Is it possible to go from a DD cup to an A cup?

I am gender non-conforming, meaning I don't feel like a woman and my breasts cause me a lot of dysphoria. I am debating between getting a breast reduction, or getting them removed. I am about a 32DD. Would it be possible to go to about a 32A and still get decent results? I want them to literally be as small as possible.

Doctor Answers 4

Is it possible to go from a DD cup to an A cup?

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Thank you for the question. I have had several patients with exactly your goals in regards to the  alleviation of dysphoria and gender nonconforming concerns.

   It is possible to reduce the breasts size very significantly. 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.  

For most patients in your situation, we have been able to decrease the breast size very significantly and achieve the patient's desired outcome with one operation.  Sometimes, a two-stage approach will allow for safe reduction and achievement of the patients' "very small" desired outcome.  Much of course depends on the patient's starting anatomy and carefully communicated goals.

My best suggestion: seek consultation with board-certified plastic surgeons who can demonstrate significant experience achieving the types of outcomes you will be pleased with. This careful selection of plastic surgeon will be the most important decision you make. Before undergoing the breast reduction procedure 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. I suggest that you do not communicate your goals in terms of achieving a specific cup size. For example, a “A 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 goal photographs. I hope this, and the attached link/video, helps. Best wishes.

Transgender breast surgery

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as noted by others, to get that type of reduction and flattening of the chest for transgender FTM procedures you will need to do a nipple graft type of mastectomy rather then what we talk about with most breast reductions. A breast reduction procedure, even an aggressive one, is going to leave you too much residual projection to get where you're wanting to go.

Transgender breast reduction

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For gender dysphoria, usually plastic surgeons would recommend breast removal to create a more masculine physique in female-to-male transgenders.  For large breasts with ptosis, this would usually involve a modified mastectomy and nipple grafting.  This technique gives the nipple-areolar complex the best chance for survival  as traditional breast reduction techniques that rely on maintaining nipple blood flow could be at high risk for nipple loss when reducing significant amounts of tissue, eg. DD to A cup.  Mastectomy and nipple grafting also creates less visible scarring and better contour.  You need to be absolutely sure that you want to transition, and I would definitely recommend consultation with a psychiatrist who has special interest in gender dysphoria, if you haven't already, before jumping into surgery. Good luck!

Gregory Pastrick, MD
Kingsport Plastic Surgeon

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Limits of Breast reduction

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Hello, thanks, this is and interesting question. The most importans things in plastic surgery are: 1) what you want?, 2) what you need? and 3) does your body support the procedure?, if we can combine all of these 3 things we can start and make a surgical plan. In breast reduction for example, 32DD  we can remove the excess of tisue until we do not compromise the viavility of the areolar-nipple and leave enough tisue to re-shape  the breast and get good aesthetic and funtional results, have a nice day!

Jean Paul Giudicelli Saba, MD
Dominican Republic Plastic Surgeon
4.8 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.