Breast reduction vs top surgery?

It is understandable that you're feeling unsure about how to approach this topic, but it’s important to know that you have options! A consultation with a plastic surgeon specializing in gender-affirming breast surgery is an important step, as your surgeon can provide personalized advice based on your goals, anatomy, and medical history.
In your situation, an extreme breast reduction could potentially help alleviate the back pain and improve your quality of life by removing a significant amount of tissue. However, it's difficult to say definitively whether this would completely eliminate the need for top surgery later, as breast reduction would not achieve a completely flat chest. While a reduction can help create a smaller, more proportionate breast size, some individuals with larger breasts may still have a noticeable chest shape after the procedure.
If you’re seeking a truly flat chest, discussing gender-affirming masculinizing top surgery with your plastic surgeon could be more aligned with your long-term goals. Even if you're not ready for top surgery right now, there may be ways to begin the conversation about your desires for a flatter chest in the future. Surgeons who specialize in gender-affirming breast surgery care generally very experienced in discussing body goals in an open manner, and they may help you find a solution that works for you.
It is important to note that there are many options, including nipples v/s no nipples, with or without targeted nipple reinnervation; liposuction v/s no liposuction; different incision patterns and approaches.
A consultation is an opportunity to explore your options and discuss your concerns about back pain and your long-term goal of a flat chest.
Best of luck on your journey!
Krishna Vyas, MD, PhD, MHSHarvard and Mayo Clinic Trained Aesthetic and Plastic SurgeonNew York, New York

It's entirely reasonable to consider an extreme breast reduction as a step towards alleviating the physical discomfort and dysphoria you're experiencing. A radical breast reduction, which often involves removing more than 50% of the breast tissue and may include a free nipple graft, can significantly reduce the size of your breasts and help with back pain caused by the weight of a 30G cup size. This procedure can also contribute to a more masculine chest appearance, potentially delaying or even replacing the need for full top surgery if the results align with your gender identity and body image goals.
Consulting with a plastic surgeon who specializes in gender-affirming care is crucial. Such surgeons are typically understanding of the various reasons patients seek these procedures and should not require extensive explanations about your personal journey. They are trained to focus on helping you achieve the physical appearance that aligns with your identity while addressing any health concerns.

A breast reduction is to reduce the breast while maintaining the shape of a smaller breast. and maintain a feminine chest appearance.Top surgery is to completely eliminate the breast and achieve a masculine appearance to the chest.
The only way to get the result you are looking for is to choose the operation that most matches with your desired outcome.sincerelyDr.G