Gender confused, torn between getting DD to small A reduction, or just getting full FTM top surgery - possibilities?

Top Surgery is the #reduction and masculinization of the breasts and chest for a person who wants a more #masculine chest.  This is often an individual who desires #gender reassignment. Breast tissue is #removed and the #nipple position is usually made smaller and then placed in a more masculine #anatomic #position.  Top surgery allows for a more #comfortable chest with improved psychosocial benefits. Clothing fits better, physical activity may be easier. The chest can also be made more masculine with fat #grafting or #implants to provide a more muscular and #sculpted #appearance. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate. An ideal candidate for FTM Top Surgery include the able to make a fully informed decision, a legal adult (exceptions may apply), any medical and mental health issues are addressed before undergoing the surgery, hormone replacement if relying on insurance coverage, long standing documented gender concerns and living in a more masculine gender role for at least one year.Being each person varies, it’s important to be realistic about your goals and what is achievable. It's best to consult with your board-certified plastic surgeon about your concerns and to confirm if FTM Top is in your best interests.

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.

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!

What is best for you depends on what your goals are, which should be well defined prior to going into surgery of any sort. It may not always be possible to get a reduction from a DD down to an A without using a free nipple graft, which would take away nipple sensation completely. It would also give you an anchor type scar, which may not be necessary if you're a good candidate for a double incision mastectomy. A double incision mastectomy (with free nipple grafting) would give you the option of "sculpting" a more masculine chest, and of having less visible scars (than a reduction) and more appropriately placed nipples for a male chest. 

Its possible to have a drastic breast reduction without having a complete mastectomy.  be sure to chose a board certified plastic surgeon that specializes in FTM top surgery with wonderful results and extensive experience with the transgender community.  

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.