I love books… but the shelves are full and the budget is tight. And so, I am very thankful to live in a city with a wonderful library network which enables me not only to access most books I’m keen to read, but even to request purchases if a title isn’t in the catalogue. After placing a reserve on Abigail Shrier’s Irreversible Damage: The Transgender Craze Seducing Our Teenage Daughters many months ago- my turn finally came to borrow it.

It’s not hyperbolic to say that I devoured this book – from opening it on Saturday afternoon to my bleary ‘I’m just finishing the last chapter’ well past bedtime on Sunday night, it was almost impossible to put down. Shrier is a warm, engaging writer, skilled at merging detailed investigative journalism and research with a touch of the personal. Her description of the phenomenon of ‘rapid onset gender dysphoria’ in teenage girls, and the various factors influencing and facilitating ROGD, is both fascinating and horrifying. It is a truly courageous book, worth reading even for those familiar with the issues.

Reading Irreversible Damage, I found myself on a number of occasions almost being able to hear the ‘clunk’ as pieces of a puzzle clicked together in my brain. One of my biggest ‘clunks’ occurred while reading Chapter 9, ‘The Transformation’, in which Shrier discusses the use of cross sex hormones and surgery to achieve the physical illusion of transitioning sex.  

Investigating “top surgery” – bilateral mastectomy, legally performed on girls as young as 13 in some states of the USA – Shrier interviews Dr Patrick Lappert, a plastic surgeon, who explains that removing breast tissue is not ‘reversible’ in the same way as some other cosmetic procedures, because a mastectomy is not purely cosmetic but actually destroys the biological capacity and function of a breast:

“A breast, as it turns out, is not a lump of fatty tissue, but a series of fibro-glandular structures roughly dividing into quadrants. Within these quadrants are a number of lobules connected through ducts. The whole breast structure works like a rainwater cistern, running milk through the ducts and out the nipple, which also serves as an erogenous zone, exciting the brain…

… ‘To completely overthrow a natural capacity would be like a person desiring to be blue-eyed, and you deciding that the best way to do that is to gouge their eyes out and give them glass eyes that are blue. Now, they’ve got blue eyes, but they’re not working. You’ve robbed them of the capacity,’ [Dr Lappert] told me. ‘Thats an extreme example, but it’s an instructive example because we are talking about cosmetic change.’ He finds no excuse for the members of the profession who are engaged in this sort of destruction.”

The obliteration of the biological capacity of a breast – both in terms of sexually pleasurable sensation and lactation – should be considered devastating. And we know that among women who have no choice but to accept this outcome as a result of life saving intervention against breast cancer, the loss of not just their breasts but the loss of the future use of their breasts is devastating. But the breasts being removed for gender ‘affirmation’ are completely healthy, and the loss of function is not a side effect but the entire point. Dr Lappert observes that the destruction of function would be considered unethical in other cosmetic operations, but “in the case of an adolescent girl, surrendering her capacity to breastfeed so that she can be appear to be a boy, that’s considered morally correct.”

Shrier goes on to explore the medical details and other risks of a mastectomy (including chronic pain, scarring, sepsis, and issues with fluid accumulation and nipple discharge if testosterone ‘therapy’ is discontinued), and the reader is left wondering how any of this can be medically justified, let alone practiced at an exponentially increasing rate. What Shrier doesn’t delve deeply into is – how has it happened that breastfeeding has become perceived as so completely disposable?

In industrialised economies, we swim in a cultural soup in which breastfeeding is consistently devalued. The vast majority of infants in Australia, NZ, the UK, Ireland, the USA and Canada have a diet partially or entirely composed of breastmilk substitutes, and those babies who do receive breastmilk are increasingly likely to consume a significant amount of that in the form of expressed breastmilk rather than directly at their mother’s breast.

The lie that there is minimal difference between what substance a baby is fed and how this is administered well predates the ‘Fed Is Best’ movement- nearly a century of formula marketing has claimed that their product is equivalent or even superior to mother’s milk, regardless of the horrific mountain of infant deaths evidencing the contrary. Add to this the fact that most health professionals have minimal or no breastfeeding education (and what they do know is likely to have been influenced or provided by industry) – why would surgeons consider that removing the biological capacity of a breast to be in the same league as removing the capacity of an eye to see, or an ear to hear?

What should be surprising – shocking, actually – is that those who do know why robbing girls and women of their breast function matters, are actively campaigning to normalise infant feeding practices which purport that breasts are optional:

But breastfeeding is not the same as ‘giving children human milk to feed at the breast or chest’. Breastfeeding transcends the transfer of milk from an adult human to a baby human – it is a complex interdependent act which is the first building of the social relationship between a mother and a baby. Breastfeeding uniquely builds empathy and immunity; it is the beginning of our capacity to connect and nurture. It may be able to be broadly approximated, but breastfeeding simply cannot be simulated or replaced without cost to both mother and baby.

Breastfeeding organisations and peer supporters KNOW THIS. It is why we advocate for breastfeeding to be understood as existing on a continuum from pregnancy and birth; it is why we fight for policy and protections which enable babies to stay with their mothers; it is why we resist claims like ‘fed is best’ and ‘my babies turned out fine’. We know that breastfeeding is as normal and essential to the human species as breathing, a thoroughly neglected human right, and we are often willing to endure being derided for our efforts to remove barriers to breastfeeding for as many mothers and babies as possible.

So why? Why are we participating in this? Why are we pretending that deliberately stripping girls and women of the capacity to produce milk or adequately latch an infant is just a matter of taping some tubing on to whatever is left? Why aren’t we asking about scarring and pain and informed decision making in women’s health care? Why aren’t we asking where all this donor milk is meant to be coming from, or how many ‘chestfeeding parents’ are left with no option but to put formula in the SNS? Why aren’t we asking about the role of the companies which manufacture breast pumps and supplemental nursing systems (SNS) and their vested interest in babies being fed away from the breast or in their role in the slow creep of the terminology of ‘human milk feeding’?

Well… we know why. Because it’s not perceived as inclusive to ask these questions. Asking these questions is evidence of a nasty bigot who needs to check their privilege. Just because you breastfed YOUR babies doesn’t mean EVERYONE can or should. Feeding a baby looks different for everyone, how dare you judge another family who loves their baby just as much as you do.

Now where have we heard that kind of thing before…

Unlike breastfeeding organisations, industry marketing is making no apologies for centring mothers and breastfeeding. Formula companies know exactly who their target market is – and they know who benefits when women tear our own cause apart. Formula companies will always be there waiting with the soft reassurance that it doesn’t matter how you feed your baby… and they must be laughing all the way to the bank that breastfeeding supporters are doing the work of undermining breastfeeding for them (a topic which requires a separate post of its own – watch this space!).

Human beings are mammals. Mammals – named for mamma, the Latin word for ‘breast’. Our taxonomy is quite literally defined by the presence of a milk-producing gland in the female of the species as characteristic in the nurturing and survival of our young. Breasts are not some kind of accessory which can be removed and replaced at will; that we could so readily accept the destruction of all future function of breasts simply to change their appearance speaks to the depth of the misogyny which grips our species. Yet instead of horror at the mutilation and loss- breastfeeding organisations are embracing it, doubling down on a rhetoric of inclusivity and justice while painting a target on anyone who dares question the impact. It remains to be seen if we can find our way back through the looking glass before it is too late to prevent damage which cannot be reversed.