Top Surgery for Butches: Have you thought about it?

[*Anya*]

Well, I won't argue with you either but the facts for her are the facts. It was her experience. Period.

As a nurse, I know very well doctors work with patients to ensure that they are given what they need. This doctor knew both of us well. He had previously removed a small tumor from my clavicle that is a barely noticeable scar now.

I was there and I went with her to all of her plastic surgeon appointments and also was in the hospital with her.

Her surgery was a breast reduction. The surgeon called it a reduction. The anesthesiologist called it a reduction, etc. etc. She was an A cup and her nipples were almost the largest things on her breasts. They were carefully replaced and when I say that they were perfect: they were perfect. She was shocked to find that she had more nipple sensation afterward then she had when they were so large.

She did NOT have a mastectomy.

I was a B cup at the time myself. She was no B cup after surgery.

When the bills came: they all stated breast reduction.

So, her experience may be different from those of other people but it was indeed her experience.

I would not dream of telling someone else that their experience was wrong.

Your experience was yours.

Hers was hers.

Anyone knows that not everyone will find the same experience.

It does seem argumentative when you challenge another's experience.

Originally Posted by DapperButch

Anya, I do remember you talking about this before. I believe I did not say anything at the time because I didn't want to seem argumentative or like I was being picky. However, I feel that it wouldn't be right to not correct what you are saying this time, because I WAS that hopeful butch with C breasts who went to a plastic surgeon with dreams of getting an A chest. I was disappointed for the next 14 years until I finally decided that I would get top surgery. This was before I decided to transition.

I'm sorry, but, it simply isn't possible that your ex had what is termed a "breast reduction" in plastic surgery, if she was large chested and now has A cup breasts. It simply cannot be done though standard breast reduction procedures.

Your ex had to have essentially gotten a subcutaneous, bilateral mastectomy (most likely), or peri, or keyhole, (aka "top surgery"), and the plastic surgeon left breast tissue because this is what she requested. If she truly had a "breast reduction", her breasts would have increased in size if she gained any weight and they would have probably decreased in size if she did lost weight. Just like any other woman with a breast reduction. However, this did not happen because the surgeon did not leave the fatty tissue that needs to be present in order for that change to occur.

Back then the term "top surgery" wasn't even coined yet. It makes sense that the surgeon even used the term breast reduction. It was also paid for by insurance because it was coded as such.

Some larger trans men/butches leave tissue so that it does not look odd. One could describe their breasts as "A cups", as well.

All day, every day I talk to trans people and gender non-conforming people about their bodies and the surgeries available to them in order to alleviate their distress and/or physical discomfort.

You ex said what she wanted and the surgeon gave her that. They both called it a "breast reduction", because that was the language they had at the time.



Right, they can't give you the size you want if you are asking for a "breast reduction". Every women is limited by how small she can go when she gets a reduction.


BullDog, I know that you do not identify as trans in any way. However, you can get "top surgery" (through your insurance, if they have trans health care benefits), as long as you are willing to say that you have gender dysphoria of some sort and you would feel better with no chest. There are non-binary people (people who don't identify as women or men and/or as female or male), and they get covered.

If you DO have insurance (private, healthcare market place, or Medicaid) and you are in a state that requires that all insurance companies provide trans health coverage, then you have it. Alternatively, you can see if you can find a plastic surgeon who will code it as a breast reduction, but that is very hard to find.

Some people get part time jobs at places like Best Buy, Starbucks, Apple, and many other places so that they can get top surgery. Bigger companies like that also don't give people a hard time when they are trying to get surgeries covered, either. They follow WPATH standards and all that needs to be said is that your chest causes you "distress", and due to this it is medically necessary that you get the surgery.

When I got my top surgery and was identifying as butch, even if my company had trans health insurance I couldn't have gotten it because I didn't identify as transgender. It is different now. It is about the person's medical need to feel more comfortable with their body, if they are in distress about the parts of their body that we connect to a person's "gender".

[*Anya*]

This is what my ex did. Even though she was told she might not have feeling in her nipples, she did report that she had more than before:

"Although most patients who visit my office are asking how large can they go with a breast augmentation, there are many who are trying to go in the opposite direction. Because of oversized breasts, these patients, both women and men, are asking about small they can go.

For men, the breast enlargement is termed gynecomastia. I am not going to speak further about this topic in this blog, but will devote my remarks to breast reduction in women.

These women suffer from back, neck, and shoulder pain, as well as rashes beneath the breasts, painful bra strap grooves over the shoulders, hunched posture, and many other limitations that affect their ability to live a normal life. They are frequently of a DD cup size or larger, and almost always want to be reduced to a C cup or smaller. They frequently ask, “How small can I go?”

The answer to this question can be given in several ways.

First, how small should they go? A woman who has been quite large for many years will often find a significant reduction in size to be somewhat akin to a mastectomy! Also, women usually are desirous of a balance between their hips and their bust line. Although smaller breasts have their advantages, there may be a mismatch between hips and breasts that may be undesirable.

Second, how small can a person go with breast reduction? The answer to that question has to do with the blood supply to the nipple area. There needs to be a large enough amount of breast tissue on which the nipple sits to provide an adequate amount of blood supply to the nipple.

The blood supply comes through the breast tissue, and if there is not enough, the nipple will suffer from a lack of blood supply that can even lead to its loss. Various techniques of breast reduction are employed that have as their goal the preservation of an adequate amount of blood flow to the remaining breast tissue so as to insure survival of the nipple.

How much breast tissue needs to be left to insure this blood supply? There is not a hard and fast answer. The amount of breast tissue is not really the issue – it’s the amount of blood flow through it that reaches the attached nipple that’s important.

>>>>>Theoretically you could take away almost all of the breast tissue and leave the blood supply behind and you would be OK. The reality is that this would leave a funny looking breast. From a practical perspective, if you are going to reduce the breast by more than 3 full cup sizes (DDD to a C cup is 3 sizes), the nipple blood supply may be endangered.

What do we do in cases where more than 3 full cup sizes need to be removed? I recommend that the nipple be removed, the breast be reduced without concern for the nipple blood supply, and then that the nipple be reattached as a skin graft.

To do this, a piece of skin in the circular shape of the nipple is removed from where the nipple is to go. The nipple is trimmed of all fatty material from its undersurface, and it is then applied to that spot and secured.

Over the course of 5 days, new blood vessels will grow from the breast to the nipple, restoring its blood supply. The new nipple will be flatter, sensation will be reduced, and nursing will not be possible. On the other hand, these issues are worth it for many women who are troubled by large breasts"<<<

My ex had zero problems and though she was stone at the time and it was "look but don't touch" I thought they looked terrific. She did not care how they would look, she just wanted super-small.

An excellent, well-researched, board-certified, plastic surgeon was key.

This doctor was not hers but he did address the info I was looking for.

http://www.drsanders.com/how-small-c...ast-reduction/

[JDeere]

Originally Posted by *Anya*

This is what my ex did. Even though she was told she might not have feeling in her nipples, she did report that she had more than before:

"Although most patients who visit my office are asking how large can they go with a breast augmentation, there are many who are trying to go in the opposite direction. Because of oversized breasts, these patients, both women and men, are asking about small they can go.

For men, the breast enlargement is termed gynecomastia. I am not going to speak further about this topic in this blog, but will devote my remarks to breast reduction in women.

These women suffer from back, neck, and shoulder pain, as well as rashes beneath the breasts, painful bra strap grooves over the shoulders, hunched posture, and many other limitations that affect their ability to live a normal life. They are frequently of a DD cup size or larger, and almost always want to be reduced to a C cup or smaller. They frequently ask, “How small can I go?”

The answer to this question can be given in several ways.

First, how small should they go? A woman who has been quite large for many years will often find a significant reduction in size to be somewhat akin to a mastectomy! Also, women usually are desirous of a balance between their hips and their bust line. Although smaller breasts have their advantages, there may be a mismatch between hips and breasts that may be undesirable.

Second, how small can a person go with breast reduction? The answer to that question has to do with the blood supply to the nipple area. There needs to be a large enough amount of breast tissue on which the nipple sits to provide an adequate amount of blood supply to the nipple.

The blood supply comes through the breast tissue, and if there is not enough, the nipple will suffer from a lack of blood supply that can even lead to its loss. Various techniques of breast reduction are employed that have as their goal the preservation of an adequate amount of blood flow to the remaining breast tissue so as to insure survival of the nipple.

How much breast tissue needs to be left to insure this blood supply? There is not a hard and fast answer. The amount of breast tissue is not really the issue – it’s the amount of blood flow through it that reaches the attached nipple that’s important.

>>>>>Theoretically you could take away almost all of the breast tissue and leave the blood supply behind and you would be OK. The reality is that this would leave a funny looking breast. From a practical perspective, if you are going to reduce the breast by more than 3 full cup sizes (DDD to a C cup is 3 sizes), the nipple blood supply may be endangered.

What do we do in cases where more than 3 full cup sizes need to be removed? I recommend that the nipple be removed, the breast be reduced without concern for the nipple blood supply, and then that the nipple be reattached as a skin graft.

To do this, a piece of skin in the circular shape of the nipple is removed from where the nipple is to go. The nipple is trimmed of all fatty material from its undersurface, and it is then applied to that spot and secured.

Over the course of 5 days, new blood vessels will grow from the breast to the nipple, restoring its blood supply. The new nipple will be flatter, sensation will be reduced, and nursing will not be possible. On the other hand, these issues are worth it for many women who are troubled by large breasts"<<<

My ex had zero problems and though she was stone at the time and it was "look but don't touch" I thought they looked terrific. She did not care how they would look, she just wanted super-small.

An excellent, well-researched, board-certified, plastic surgeon was key.

This doctor was not hers but he did address the info I was looking for.

http://www.drsanders.com/how-small-c...ast-reduction/

Thank you for all this. I'm going to look more into this before I try to get insurance.

[ClintB]

I think I've kinda formulate my attack. I'll try the binders Dapper suggested... I've heard good things about them. I went with a zippered style instead though because I'm scare of getting stuck in it lol.... I've heard stories.

Second is just to pursue the reduction and see what size they will do. I'm not sure if it would be worth it if they will only go down to a C, but maybe a B cup wouldn't be so bad.

If none of that proves satisfactory, then I will have to decide... accepted them or consider full top surgery.

[JDeere]

Originally Posted by ClintB

I think I've kinda formulate my attack. I'll try the binders Dapper suggested... I've heard good things about them. I went with a zippered style instead though because I'm scare of getting stuck in it lol.... I've heard stories.

Second is just to pursue the reduction and see what size they will do. I'm not sure if it would be worth it if they will only go down to a C, but maybe a B cup wouldn't be so bad.

If none of that proves satisfactory, then I will have to decide... accepted them or consider full top surgery.

Make sure to pick a board certified doctor, please, I have heard stories of trans men and women picking a doctor, then end up having some serious problems.

[DapperButch]

Anya,

I really don't have an investment in what your ex's surgery was called 20 years ago. I even said it was probably called breast reduction even if it more closely resembled "top surgery", as the term "top surgery" wasn't used back then.

What I care about is C+ butches getting excited thinking they can get a plastic surgeon to provide them with a "breast reduction" that will make them a small A, which can be billed under their regular insurance, only to find out that they can't. Many, many butches and trans men have gone this route over the years and were disappointed. I attempted to go this route. It sucked when I was told that a breast reduction could not give me this. It sucked. It sucked BAD. 20 years ago, even 10 years ago, surgeons would provide top surgery, but code it and bill it as a "breast reduction".

I knew I was taking a risk of you pissing you off and others thinking I am an ass (both which have appeared to have happened), but I wasn't going to let another big chested butch get their hopes up based on the experience of one person from 20 years ago. Well, maybe I couldn't impact their hope, but at least I might be able to suggest they shouldn't assume it could be done.

I'm not going to respond any more to this topic of breast reduction. This is a top surgery thread for butches, to talk about their interest in top surgery. I am not going to continue to clog up the thread with a different topic.

[cathexis]

guys...guys...GUYS!

What's with the animosity? Yes, the thread is entitled "Top Surgery for Butches," but why complain about any information that's available and helpful?

I, for one, am interested in reading about anything useful.

[DapperButch]

Originally Posted by DapperButch

Anya,

I really don't have an investment in what your ex's surgery was called 20 years ago. I even said it was probably called breast reduction even if it more closely resembled "top surgery", as the term "top surgery" wasn't used back then.

What I care about is C+ butches getting excited thinking they can get a plastic surgeon to provide them with a "breast reduction" that will make them a small A, which can be billed under their regular insurance, only to find out that they can't. Many, many butches and trans men have gone this route over the years and were disappointed. I attempted to go this route. It sucked when I was told that a breast reduction could not give me this. It sucked. It sucked BAD. 20 years ago, even 10 years ago, surgeons would provide top surgery, but code it and bill it as a "breast reduction".

I knew I was taking a risk of you pissing you off and others thinking I am an ass (both which have appeared to have happened), but I wasn't going to let another big chested butch get their hopes up based on the experience of one person from 20 years ago. Well, maybe I couldn't impact their hope, but at least I might be able to suggest they shouldn't assume it could be done.

I'm not going to respond any more to this topic of breast reduction. This is a top surgery thread for butches, to talk about their interest in top surgery. I am not going to continue to clog up the thread with a different topic.

Ok, so I just realized where my error may be in explaining things.

I am defining breast reduction vs. top surgery based on the amount of tissue removed and the type of incisions that would have had to be done in order to take someone from that size TO an A. I am not arguing, something like when the surgeon removed your ex's nipple/areola complex and resized it, that they placed it where a female areola complex would be located.