I want a drastic breast reduction; some think it's too extreme. Advice? Experience?

Yes, I have had a few patients who basically wanted a simple mastectomy and wanted most of their breast tissue removed. Not all were transgender patients either, but all had a variety of reasons, including a higher chance of breast cancer in some. All that I did were very happy and none returned to me for any augmentation. You could consider going down to a small B as well and save the nipples. Ask to look at small B photos and A photos of preop augmentation patients.

Hi RileyLouise320,
Patients choose to optimize their breast aesthetics for many reasons. Ultimately, what you choose to do with your body is up to you.
Patients with large breasts often have multiple problems, including but not limited to back and neck and shoulder pain, bra strap grooving, trouble finding clothes that fit, and awkwardness in social situations. Breast reduction can be impactful in treating all of these symptoms.
You correctly note that there are limitations to how small the breast can be made, given the breast tissue that needs to be retained in order to keep the nipple alive. For women with substantial ptosis, or descent, of the breast, amputation and Free nipple graft technique and often help the breasts to be as small as possible. As such, and with your goals, your surgeons plan seems reasonable.
Ultimately, I would suggest making an informed decision after an in-depth consideration of your own goals, and with the guidance of your experienced board-certified plastic surgeon.
I hope this helps.
Sincerely,Christopher Pannucci, MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

If you want to have A cup breasts and your surgeon is confident that he/she can achieve your desired result with a free nipple graft, then go for it! Keep in mind that you will not have nipple sensation after a free nipple graft, but if you are fine with that too, go for it! You mentioned "reverse dysmorphia" so if your family members or you are concerned about body dysmorphic disorder (BDD) you may want to investigate this further by seeing a psychologist or psychiatrist who helps patients with these issues. If this is not a concern for you and you think this is the right decision for you, go for it! Yes, reductions with free nipple grafts look great and are frequently used in women who want a very big reduction.