The Moral Atrocity of “Top Surgery”: Do surgeons obtain truly informed consents for life-altering procedures on minors?

Increasingly, confused girls with mental-health issues are lining up to have their breasts removed, erroneously believing my colleagues who tell them the operation will alleviate their emotional pain and allow them to emerge as their authentic selves. Girls as young as 13 are having “top surgery,” a euphemism for a bilateral mastectomy—the removal of both breasts—in order to create, as gender surgeons put it, a “masculinized” chest. “Bilateral mastectomy” sounds jarring and clinical; it’s a treatment for cancer, after all—one that women agonize over.

Mind you, these are the same people who insist that five-year-olds use anatomically accurate terms, not childish nicknames, for their genitals. They soberly instruct us to teach the words “scrotum” and “vulva” to kindergarteners. But the vague, trivial-sounding terms “top” and “bottom” surgeries—that language is fine. As if the consequences of those major operations—infertility, sexual dysfunction, infection, and chronic pelvic pain, to name a few—aren’t permanent and debilitating.

As an intern in pediatrics, when one of my patients needed a medical procedure, I was required to obtain informed consent from the parents or guardian of the minor. I was obligated to explain, accurately and comprehensively, the risks—both immediate and long-term—of the procedure. I wonder how accurate and comprehensive are the consents obtained by surgeons who perform double mastectomies on minors. Mia’s mother was almost certainly told that mastectomies for minors with gender dysphoria are evidence-based treatment, supported by well-documented standards of care. But did the surgeon mention that this deceptive reassurance is being challenged in court by the Society for Evidence-Based Gender Medicine?

SEGM’s arguments against mastectomies for girls like Mia are compelling. They point out that long-term outcomes are highly uncertain and that many girls have untreated mental-health issues. They explain why the evidence supporting mastectomies in minors is low-quality and unreliable. According to SEGM, mastectomies on minors are an “experimental procedure on vulnerable youth” whose brains and identities are still developing. Leading gender clinics and psychiatric associations worldwide are rejecting these procedures. They’re saying that girls who want their breasts removed need in-depth psychotherapy, not a surgeon’s scalpel.

I know many girls like Mia, and I’m well aware that she can’t tolerate talking about her periods, let alone pregnancy, because she’s fleeing womanhood. But her identity is still evolving; if she’s like other gender-confused girls, she wore lace push-up bras less than a year ago. In the next decade, she will go through many more changes—and one of them, I hope, will be re-acceptance of her female biology. She may follow the same path as Daisy Chadra, a young woman who lived as a man for five years and had her breasts “amputated” (her word). What she lost is irreplaceable, but Daisy’s back at peace with her female biology. There appear to be thousands like her, who regret the medical and surgical interventions they believed would solve their emotional problems. Transgender activists claim regret is rare, but this de-transitioners’ site alone has 26,000 members. If Mia someday joins their growing ranks, she may experience her flat, scarred chest as a loss.