I've always been uncomfortable with the size of my breasts, so I got a breast reduction. It wasn't until I was in the surgeon's office that I realized I'm transgender.

Bowie Rowan smiling and looking at the camera in a pullover sweatshirt
Bowie Rowan.Courtesy Bowie Rowan
  • Growing up, I developed breasts quickly but never felt comfortable in my body.

  • As I started to get attention for my breasts, I started to consider breast-reduction surgery.

  • Getting approval wasn't easy, but the process helped me work through my gender identity.

I never wanted breasts. I have no memory of desiring a body with traditionally feminine traits that would cause someone to identify me at first glance as a girl. I wasn't necessarily ashamed to be seen as a girl, and I didn't exactly want to be a boy, either.

As a kid, I always found it jarring to be seen as a girl. It wasn't until I was 33 years old, standing in a plastic surgeon's office with his cold hands examining my large breasts, that I began to understand those childhood feelings.

I always felt disconnected from my body, but the feeling grew as my breasts developed

I almost never saw myself reflected in TV shows, movies, or books. The closest I got was when I watched the movie "Now and Then" from 1995 and saw the character Roberta Martin, a tomboy. As she began to develop, she taped over her bra so her chest would be flat. I thought of her often during my own tomboy years.

Eventually, Roberta grew out of her tomboy phase. She grew up and married a man, and I felt I was someday supposed to do these things, too. By the age of 12, I could no longer wear college-sports pullover sweatshirts without being made fun of even more than I already was; expectations around my behavior and how I presented myself had changed, and I felt social pressure to start dressing differently.

My breasts developed quickly. I was a D cup by the time I entered the eighth grade, and as an athlete, I found this incredibly annoying. I always had to wear two sports bras. I hated how clothes looked on me, and I felt uncomfortable with the way older boys and men sometimes leered at me. When I complained about the size of my breasts or the extra attention, all the girls and older women around me shrugged off my concerns and said I should be grateful.

Becoming sexually active intensified the feelings of confusion I had about my body

The confusion around the disconnect between how I felt about my breasts and how others seemed to feel about them intensified as I began having sex as a young adult. To cope with my discomfort, I disconnected from my body. The dysphoria worsened with attention.

When I slept with people, I never knew whether they wanted to sleep with me because of a real connection or because my breasts were an object of curiosity. I was told often that my breasts were the largest my partners had ever seen.

I spent so much time trying to make peace with my breasts in the name of body positivity. But it wasn't just that I was emotionally disconnected from them — though that would've been enough of a reason to want a breast reduction, as any reason is valid — but also that they were also causing me physical pain. I've had back problems since I was 12 years old, at least partially because of the size of my breasts. Finally, I decided to look into surgery.

It wasn't an easy road to surgery, but it was eye-opening

Getting the procedure covered by insurance proved a long process. Even though I'd had back issues for years, my pain wasn't enough for insurance to cover breast-reduction surgery. They wanted documentation of more ways in which the size of my breasts hindered my life. I'd been going through the cumbersome process of getting insurance to cover surgery for almost two years when, at the start of the pandemic, I ended a relationship and then, two months later, a friend passed away suddenly. Around this time, the surgery was finally approved by my insurance.

The surgeon I'd been hoping to work with was booked for the next year. I didn't want to wait. My breakup and the sudden loss of my friend put into perspective how precious my life is and that there was no guarantee of how much time I'd have left. I didn't want to spend another moment feeling uncomfortable in my body.

I met with another surgeon quickly and let him know that I already had my insurance's approval. During our consultation, he held my breasts in his hands and told me he couldn't agree to the surgery because the amount of tissue my insurance required to be removed to cover the procedure would leave me with practically no breast tissue. He presumed that this would be a problem for me.

Black and white image of Bowie Rowan sitting on the ground looking at camera
Rowan.Courtesy Bowie Rowan

At that time, I failed to consider which size breasts I wanted in the end. All I knew was that I wanted them smaller, and I realized then that maybe I didn't want them at all. The surgeon asked if perhaps we could try to use my husband's insurance instead — though I am not married and I date people with various gender identities — since each insurance had different requirements for breast-tissue removal and some were more generous than others. I decided to move on.

By the time I made my way to a third surgeon, I felt disheartened. He agreed with the second surgeon I saw. He said he didn't want to "butcher" me by leaving me too flat-chested and wouldn't agree to do what the insurance required because he couldn't guarantee a "positive cosmetic result." I didn't know how to tell him that being completely flat-chested was something I was now considering. I also felt ashamed of my desire because I didn't fully understand it.

Not one of the surgeons or healthcare professionals I interacted with throughout this process asked me about my gender identity or how the surgery might be connected to my larger experience of myself. I can't say for sure, but presumably, they were coming from the assumption that I was a straight, cisgender woman who wanted the most conventionally appealing breasts that plastic surgery could offer. I didn't correct them at the time because I didn't know how. I also felt worried that if I did, I wouldn't be able to get the surgery I so desperately wanted and had worked so hard to make happen.

Even though these consultations were difficult, they led to a realization about my gender

In the third surgeon's office, I remember standing and looking in the mirror at my naked body as he examined my breast tissue and discussed my options. The thing is, I wanted to want my breasts, but when I saw them, I saw only an obstacle to living my most authentic life. When I imagined myself flat-chested, I felt relieved — I felt like myself.

I'd been questioning whether I wanted breasts at all for months by that point. I realized I wasn't yet ready to fully let them go but that they would no longer be something that I'd let get in the way of me fully experiencing and expressing my expansive sense of myself. It had never occurred to me that my early discomfort with this part of my body was related to my gender, but looking back, I never felt quite like a girl. I let myself be defined by society's expectations and binary labels because I didn't know it was possible for me to define my own experience of myself for myself.

I understand now that when it comes to gender, I am a fluid being. This self-knowledge was solidified when I decided to finance the surgery myself, on my own terms. Shortly after I saw the third surgeon, I began doing research into gender-affirming surgeons in my midsize city. My search turned up empty, and I knew that I'd have to go through another long process with my therapist to get insurance to cover the surgery as gender-affirming care rather than a breast reduction for pain relief.

I knew of acquaintances who'd traveled to other, larger cities for top surgery, but I couldn't afford both the cost of traveling for the procedure and the stay there during my recovery. So when the third surgeon I'd seen offered me zero-interest financing for the procedure for the first year and a half after the surgery so that I could control the exact amount of tissue I wanted removed, I knew it was my best option with the resources I had.

Months later, only a few days after surgery and a month before I turned 34, I saw my small breasts in the mirror for the first time. In this moment, I felt euphoria I didn't know was possible. Even though I was still healing, I could see myself fully, despite the stitches. Since I had surgery in September 2020, I have socially and legally changed my name, expanded my pronouns, and given myself full permission to dress however I want based on what feels right — which, at any given moment, can be presenting as masculine, feminine, or anything in between.

I don't know what the future holds for my breasts. Some days I still feel intense discomfort in carrying any breast tissue on my body. Other days, I barely notice them, or I might even enjoy how they look in a particular piece of clothing. All I know is that my physical, mental, and emotional health have improved since I received gender-affirming care. Whether I had a reduction or top surgery or an augmentation, that's what it would have been — gender-affirming care — and I deserved the attention of healthcare professionals with knowledge and sensitivity around my needs and desires, rather than assumptions based on social norms.

While I didn't understand myself to be trans when I first sought surgery, realizing I wanted top surgery was the best twist of fate I'd ever experienced. It has forever changed my relationship to my body and my gender. When I chose my new name, I made "freedom" my middle name because free was how I felt — free to be fully myself.

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