Amongst my transgender mastectomy patients, I have a group of lesbian women who have come in for breast removal with no intention of transitioning. Most often, the reason for the desire to remove the breasts is something like "I have never felt that my breasts were part of me." We usually end up with a small A cup size that does not require a brassiere. We do not proceed with male chest contouring such as pectoral augmentation.
Aggressive breast reduction versus FTM mastectomy
Thank you for your question. I would recommend that you first determine what your ultimate goals are; that is, are you truly seeking gender reassignment or are you looking for a very aggressive breast reduction. Certainly, going from a DD to an A is possible, although it may require a nipple graft which would result in loss of nipple sensation to achieve that size. If you truly want an FTM procedure, then you would require a double incision mastectomy. Because these are somewhat different operations, the resultant scars can be different depending on the goals of the patient. For example, if I were reducing a female from a DD to a small B/A I would likely utilize an inverted T incision. For an FTM procedure, a double incision mastectomy would be utilized in order to achieving more masculine visual appearance to the chest. These are things you need to consider prior to undergoing surgery. As mentioned below, any reputable surgeon performing FTM procedures will require a letter from a therapist or psychologist stating that the patient has a diagnosis of gender dysphoria and that the patient is felt to be an appropriate candidate for gender affirmation surgery. This is done for the safety of the patient. You should meet with a board-certified surgeon who has experience with transgender surgery. Similarly, if you haven't met with therapist, it certainly may be helpful in assisting you in determining your goals. Best of luck.
Transgender Top Surgery or Breast Reduction
Dear MadcapCanuck, It is important that you determine what you want prior to having surgery. Most surgeons will not operate until you are able to provide a letter from a therapist specializing in gender dysphoria. It is hard to determine how many grams could be removed during a breast reduction without an exam, but going from a DD to an A is not always possible, and the surgeon may decide that they cannot safely remove that much. You would likely be a candidate for double incision transgender top surgery. You should make an appointment for a consult with a board certified plastic surgeon who has experience with both breast reductions and FTM/gynecomastia procedures. Good luck!