A sex change woman to man reshapes the female body and gives it a masculine look. Several surgical procedures are required to complete the process. 'Top' surgery includes a mastectomy to remove both breasts. After the breasts are removed the chest is shaped to give it a male appearance. 'Bottom' surgeries include a hysterectomy and genital reassignment. A hysterectomy does not change the appearance of the body but it is performed to help with the mental change from female to male. Patients also choose to have the surgery to reduce the risk of cervical and ovarian cancer. The second major 'bottom' surgery is the reassignment of the genitalia. Surgeons will use the clitoris and tissue grafts in addition to erectile prosthetics to form a penis. This requires several surgical procedures and does not always result in the desired outcome. While each of the sex change procedures is expensive, the reassignment of the genitalia is the most expensive. Unfortunately, most insurance carriers do not cover this type of procedure.