Breast reduction for androgynous/flat shape, not "proportionate": how to find a surgeon who gets it? Is FTM my only option?

Question

46, 166 lb, 32G UK, dense/heavy, no kids, seeking breast reduction. Despite my wide hips, I want a shallow, self-supporting, androgynous, flat, ~A/B chest. I don't care about scars, or even nipple retention (it's a nice to have), I just don't want to drop $12K+ for a "proportionate" still-quite-large chest. Augmentation patients seem to have their shape and size wishes respected. How do I find a surgeon who will listen to and work with me on mine? Am I better off working with an FTM top surgeon?

Tom J. Pousti, MD · Answer

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. You may be surprised to know that your goals/requests are not that unusual.   I see several patients every year who wish to achieve as small of a breast appearance outcome, for a variety of personal reasons. Generally speaking, it is possible to reduce the breasts size very significantly.  Based on the sophistication of your question, I think you may already understand that the concern with the amount of tissue removed is related to blood flow to the remaining tissue; if too much tissue is removed in one operation the blood flow to the remaining tissue (including nipple/areola) may be compromised. Part of the tissue that is left in place is called the “pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue. If the pedicle is made too small (in the effort to reduce the breasts as much as possible) then patient will likely have problems with tissue survival.   Cccasionally, a staged procedure is helpful; in others, nipple/areola grafting is helpful.I think that you are wise in understanding the importance of preoperative communication when it comes to achieving an outcome that you will be pleased with. In my opinion, successful outcomes with  etc. surgery depend on:

1.  Careful selection of plastic surgeon (and from the surgeon's  standpoint, careful selection of patient).  I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons. Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. ***Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.

2.  Careful communication of goals ( which I will discuss further below).

3.  Skillful execution of procedure ( preoperative, intraopererative, and postoperative patient management).

In my practice, I would ask that you NOT communicate your goals, or evaluate the outcome of the procedure performed, based on cup sizes.  There is simply too much variability when it comes to bra sizes between bra manufacturers and even store employees doing the bra fitting measurements.

Generally speaking,  for the benefit of patients undergoing breast reduction surgery:  it will be very important to communicate your size goals with your surgeon. Most patients wish to achieve a enough of a reduction to help with their symptoms while remaining proportionate with the remainder of their torso. Again, I suggest that you do not communicate your goals in terms of achieving a specific cup size. For example, a “A or B cup” may mean different things to different people and therefore may be a source of miscommunication.

In my practice, I ask patients to communicate their goals with the help of  computer imaging and/or goal photographs,  as you have done here.  Obviously, the outcome associated with the breast surgery will not necessarily match that of goal photographs perfectly, but they do serve as a better communication tool that subjective terms such as "natural", "proportionate", "flat"… Evaluating goal photographs also allows for a plastic surgeon to determine the consistency of the patient's goals and allows for a discussion of realistic expectations as well.

***Needless to say, when it comes to achieving patient satisfaction with the outcome of surgery,  it is very important that a patient has consistent goals (fully decided on what she would like to achieve) and a good understanding of realistic expectations (what outcomes can and cannot be achieved).  Best wishes with your decision making and for an outcome that you will be very pleased with.

Elliot W. Jacobs, MD · Answer

There are many types of breast reduction -- but most important would be your discussion with your surgeon.  You have to be on the same page prior to any surgery.  There must be a mutual understanding of your goals and what your surgeon thinks would be appropriate.I have extensive experience in female breast reduction, male breast reduction and FTM surgery, and would be pleased to discuss all options with you.Elliot W. Jacobs, MD, FACS'New York City

Steven Wallach, MD · Answer

It sounds like from your description that you might want more of a mastectomy to achieve the final size that you want.  This would be similar to what I do for men that have female like breasts. I often do this with either a free nipple graft and excision of tissue or making a very thin pedicle.  This can be achievable, but you would need to be seen in person to be properly evaluated. Best of luck.

Breast reduction for androgynous/flat shape, not "proportionate": how to find a surgeon who gets it? Is FTM my only option?

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Breast reduction for androgynous/flat shape, not "proportionate": how to find a surgeon who gets it? Is FTM my only option?

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Everything you need to know about Breast Reduction

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