Thank you for the question. In my practice, this process is not “difficult”.I have the opportunity to work with several men a year interested in breast implants ( to feminize the chest wall). This is a different situation from trans gender patients in transition and from men who are looking to augment their chest walls ( pectoralis implants). It is also a different situation than men who wish to have pectoralis implants placed.Nevertheless, this subset of patients is somewhat uncommon; it is very important to understand patient motivation clearly and to educate these patients about the long-term effects of having feminized chest walls. Once I feel confident will about patient motivation, expectations, and feel that I can positively improve his quality of life, I proceeded without hesitation.Best wishes.