Now there’s a solution. While the concept of a “boob job” for most people conjures up images of turning triple-A mosquito bites into double-D bazookas, some women would like nothing more than just the opposite. Known as mammoplasty reduction, or breast reduction, this inverse boob job makes big breasts smaller, giving large-chested women a new lease on life by giving them – and others – something else to focus on apart from their bosom.

Now that we’ve got that off our chest, let’s continue…

All About Breast Reduction Surgery

Reduction mammoplasty seeks to reduce the size of the breasts by taking away excess glandular tissue, fat and skin. In rare cases the operation can be done simply through liposuction, when the fat is literally sucked from the body using a small hand-held device that works a bit like a vacuum cleaner. But this can only occur when the breast is large purely due to fat build-up, and there is no excess skin that needs to be excised, or cut off.

While different techniques are employed, the most common type of breast reduction surgery involves making a large T- or anchor-shaped incision that goes around the areola, or outside of the nipple, down toward the crease between the breast and the abdomen, then horizontally underneath the breast. Smaller breasts may require a vertical incision only, which means the bigger you are, the more scarring.

In the case of exceedingly large and/or droopy breasts, the surgeon will remove the nipple, take away some breast tissue and skin, raise the part of the breast that’s left, then put the nipples back using a skin graft. It will be positioned higher, so it will appear natural. The good news is that you won’t have a nipple adjacent to your armpit, the bad news is that you may suffer nerve damage and lose all sense of feeling if this happens, and may also be unable to breastfeed in future.

A reduction mammoplasty takes up to four hours and is performed under general anesthesia. When it is over the breasts are wrapped in a supportive undergarment, and as dissolvable stitches are often used you may not need to have them removed. Drains may be left in each breast for up to two days.

Interestingly, the amount of fat taken from each breast often differs, as breasts are not always the same size. In fact, breast reduction surgery can also be performed when one breast is larger than the other, to make them appear more symmetrical. If that’s the case you may not want breast reduction surger: another option is an implant to make the smaller one larger so you have a matching pair.

After-Care and Risks

Women having this operation are advised not to undertake strenuous activities or indulge in heavy-lifting for at least six weeks, and to wear support bras without underwiring during this time. You will be given painkillers when you leave the hospital, as well as follow-up appointments to make sure everything is healing well and that the drains are emptying properly.

It’s considered best to wait to have the operation until you reach the grand old age of 20 at least, giving the breasts time to fully develop. Women should also abstain until they have had all the children they want, and should be fully aware that having a reduction mammoplasty could make breastfeeding difficult, or even impossible (see above). Some surgeons argue that the ability to breastfeed won’t be affected in the slightest, but there is actually no guarantee.

Women with pendulous breasts that tend to droop may opt instead for a breast lift, or mastopexy, in which excess skin is removed and surrounding tissue tightened to lift and raise the breasts. This can work well when breasts are not overly large, but obviously is not recommended if you want to reduce size as well as reshape.

Risks for a standard reduction mammoplasty include:

• Scarring. The severity of the scars will depend on the patient, but they usually fade over time. Be aware that people with darker skin run a greater risk of keloid scarring.
• Infection. Risk can be reduced by taking antibiotics before surgery.
• Nipple necrosis, or loss of nipple. This means that the skin on the nipple dies, but this complication is, thankfully, exceedingly rare.
• Hematoma. This can happen if the drains inserted into the breast do not drain away all the blood properly. Blood can collect underneath the breast and become painful. Further surgery will needed to have the clot drained.
• Loss of nipple sensation. Happens in rare cases. In even rarer ones, patients may experience nipple hypersensitivity.
• Breast asymmetry. This is not common but can be corrected if need be.
• Problems associated with general anesthesia. Any surgery requiring a general anesthetic carries this risk. You can reduce it by not smoking and losing weight before surgery.
• Be aware that estrogen therapy, or HRT, can sometimes cause breasts to grow again, and in some cases women have needed repeat breast reduction surgery.

While breast reduction surgery may sound scary and a bit off-putting, the vast majority of women are satisfied with the outcome. An estimated 104,000 breast reductions were carried out in 2006, according to the American Society of Plastic Surgeons, and the number is still growing. Indeed, a greater percentage of women are satisfied with breast reduction surgery than they are with breast enlargement operations.

While people often mistake a reduction mammoplasty as pure cosmetic surgery, the end goal is not purely aesthetic. Women who had successful breast reductions had reduced back and shoulder pain, fewer headaches, and significantly less numbness in the breast as well as breast pain. It was a help to them not only aesthetically and physiologically but emotionally as well, raising their self-esteem and boosting their confidence (and the number of revealing tops in their wardrobe!). Those who had small bodies in proportion to their breasts were those who gained the biggest results.

The information in the article is not intended to substitute for the medical expertise and advice of your health care provider. We encourage you to discuss any decisions about treatment or care with an appropriate medical professional.

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Transitioning from a biologically female state to a male identity can be a very complicated or very simple procedure. Depending on the preferences of the individual patient, it can involve simply cross dressing to appear as the opposite sex or include hormone replacement, chest reconstruction and, in the most extreme cases, a full genital sex change.

Hormone Replacement Therapy for Female-to-Male Transsexuals

In general, transitioning from a biologically female state to a male appearance involves the use of extensive hormone therapy. This procedure, which must be performed with the careful supervision of a physician, is similar to traditional male hormone replacement therapy (HRT) and is one of the biggest steps that can be taken to transition to a male appearance that matches the patient’s gender identity.

Hormone replacement therapy for transsexual men generally involves shots, patches, pills or skin implants. These treatments, which vary widely in their cost, generally increase the amount of testosterone in the body. Other forms of female-to-male HRT do not use testosterone, instead relying on steroid-like compounds or “ando pro-hormones,” which encourage the patient’s body to produce its own testosterone.

This process produces a male-like appearance, often leading to the growth of more facial and body hair and increased muscle mass. In general, it also causes menstruation to stop within five months and the clitoris to enlarge. This transition is usually the first, and sometimes the only, step taken when undergoing a female-to-male sex change.

Hormone replacement therapy for transsexual men has some drawbacks, including the tendency to aggravate cardiovascular disease and cause psychological disruptions. Many transsexual men undergoing HRT report mood swings and aggressive outbursts. Unless a hysterectomy is also performed, many are also at risk of developing endometrial, ovarian or uterine cancers.

Chest Reconstruction for Female-to-Male Transsexuals

Because genital surgery is often prohibitively expensive, complicated or unsuccessful, many transsexual men opt to have “top” surgery only, which usually involves the removal and reshaping of the breasts. Cosmetic breast surgery performed on female-to-male transsexuals usually involves a full mastectomy. Although care is taken to prevent scarring, many transsexual men experience scarring on both sides of the chest.

During chest reconstruction surgery, fatty tissue is removed from a single incision on each breast. The areola (the dark part of the breast) is then shrunk and placed as a graft on a different part of the chest, where it is dressed carefully with sterile bandages. Usually, the surgery is not particularly painful and daily activities can be resumed within a week.

In general, chest reconstruction surgery is the easiest and most successful part of a female-to-male sex change. The chests of transsexual men are usually almost identical to the chests of biological men, with the only key difference being mild scarring on each side of the chest. The majority of transsexual men are very satisfied with the results of this surgery.

Genital Modification for Female-to-Male Transsexuals

The most complicated step in a female-to-male sex change, genital modification, can occur in a variety of forms, with varying degrees of complexity and complication. The simplest form of female-to-male sex change surgery includes the removal of the vaginal canal (by sewing it shut), which is a procedure that usually takes place only if the patient has already had a full hysterectomy. Hysterectomies that involve the removal of the uterus and ovaries are also often performed to eliminate female hormones.

Phalloplasty, or a penis construction, is also a common procedure for female-to-male sex reassignment. With all forms of phalloplasty, the labia are joined together to form the appearance of a scrotum. Implants, which are designed to look and feel like testicles, are sometimes placed inside this new scrotum. A new penis is then constructed using a variety of different methods.

Another method known as metoidioplasty creates a new penis from the clitoris. Tissue from the labia or another part of the body can then be used to make it slightly larger. This usually results in a small penis when compared to the penis of a biological man.

Another popular genital modification used to create a penis involves the insertion of a tissue graft from the leg, arm or abdomen. This can incorporate unneeded muscles or even small bones, from other parts of the body, to create a relatively large phallus. This surgery is quite complicated in some cases but can create a penis up to seven inches in length of surprisingly normal appearance.

Phalloplasties can also involve the additional use of an erectile implant to enable erection and sexual penetration. These implants can be simple, rod-like prosthetics or very complex pumping mechanisms. The urethra can also be directed, often in a separate surgery, to flow into the new penis. While this adds complexity to the procedure, it is an important aspect of a sex change for many transsexual men.

Other surgical alterations undergone by transsexual men include facial implants, pectoral-muscle chest implants and body contouring with liposuction. These procedures, often far more simple than the others involved in the transition, can contribute to the patient’s male appearance.

Depending on the patient’s own circumstances, a female-to-male transsexual might choose to undergo most, many, a few or none of the procedures described. While some transsexual men are content and satisfied without any surgical or hormonal alteration, others may be willing to undergo the risks associated with gender reassignment treatments in order to confirm and experience the physical sensations of male biology.

For more information on transgender issues and health, try the following links:
American Educational Gender Information Service
Transgender on Wikipedia
Transgender Organizations on GenderAdvocates.com

If you are considering cosmetic or plastic surgery procedures, Yodle Local can help you find a plastic surgeon near you.

The information in the article is not intended to substitute for the medical expertise and advice of your health care provider. We encourage you to discuss any decisions about treatment or care an appropriate health care provider.

Atlanta Plastic Surgeon | Boston Plastic Surgeon | Charlotte Plastic Surgeon | Chicago Plastic Surgeon | Dallas Plastic Surgeon | Los Angeles Plastic Surgeon | Miami Plastic Surgeon | Minneapolis Plastic Surgeon | New York Plastic Surgeon | Philadelphia Plastic Surgeon | Phoenix Plastic Surgeon | San Francisco Plastic Surgeon | Seattle Plastic Surgeon | Washington, DC Plastic Surgeon | See More Cities

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