Susan's Place Transgender Resources

I'm in a bit of a non-standard situation when it comes to top surgery, and I'd appreciate your opinions on the matter.

Background: I'm 5ft. tall and 25 years old, with 42I breasts that have plagued me for years medically and made it impossible for me to be read as anything other than female with even the best binders. I never thought I'd be able to afford any sort of top surgery, but my new doctor said that they've been able to get insurance to pay for medically necessary reductions like mine. So I'll be able to get a reduction mostly paid for; not masculinizing top surgery, sadly, but I'm lucky to have a chance to get down to a point where I could pass with a binder on. The doctor doesn't know about my gender identity yet, because I'm afraid to talk to her about testosterone until after the reduction, as my insurance explicitly doesn't cover transition-related expenses and I don't want it on my medical record before the reduction (in case they try to use it as an excuse not to cover it even though it's medically necessary regardless of gender ID).

But.

It seems that reduction surgeons typically don't want to go "too small for your frame" for female-aesthetic reasons (and in some cases due to actual physical limitations). I'm going to try to convince mine to go as small as he will, but they also say to tell the surgeon if you plan to lose a significant amount of weight afterwards (and I do; I've lost a good deal already in my quest to masculinize my body, and it will hopefully be even easier after the reduction). I can't figure out if that's for medical reasons or aesthetics, so I figure it's something I should mention. But I'm worried that it might be for aesthetics only, in which case I could obviously care less.

I'm torn over whether or not I should mention to him that I'm transgender, to help impress the need for them to be as small as possible post-op and post-exercise, or to not mention it. I live in Arkansas, not the most trans-friendly of places, and I'm afraid that it could wind up prejudicing him or my insurance against me regardless of the fact that it's a medically-necessary procedure.

What would you do in this situation?

If there were a real risk of the reduction not being covered at all, and the potential benefit would be limited (can't get top surgery, just a matter of how small they'd go with the reduction), I wouldn't disclose. I would try to think of something non-trans-related to say to explain a preference that the reduction go as small as possible. Unfortunately I don't know what would sound like a good reason to the surgeon. All I can think of is "personal aesthetic preference" and/or wanting the chest as small as possible so it won't hinder athletic endeavors. Maybe adding in that it's not an overreaction to a chance to finally have the chest reduction (this is something I've heard surgeons look out for), and that I was really sure about it and had put a lot of thought into it.

Good luck with whatever you decide to do.

You could try to swing it as wanting it flat and everything gone so you don't have risk for cancer.

I would talk to a doctor and ask them to label your top surgery as a breast reduction (12,000). Typically if ones chest is 500g removed per breast insurance will cover it. I tried this method, but insurance denied me because my breasts weren't large enough. Also your BMI would need to be below 30 as well (my data is from BCBS). My surgeon did give me a discount of 2k, so with hotels and such with out of state it was about the same cost. However, if they don't cover it it will be more expensive than top surgery (8,000).

My insurance will cover a reduction for me, which is the only reason I'm able to afford one. I think I didn't word something clearly in there, sorry. I'm just hoping they'll reduce things down as flat as possible, and wondering if mentioning that I'm trans would get them to go any smaller for me, or if it's not worth the risk. My insurance specifically excludes transitional surgeries, so if the fact that I'm trans gets put down in my medical record, they might try to wriggle out of covering it despite the fact that it's medically necessary regardless of my gender ID.

The lower cancer risk is something I wouldn't have thought of, but it is a helpful thing to mention, and my husband will be there to back up the fact that this isn't a momentary overreaction to being able to have a reduction, if that becomes an issue. Thank you so much for the feedback, everyone. <3

I think that if I were in the same situation, I would most certainly not mention being trans. I wouldn't even hint at it. Make it clear that both you and your husband prefer that you be very, very small up top.

It might "help" (I use that word with hesitation) if your family has some history of breast cancer. It might even help if there's a history of benign cancer or cysts. But you don't want the surgeon thinking that you are overreacting and behaving irrationally about cancer fears, so be careful.

My guessing this is covered under insurance?

--Jay

I disclosed with my surgeon with some help of my mom. What they said was if I got a reduction the shape would still be a female breast and they would be perkier. This is because women prefer to not have saggy boobs if the are having any breast work done. My surgeon was very understanding about it because medical people tend to be more open about it. I was her first trans man, but in speaking to her she has likely worked with trans women.

In short if you don't disclose your going to get smaller perkier breasts and you will still have to bind.

@David, the thing is that his chesticles are such that I can't see he would NOT end up binding. Short of a masectomy there isn't any way, imo, to get all that tissue gone. I think that a very great reduction is the goal here. If you started out smaller it would be one thing. Going for an A cup, is still okay for a 5 foot tall person. You would have to do something but it could be something like a compression shirt vs a whole type binder and be much much more comfortable.

Maybe I am wrong re: my assumptions here.

I think going with the I'm a very active person and hate bras route?? Not actually untrue at least the hate bras part. :) (I'd love to do rock climbing and so on, might be another approach.)

--Jay

@aleon515 Yes, insurance will cover a reduction for me, due to the sheer size and issues they cause me with such a small frame (luckily I'm stocky and broad-shouldered, or they would have caused even more issues before now). I'm well aware that I will have to bind even after surgery, but it's very exciting for me to have the concept of "binding enough to hide the chest" even be within grasp. And I'll still have the option later on in life to have more traditional masculinization surgery up top, too (I've looked that up).

I appreciate the advice! I do intend to be rather active post-op/healing and I do hate bras, so you're completely on target with the suggested comments, haha.

@Arch
We do have some odd breast tissue that's run in the family, so I'll likely mention that too. Thanks.

Is it just me, or does anyone else think that this is kinda crazy. I mean, just because society (and thus the general population) wants big breasts, doesn't mean that everybody does. So when you request a chest as small as it can be, the surgeon simply denies you this because of society's preference. It's crazy! I do get that the surgeon wants to be safe. So if he'd give you A cups, you won't get any regrets and sue him. Can't you offer him to sign a form that he's safe if he gives you the smallest thing he can do? I think disclosing is indeed risky, but you can always tell him that you're big on sports, such as running, so the smaller they are, the less inconvenient it will be.

Quote from: Mr.X on May 18, 2014, 05:32:22 AM
Is it just me, or does anyone else think that this is kinda crazy. I mean, just because society (and thus the general population) wants big breasts, doesn't mean that everybody does. So when you request a chest as small as it can be, the surgeon simply denies you this because of society's preference. It's crazy! I do get that the surgeon wants to be safe. So if he'd give you A cups, you won't get any regrets and sue him. Can't you offer him to sign a form that he's safe if he gives you the smallest thing he can do? I think disclosing is indeed risky, but you can always tell him that you're big on sports, such as running, so the smaller they are, the less convenient it will be.

I agree.  It's ridiculous that you can't specify your preference for what he's doing to your body.  If anything, I'd think that tiny boobs are in fashion considering the anorexic supermodel-look that everyone seems to want. 

Plus the gender of the doctors can't even be on our side. If it's a male doctor they can't understand why a "girl" doesn't want boobs. If it's a female doctor they can't understand why another "girl" doesn't want them like she does.

Quote from: Alexthecat on May 18, 2014, 10:12:54 AM
Plus the gender of the doctors can't even be on our side. If it's a male doctor they can't understand why a "girl" doesn't want boobs. If it's a female doctor they can't understand why another "girl" doesn't want them like she does.

Yeah it's ridiculous. IF someone wants them so big they have to carry them around in wheelbarrow, that's no problem at all. Even though that is arguably a health risk.

--Jay

i think i can give you some in sight on this because i've been in your situation. when i got a reduction done, i didn't mention it. all i did was tell the doctor i wanted to be as small as possible and she did that. i went from about H??? to a C or D. the doctor explained it to me that it was hard to go down any further because you do need the fat there still or something along those lines, nothing about your body shape, etc. but it was easy to bind from there and made me flat and didn't get read as anything else but male since then. the thing with reductions though is that if you don't keep off the weight or maintain a healthy diet, it will go STRAIGHT back to your chest and that wouldn't be cool at all.

Quote from: invisiblemonsters on May 18, 2014, 05:45:17 PM
i think i can give you some in sight on this because i've been in your situation. when i got a reduction done, i didn't mention it. all i did was tell the doctor i wanted to be as small as possible and she did that. i went from about H??? to a C or D. the doctor explained it to me that it was hard to go down any further because you do need the fat there still or something along those lines, nothing about your body shape, etc. but it was easy to bind from there and made me flat and didn't get read as anything else but male since then. the thing with reductions though is that if you don't keep off the weight or maintain a healthy diet, it will go STRAIGHT back to your chest and that wouldn't be cool at all.

That don't sound right. If you needed fat there then both genders would be sprouting boobs.

Quote from: Alexthecat on May 18, 2014, 06:18:03 PM
That don't sound right. If you needed fat there then both genders would be sprouting boobs.

i said or something along those lines. if you're female bodied, they're gonna want some fat there or tissue or w/e else to still give you breasts. you can't go completely flat because that's not what a breast reduction is for. it's to go from a large cup (f, h, w/e) to a smaller cup so you're more comfortable and stop having issues like back problems. this was years ago, i don't remember that well but i do remember that nothing about breast size for body shape was mentioned.

Quote from: Alexthecat on May 18, 2014, 06:18:03 PM
That don't sound right. If you needed fat there then both genders would be sprouting boobs.

I think it's basically the difference in procedure between a mastectomy and a reduction. With a reduction there's only so far down you can go, but a mastectomy takes out more kinds of tissue, from what I understand. The limits on reduction have to do with what types of tissue comprise your breasts and how dense they are, I think.

@invisiblemonsters
Thank you for sharing your experience! I hope mine goes that smoothly. My consult with the surgeon is in two months and I won't find out anything until then for sure, but I wanted to gather experiences, information, and opinions well in advance. It's encouraging to know that you can bind and pass post-surgery. It seems reasonable to expect that I could get the surgeon to go to a C or D. Thanks!

Actually I wondered about this somewhere. I don't think a reduction can do everything. If that was the case we would all have gotten reductions and just go to 0 cup. There is a reason that guys get DIs.

--Jay

Here's a thing about a reduction. A lady my mama knows actually got one and about three years later, her breasts actually became larger than they were before the reduction. I'm not sure how likely this is, but I'm guessing if one person can get an increase, it can happen.

Reaver

Quote from: ReaverMarcus on May 19, 2014, 12:23:45 AM
Here's a thing about a reduction. A lady my mama knows actually got one and about three years later, her breasts actually became larger than they were before the reduction. I'm not sure how likely this is, but I'm guessing if one person can get an increase, it can happen.

Reaver

I've seen this happen once. But, I've known about 10 women who got reductions and only one had any increased growth.

I'd say if it's the best you can do to get your chest smaller, it can't hurt to consider it. I know much it sucks to have them, and I'm small by comparison to a lot of guys.

I wouldn't disclose though. It's one of those tricky situations where I usually am pro disclosure to medical professionals, but I can see more cons to disclosure than pros in this case. What I can tell you is that my aunt was pretty too heavy and had a reduction. She asked the doctor to take as much as possible off. Her reasoning was that she didnt want sagging and she wanted to live as a small chested woman. The doctor took her from E cup to a small-medium B. it's pretty easy to push B cups down flat in my experience, since I was a medium/large B. have you met your surgeon? Are you in a fairly progressive area?

Quote from: Ayden on May 19, 2014, 12:35:13 AM
I've seen this happen once. But, I've known about 10 women who got reductions and only one had any increased growth.

I'd say if it's the best you can do to get your chest smaller, it can't hurt to consider it. I know much it sucks to have them, and I'm small by comparison to a lot of guys.

I wouldn't disclose though. It's one of those tricky situations where I usually am pro disclosure to medical professionals, but I can see more cons to disclosure than pros in this case. What I can tell you is that my aunt was pretty too heavy and had a reduction. She asked the doctor to take as much as possible off. Her reasoning was that she didnt want sagging and she wanted to live as a small chested woman. The doctor took her from E cup to a small-medium B. it's pretty easy to push B cups down flat in my experience, since I was a medium/large B. have you met your surgeon? Are you in a fairly progressive area?

I haven't met my surgeon. I know which one I'll be referred to, but it'll be about 2 months before our initial consult. I'm gathering info ahead of time, heh. I can't find any info on whether he's worked with the transgender community, but I'm in Arkansas, which is not exactly a progressive area, so I'm going to hazard a guess of no since he's not on any of the resource lists I've found for Arkansas transfolk. And assuming he's able to take me down from an I-cup to a C- or D- as was mentioned by someone earlier in the thread, I highly doubt I'd gain that much back at any point, so either way I'm probably still better off than where I started from.

And I definitely understand where you're coming from on the disclosure. I'd prefer to be able to disclose, but hopefully with the tips and advice in this thread I can convince the surgeon to go as small as possible without risking a loss of insurance coverage. And if I come up with the money for top surgery down the line, I can get the more traditional masculine treatment. Thanks for the advice.

I was a C before top surgery. I did need to bind but it's not super big that you can't deal with them. So I'd go small as possible. I don't think he'd be able to get you down to nothing anyway. So telling him to get you as small as possible (for your active lifestyle etc) is a good idea. I think since you are 5' an A cup even is proportional.

--Jay

I realize this is an old topic, but I wanted to update it with what wound up happening, in case any future guys want a case to reference.

I did not disclose my trans identity to my surgeon, but I did emphasize that he should get my breasts as small as he could, with small areolas. I had my consult July 31st and my surgery October 3rd. I was a 42I and he could only get me down to a 42D even after removing 7 pounds of tissue, because my breast tissue was super dense. It's been almost two months, and I've healed very well aside from two minor open wounds that were caused by steristrip irritation (and they are healing with daily application of antibiotic cream). From the talks I've had with trans guys, most of the recovery process seems very similar to that of top surgery, so top surgery recovery advice has been pretty applicable.

I was able to comfortably bind about a month out from surgery, and it's definitely easier to do so. I'm fairly overweight, so it's my hope that as I lose some weight and get on T, and the remaining breast tissue breaks down a bit from the pressure of the binder, it should get even easier to hide them. I'm definitely a lot more comfortable in my skin even with just a reduction, so I'd say it was worth it since my insurance covered most of it. If your insurance won't cover a reduction, I'd probably advise that you just save up for full top surgery.

Hope it helps someone out!

Quote from: Aewin on November 23, 2014, 06:13:41 AM
I realize this is an old topic, but I wanted to update it with what wound up happening, in case any future guys want a case to reference.

I did not disclose my trans identity to my surgeon, but I did emphasize that he should get my breasts as small as he could, with small areolas. I had my consult July 31st and my surgery October 3rd. I was a 42I and he could only get me down to a 42D even after removing 7 pounds of tissue, because my breast tissue was super dense. It's been almost two months, and I've healed very well aside from two minor open wounds that were caused by steristrip irritation (and they are healing with daily application of antibiotic cream). From the talks I've had with trans guys, most of the recovery process seems very similar to that of top surgery, so top surgery recovery advice has been pretty applicable.

I was able to comfortably bind about a month out from surgery, and it's definitely easier to do so. I'm fairly overweight, so it's my hope that as I lose some weight and get on T, and the remaining breast tissue breaks down a bit from the pressure of the binder, it should get even easier to hide them. I'm definitely a lot more comfortable in my skin even with just a reduction, so I'd say it was worth it since my insurance covered most of it. If your insurance won't cover a reduction, I'd probably advise that you just save up for full top surgery.

Hope it helps someone out!

Aewin, glad to hear things went well.  Yes, breast reduction can only get someone so small, based on what size they start at.  I am curious to know which breast reduction method they used? 

Quote from: Brett on November 23, 2014, 08:18:52 AM
Aewin, glad to hear things went well.  Yes, breast reduction can only get someone so small, based on what size they start at.  I am curious to know which breast reduction method they used?

He used the inverted-T method, and there was no nipple graft, though he did reduce the size of the areolas quite a bit. I'm actually more sensitive after surgery than I was before. I was hoping he could go smaller than a D, but apparently I have super-dense tissue, so there wasn't much to be done about that. Hopefully that won't be an issue when I'm eventually able to get top surgery. Thanks for the well-wishes.

Quote from: Aewin on November 23, 2014, 08:50:55 AM
He used the inverted-T method, and there was no nipple graft, though he did reduce the size of the areolas quite a bit. I'm actually more sensitive after surgery than I was before. I was hoping he could go smaller than a D, but apparently I have super-dense tissue, so there wasn't much to be done about that. Hopefully that won't be an issue when I'm eventually able to get top surgery. Thanks for the well-wishes.

Your top surgeon may be able to use those same incision lines when you get top surgery, which is good.  There are some guys who get the T-anchor for their top surgery.  When you get ready for top surgery, look for a surgeon who does this procedure. 

Quote from: Brett on November 23, 2014, 04:39:42 PM
Your top surgeon may be able to use those same incision lines when you get top surgery, which is good.  There are some guys who get the T-anchor for their top surgery.  When you get ready for top surgery, look for a surgeon who does this procedure.

Good to know! I knew inverted-T was a possible method for top surgery, but I didn't know whether that would end up making it more or less difficult to work with my reduction results, in the end. Thanks for the tip.

A surgeon in Chicago used to do the anchor. I can never remember his name.

I'm glad you at least got through a reduction and were able to get most of the cost covered.

Dr Steinwald. AFAIC, he looks like he has the nicest results with it, that I've seen anyway.

--Jay

Quote from: Arch on November 23, 2014, 11:28:10 PM
A surgeon in Chicago used to do the anchor. I can never remember his name.

I'm glad you at least got through a reduction and were able to get most of the cost covered.

I was thinking it was something-stein, so I wasn't far off the mark. I think I mix him up with Brownstein.