair flip, a kick, a hand on the hip — alongside text telling their stories. Participants were also asked to fill in the blank of what they are “still” after their surgery; the answers accompany their photographs. The women are “still fabulous,” “still resilient,” “still sexy” and, as 70-year-old Lynda Pagliarulo put it, “still fucking going.”

Sylvester said it was important for the photographs to exude confidence, rather than the somber tone sometimes conveyed by cancer-related imagery.

“This is not about the battle. This is not about what got them here,” Sylvester said. “This is about how they are thriving and living and how they are ‘still’ afterwards.”

That message is personal for Sylvester, who thought she would wear prosthetic breasts when she first decided to go flat. She ordered cups in sizes A through D — because, she said wryly, “If you’re going to pick what size your chest is going to be, you might as well have fun with it.” But in the end, wearing the prosthetics felt like hiding.

That evolution toward self-acceptance resonated with many of the photographed women. Among them was Starr Ewing, a 42-year-old English tutor from upstate New York. In 2012, her doctor found precancerous cells in her breasts and recommended a double mastectomy. She got breast implants, unaware that there were alternative options.

At first, the implants “looked great” — like her pre-breastfeeding body, she said. But the weight of the objects began to drag down her skin. Ewing went through three replacements, and by the last set, they felt like boulders on her chest. The pain kept her up at night. Worst of all, she couldn’t comfortably hold or hug her two sons. She reached her breaking point in 2022 and asked her surgeon to remove the implants, stat.

“Finally, finally, I got my implants out,” Ewing said. “And I have been free ever since.”

At the shoot in September, Packert captured Ewing with her blonde cornrows, black sunglasses and metallic pants. Her mantra? “Still stylin’.”

Jennie Cisneros, 33, from Ocoee, Fla., was another model. She got implants after being diagnosed with stage 3B breast cancer in 2022. Like Ewing, she said her surgeon never presented the option of going flat, and her implants caused complications. She had five corrective surgeries before finally insisting on having the implants removed. She said her high school self would be mortified; as a teenager, she used to pray for a larger chest.

But now, surprisingly, Cisneros said she feels more like herself than ever. She’s determined to help other women facing mastectomy know that aesthetic flat closure is a legitimate choice.

“I’m so happy that Lisa is doing these compendiums that are going into doctors’ offices,” Cisneros said. “Hell, yeah! I want my face and my chest to be on those brochures.”

She’s not alone. Sylvester said she was overwhelmed by the number of women who responded to her casting call with their “still” phrases, even if they didn’t end up at the photoshoot.

The most common response? “Still me.”

This article appears in May 7-13, 2025.

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