Thought I should chime in here. I just had a consult. My main question was "What will the differences be - re intrusiveness, appearance, and cost - of a major reduction version double incision. I am probably about a 42D right now and I'm in my 50s. Before I gained 30 (unwanted) pounds I was always pretty much a 38B. The surgeon and I talked quite extensively about the differences. At my age I have no interest in ever going out in public shirtless. This is all about how I look in clothes and to myself. My partner and medical personnel are likely the only people who will ever see me shirtless. So, I don't really care about chest masculinization as much as I just want to be flat. Here's an abbreviated version of what he had to say -
1. Intrusiveness - The reduction would mean no drains, no compression vest, and a somewhat 'easier' recovery.
2. Appearance - The reduction would mean still wearing a bra and having, as he described it, 'droop.' While a sports bra or compression tank might make me look pretty flat, especially given my weight, I'd still have to wear something. No dice on the bra.
3. Cost - They are within a few hundred dollars of each other, at least with this guy.
I should add that he was actually pretty adamant that, in his view, what I really want is top surgery and that's what I should go for. I thought there was something to be said for that, meaning he didn't try to discourage me.
For those interested, this was Dr. Tholen. I've also done a phone consult with Dr. McLean and will likely go with him only because with the exchange rate currently so favorable toward the USD, even with travel costs it will be less expensive and I love his no-drains approach.
As for weight loss and chest size, I can say that for me - weight loss and gain definitely affects breast size, but even if I lose 50 pounds I'll still be a full-on B.