As a specialist in breast surgery, I spend a lot of time considering patient goals with their breasts. This goes way beyond size and shape, and extends into a very broad area of what I call “vibe.” There is a vibe to each breast, that carries with it a sense not only of gender, but of identity as a whole. The first iteration of this came for me with the concept of Ballet, Barre, Body where I described the way that patients want to feel about their breasts, or the story that they want them to tell.
The traditional female breast is teardrop shaped, round on the bottom, and has a round nipple that is just slightly off to the side in orientation. It can be petite or full, with varying degrees of sag. But even within this category, it can suggest a thin and elegant ballerina, a more vigorous athlete with well-developed muscle below it, or a voluptuous female fatale. Coupled with clothing, the breast can become a true palette for identity expression.
The traditional male chest is more square, with the top being the heavier part, and with the nipple smaller, more oval, and very lateral (off to the side and low on the breast). In cases where the male chest looks more like a female breast, it is not uncommon for patients to seek contouring procedures to restore their breast identity. In these cases, patients are looking to affirm their existing gender identities. In other cases, they are looking for change.
Typical TOPS surgery involves either a patient with a female looking breast changing it to a male appearing breast, or the inverse. But much as gender is a continuum, there are also many breast identities that lie in between. For some patients, this is the ultimate goal.
I have spoken with many women who have told me that they love being able to enjoy their breasts when they go out at night, or with their partners at home, but they wish they could “put them away” in the boardroom. Whether they are going bigger with an implant, or smaller with a reduction, we have long discussions about reaching that perfect size in the middle where they can dress them up or dress them down. I call this the Flexible Figure. For me, the nonbinary breast is the gender-affirming equivalent to the flexible figure.
For many nonbinary individuals, the whole point is that they do not identify as either female or male. The intention is to live somewhere in the middle; and sometimes the intention is to have the flexibility to move within the range. In these cases, having a typical teardrop breast is not the solution, but neither is the typical squared-off pec. The ideal here, often, is to have a small, slightly bottom round, but minimally projecting breast, with a discreet nipple in an in-between position. In the right clothing, this can look like a variation of the ballet breast. In other settings, it can pass as a flat pec; but in neither case is it very insistently either male or female.
The nonbinary breast is an entity of its own. It should not be confused with the Extreme Breast Reduction , which is simply a very significant reduction on a very female breast. It is a flexible, malleable, adaptable variation of body contouring that allows for the ultimate in gender expression. It is important to recognize how and why this is different from existing reduction or TOPS surgeries, and take that into consideration when planning surgery for these patients. I have always maintained that the breast has one of the strongest personalities of any body part. It is not surprising that it can have more than two voices.
