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The medical costs can include hormones, facial surgery, hundreds of hours of electrolysis, mammoplasty, vocal surgery, voice training, and gender-confirmation surgery.

The pastoral imagery initially released suggests West has abandoned his plan to use as its artwork a photograph of Jan Adams, the plastic surgeon who performed liposuction and mammoplasty on West’s mother, Donda, who died of complications related to the procedure.

So does another development, the perfection by Dr. Jon Olaf Strombeck of Stockholm of reduction mammoplasty, a technique for reducing the size of the breast.