This commentary on The Breast Book is a guest post from Eufemia Torres. Eufemia is a qualified teacher from the UK and a mother of two breastfed children. She has a keen interest in the politics and social issues.

This article is not intended to be a book review. The commentary is centred on chapter four with some references to other information within other sections, and the wider social context in which this book resides.

Part 1 here.

The qualifications, present, and past employment of the author confers a deep understanding of the nuances around
her duties of care in safeguarding in health care and education provisions. Duty of care is not a hat which safeguarding person can remove when writing a book.  As someone who will understand that information presented in a timely and age appropriate way is at the heart of protecting the right to give or withhold consent, this lack of full disclosure of risks represents a failure of duty of care.  Parents and carers who may be tempted to buy this book to educate themselves alongside their children, may also not know the some of the hazards that could accompany a mastectomy especially one undertaken for elective or cosmetic purposes.

Instead, mastectomy has been presented as an affirming, positive body modification (pg 88), which from Jack’s perspective, it was. Jack states that ‘after the surgery I had a real high’ and ‘a great sense of relief’.  That honesty of perspective is welcome and Jack has every right to tell their own story.  However within the greater context of the book, the physical and emotional risks of this surgery -of which there are many – have not been adequately explored either by Jack or in the author’s voice.  This omission is another failure of safeguarding, along with a lack of information about detransitioning or the fact that breast reconstruction post-mastectomy is something that most women who detransition are not able to achieve.

For girls who do not yet have breasts, it may be very difficult to imagine that once their breasts have developed, removal is not simply a reversal to what their chest was like before puberty.   The surgical removal of healthy breasts is not straightforward and carries a statistically significant risks of post surgery infection including antibiotic resistant MRSA infections, scarring including keloid scarring, asymmetry of the chest and remaining breast tissue, nipple loss where grafting is unsuccessful, reduction of nipple sensitivity including sexual sensibility is decreased at least in 50% of the subjects” (Seleem & John 2013).  This link provides an outline of further risks are presented in layperson’s language.

But while Pickett glosses over the medical risks and long term impacts of breast removal, she is fare more forthright about cosmetic surgery to enlarge the breasts. Some hazards of cosmetic surgery on the breasts are outlined in a real-life story of breast augmentation, which occurs in the context of breast hypoplasia (page 153). And in pages 44-5 Pickett employs strong words of caution, framing breast augmentation and reduction as a ‘big decision’ that ‘has to be’ – note the grammatical command – thought about ‘very very’ – note the intensified urgency – ‘carefully’.  The texts ‘complications’, ‘painful’, and ‘long time to recover’ are used right before explaining that further surgery may be necessary in the future.  In this light, the final question in the author(itarian’s) voice states, ‘What would you say to a friend who said they wanted to have plastic surgery?’ This closed question implies a warning in the context of the information provided in the paragraph.  Only one type of answer from a ‘good’ daughter is implied. These dire implications are not connected to the removal of healthy breasts for Jack.  With this question at the end the writer fails to model independent decision making for young girls.

A major and obvious complication of mastectomy worth highlighting in greater detail  – particularly given the book’s themes of breastfeeding positivity and the function of breasts in making milk – is partial or total lactation failure.  ‘Jack’ raises the point that transmen would probably need breastmilk donation from breastfeeding women in order to feed their babies. Of course the irony here is that a person with who resents the femaleness of their perfectly healthy breasts would remove them and then expect that women, many of whom will also have experienced complicated relationships with their intact breasts and femaleness, could then be called upon to provide their breastmilk.  The circle of entitlement here is a little stunning with natal women fulfilling the role of milkmaidens for individuals who have centered masculinity in their worldview. The dialogue of ‘gender fluidity’ may be an aspect to explore but is outside the remit of this article.

At the rate at which girls are now recommended for gender transition therapy there are likely to  be an unprecedented number of transmen asking for breastmilk in the future, as well as detransitioned women who have lost their breasts in this social experiment.  With sick newborns being prioritised for receiving breast milk as medical therapy, healthy babies from Jack’s gender nonconforming peers do not qualify for banked human milk and will potentially push mothers experiencing breastfeeding struggles further down a list of recipients already exceeding the supply of donor milk. This demand for altruistic peer-to-peer milk donation from women who have lactating breasts would be reduced, were psychosocial therapy for the body image dissonance occurred when our Jacks were tweens and teens.  The current trend that seems weighted towards medicalising of this social phenomenon that for most generally goes away with time without any interventions.

Jack’s personal story is condensed, and edited in age appropriate language, and written in the past tense.  There is a tone finality to Jack’s mastectomy as a fragment situated entirely in the past. To most 10 year olds, 35 year olds are ‘old’ as the cited current age of Jack with his mastectomy at 27 is up there with ‘all grown up’ in the minds of 9 to 13 year olds. The word choices and sentence structures may unintentionally confer further authoritative power for practical reasons connected to grammar structure in English, and also coincidentally because they intersect with narratives in public health literature. Leaflets created by the National Health Service and other EU health bodies are pitched at the literacy ability of 13 year olds. This inherent bias has no counterweight which could have been provided by inclusion of the material that have been ignored.  More confer of power comes from the fact that this not an intangible online resource or an oral story but a hard copy book that can be touched and held.

Books occupy a privileged position in the public mind in a way that the oral words from elderly females confer some of the most limited power.  Layered upon this, the author is a respected woman in several spheres of power including as a leadership educator in primary schools. These layers of power in which a child and their parents are already socialised, confer much power to the pro-transgender storytelling and also removes power from any other narratives indicated in previous paragraphs.  With this power comes the social responsibility for the author and publisher to disseminate difficult truths at a time when it could be uncomfortable to bear for many.  Truths that counter pro transgender narratives are ignored while a trans ideology is repeated as fait accompli on page 84, though even within transpolitics other competing theories exist [see footnote].  It is therefore another failure of duty of care to represent only one perspective and do so without disclaimers, hedging language, and other safeguarding measures.


Footnote 1: Jamie Shupe the first American to achieve legal recognition of a change of gender to non-binary, on official documents has detransitioned. Before the non-binary designation, he was a trans identifying man: so from natal male (man), to trans identifying man (transwoman) to non-binary (X), to natal male (man) once again.  His case is based on the primacy of his feelings over his biology, as Jack’s story is based though this isn’t an attempt at conflating their different experiences. He gives context to the realities of his dysphoria which is not an atypical outline seen in reports of transitioning and detransitioning and for which Jamie deserved therapy as a human right rather than complicity from medical, legal, and social gatekeepers.

Jamie’s detransition story has been retold in several right leaning and conservative news outlets but seems to have been completely ignored by the more left leaning and liberal and mainstream outlets.  While many inferences can be drawn by this flow of information, one worth highlighting is that Jamie’s first transition was widely told in the mainstream and left liberal press at the time. The mainstream and left also needs to ask itself why it isn’t covering his story anymore and this biased flow of information without dismissing his story with dog whistle comments about the right.


Footnote 2:  “there is a narrative that gender identity is neurobiological – that you can have such a thing as a female brain in a male baby’s body and vice versa.”

“The other main narrative … is its opposite and yet it runs concurrently. It comes from queer theory. This narrative basically says that your body is irrelevant – it’s what you feel like and think you are that is the truth. So if you think you’re a woman, you are. This is where you get the ‘trans women are women’ mantra.”