When a gentleman anticipates impending castration, he may prefer, post-surgery, not to grow breasts.

A consequence of hormone therapy to treat side effects may still cause unwanted breast growth (gynecomastia).

As far as I can tell, the usual approach is to perform the castration, then apply the planned hormone therapy.

If there is gynecomastia, then a surgeon is retained to remove unwanted tissue, often requiring general anesthesia. This approach involves significant risk to the patient.

This seems backward to me. I consider a five-percent chance of death from a cosmetic procedure to be unacceptable (risk from a radical mastectomy). My significant-other had breast reduction surgery. They removed thirteen pounds of breast tissue. There were good reasons for the surgery, enough to justify the risk, but this was quite serious.

A mastectomy for an ordinary guy with no breast development should be a simple procedure for any plastic surgeon. I would think the whole thing should resemble removal of a suspect mole. Surgery to remove two undeveloped nipples might take twenty minutes under local anesthesia. Two or three weeks for recovery. Outpatient level of treatment.

I never see this approach described, or taken.This could be a common practice, but I simply haven't heard about it. Or, there might be some very good physical justification for not doing this.

Obviously, I am missing something, but what?

Good question, I know I wasn't offered any such option and the concern about not wanting big was the biggest issue I raised about reasons not to want to be fixed...

I would wonder if a reason for not wanting to offer it is the idea (not sure how 'real' it is in actuality) that it would cause loss of sensation in the 'erotic' sense - something I've heard about female breast enhancement increasing visual appeal, but decreasing her physical enjoyment of playing w/ them... However it would seem like some might welcome that consequence...

Another approach I've seen mentioned a very few times, w/ relatively little detail is to do radiation treatment similar in nature and using the same equipment as is used for cancer treatments... Supposedly this will prevent the breast buds from growing. However no data about risks, side effects, impact on sensation, etc...

Of course the cynical explanation might also apply - presumably the docs wouldn't make as much off the 'pre-growth' treatment....

WheelyFixed