Top Surgery for Transgender Men and Nonbinary Individuals


Top surgery is a gender-affirming surgical procedure that involves altering the chest to align with an individual’s gender identity. It is commonly sought by transgender and non-binary individuals who wish to have a chest that is more consistent with their true selves. The procedure typically entails removing breast tissue, reshaping the chest, and repositioning the nipples to create a masculine or gender-affirming appearance.

The decision to undergo top surgery is deeply personal and can have a profound impact on an individual’s mental and emotional well-being. It is an important step in the gender affirmation process, helping individuals feel more comfortable and confident in their bodies. By aligning their physical appearance with their gender identity, many individuals find that top surgery positively influences their self-esteem and overall quality of life.

Top surgery is not only a physical transformation but also an emotional journey. It requires careful consideration, consultations with experienced surgeons, and a supportive network of healthcare professionals, friends, and family. Each individual’s experience with top surgery is unique, and the procedure can greatly contribute to their sense of authenticity and self-acceptance.

While the specifics of top surgery may vary based on surgical techniques, body type, and personal preferences, the ultimate goal is to provide individuals with a chest that reflects their true identity. The procedure has the potential to improve mental well-being, boost self-confidence, and enhance overall quality of life for those undergoing the process.

Why Top Surgery Matters

Top surgery matters for a multitude of reasons, deeply rooted in the realms of identity, mental health, and well-being. Here’s why top surgery holds such significance:

  • Alignment with Identity: For transgender and non-binary individuals, top surgery is a pivotal step towards aligning their physical appearance with their true gender identity. It allows them to live more authentically and comfortably in their bodies, reducing the distress caused by a mismatch between their internal sense of self and their external appearance.
  • Positive Impact on Mental Health: The emotional toll of experiencing body dysphoria – the distress caused by the incongruence between one’s body and gender identity – can be immense. Top surgery addresses this by providing a chest that matches the individual’s gender identity. This alignment has been shown to have a positive impact on mental health, improving self-esteem, reducing anxiety, and enhancing overall psychological well-being.
  • Enhanced Quality of Life: By alleviating the distress caused by gender dysphoria, top surgery has the potential to significantly enhance an individual’s quality of life. It empowers them to participate more fully in daily activities, social interactions, and relationships without the burden of self-consciousness or discomfort.
  • Body Confidence: Top surgery contributes to a sense of body confidence and self-acceptance. It allows individuals to embrace their bodies and feel more comfortable in their skin, fostering a positive relationship with their physical selves.
  • Empowerment and Autonomy: The decision to undergo top surgery is a personal one, often representing an individual’s autonomy and empowerment over their own body. It’s a step towards asserting control over one’s life and body narrative.
  • Validation of Gender Identity: Top surgery provides tangible validation of an individual’s gender identity. It communicates to the world – and to themselves – that they are taking proactive steps to become their authentic selves.
  • Representation and Visibility: As more people undergo top surgery and share their experiences, it increases visibility for the transgender and non-binary communities. This visibility fosters understanding, acceptance, and empathy among broader society.
  • Educational Opportunities: The discussions around top surgery open doors for education about transgender and non-binary experiences. It encourages conversations about gender diversity, promoting a more inclusive and compassionate society.
  • Supporting Diversity: Embracing the significance of top surgery contributes to a world that recognizes and respects the diversity of gender identities. It challenges the societal norms surrounding binary gender and promotes a broader understanding of gender expression.
  • Celebrating Authenticity: Top surgery celebrates the authenticity of each individual’s gender journey. It signifies a step towards living life as one’s true self, embracing self-discovery, and embodying personal growth.

Types of Top Surgery Procedures

Here are some common types of top surgery procedures:

  • Double Incision Mastectomy: This is one of the most common types of top surgery. It involves making horizontal incisions across the chest, typically following the pectoral muscle line. Breast tissue and excess skin are removed, and the chest is contoured to create a flatter, more masculine appearance. The nipples are often resized and repositioned. This procedure is suitable for individuals with larger breasts.
  • Peri-Areolar or Keyhole Surgery: This procedure is ideal for individuals with smaller breasts and minimal excess skin. It involves making small incisions around the areola (the dark area surrounding the nipple). Breast tissue is removed through these incisions, and the nipples are resized and repositioned. This technique results in minimal scarring.
  • Buttonhole or Inverted-T Technique: This technique is a hybrid of the double incision and peri-areolar methods. It involves making an incision around the areola and then a vertical incision below it, creating an inverted-T shape. This approach is often used for individuals with moderate-sized breasts.
  • T-anchor or T-shaped Incision: This procedure combines a horizontal incision along the inframammary fold (under the breast) with a vertical incision extending from the bottom of the breast to the areola, creating a T-shape. It’s suitable for individuals with a moderate amount of breast tissue.
  • Buttonhole with Free Nipple Graft: Similar to the buttonhole technique, this method involves creating a horizontal incision below the nipple and then a vertical incision from the nipple down. The nipples are removed as grafts and resized before being reattached. It’s used for individuals with larger breasts.
  • Liposuction-Assisted Mastectomy: In cases where there is minimal breast tissue but excess fat, liposuction can be used to remove the fat and achieve a flatter chest contour.

Preparing for Top Surgery

Preparing for top surgery involves a combination of physical, emotional, and practical steps to ensure a smooth and successful experience. Whether you’re a transgender or non-binary individual seeking gender-affirming surgery, adequate preparation is key to achieving the best possible outcome. Here’s a comprehensive guide on how to prepare for top surgery:

  1. Consultation with a Gender-Affirming Surgeon:
  • Schedule consultations with experienced surgeons who specialize in gender-affirming procedures.
  • Discuss your goals, expectations, medical history, and any concerns you might have.
  • Ask questions about the different surgical techniques, expected results, and potential risks.
  1. Medical Assessment:
  • Complete any required preoperative tests, such as blood work, ECG, and chest X-rays.
  • Inform the surgical team about any medical conditions, allergies, and medications you’re taking.
  1. Mental and Emotional Preparation:
  • Reflect on your motivations for undergoing top surgery and consider how it aligns with your gender identity.
  • Prepare for the emotional journey by seeking support from friends, family, therapists, or support groups.
  1. Lifestyle Adjustments:
  • Follow any preoperative instructions provided by your surgeon, such as discontinuing specific medications or avoiding certain substances like nicotine.
  1. Arrangements for Recovery:
  • Plan for your post-operative recovery period, which may involve taking time off work or arranging for help at home.
  • Set up a comfortable recovery space with essentials like pillows, blankets, and entertainment.
  1. Finances and Insurance:
  • Discuss the cost of the procedure, payment options, and insurance coverage with the surgical team.
  • Determine if preauthorization is required from your insurance provider.
  1. Communication with Surgeon:
  • Communicate openly and honestly with your surgeon about your goals and expectations.
  • Address any last-minute questions or concerns before the surgery day.
  1. Surgical Garments and Supplies:
  • Depending on your surgeon’s recommendations, purchase any necessary surgical garments or compression garments to aid in the healing process.
  1. Mental and Emotional Well-Being:
  • Engage in self-care activities that help manage stress and anxiety leading up to the surgery.
  • Consider seeking therapy or counseling if you feel it could be beneficial.
  1. Post-Operative Care:
  • Discuss the post-operative care plan with your surgeon. Understand what to expect during the recovery process, including potential discomfort, activity restrictions, and follow-up appointments.

The Top Surgery Procedure

 Here’s an overview of the top surgery procedure:

  1. Preoperative Preparation:
  • On the day of surgery, you’ll arrive at the surgical facility and complete necessary paperwork and preoperative assessments.
  • Anesthesia options will be discussed with you, and the most suitable choice for your case will be determined.
  1. Anesthesia:
  • You’ll be administered either general anesthesia or intravenous sedation, ensuring you’re comfortable and pain-free throughout the procedure.
  1. Incision Placement and Technique:
  • The surgical technique chosen will depend on factors like breast size, skin elasticity, and your desired outcome.
  • Common techniques include double incision mastectomy, peri-areolar or keyhole surgery, buttonhole or inverted-T technique, and more.
  1. Tissue Removal and Contouring:
  • The surgeon will make precise incisions to access and remove breast tissue and excess skin.
  • The chest will be contoured to create a flatter, more masculine appearance.
  1. Nipple Resizing and Repositioning:
  • If necessary, the surgeon will resize and reposition the nipples to achieve a natural and aesthetically pleasing chest contour.
  1. Nipple Grafting (if applicable):
  • In some cases, the nipples might need to be completely removed and grafted back onto the chest in a new position.
  1. Closing Incisions:
  • The surgeon will meticulously close the incisions using sutures or surgical adhesive. Depending on the technique, drains might be placed to prevent fluid buildup.
  1. Dressing and Compression Garments:
  • Dressings and compression garments will be applied to support healing and reduce swelling.
  1. Recovery and Follow-Up:
  • After a brief period in the recovery room, you’ll be monitored before being discharged.
  • Follow-up appointments will be scheduled to monitor your healing progress and address any concerns.
  1. Scarring and Healing:
  • Scarring is a natural part of any surgical procedure. Over time, scars will fade, and scar care strategies can help minimize their appearance.

Recovery and Aftercare

  1. Immediately Post-Operation:
  • You will spend some time in the recovery area of the surgical facility to ensure you are stable.
  • You might experience some pain, discomfort, and grogginess from anesthesia.
  • You’ll likely have dressings and possibly drains in place to collect excess fluid.
  1. First Few Days:
  • You’ll need someone to assist you during the initial days, as movement and lifting will be limited.
  • Pain and discomfort are common, but they can be managed with prescribed pain medications.
  • Follow your surgeon’s instructions regarding wound care and dressing changes.
  • Rest is crucial for proper healing, so avoid strenuous activities.
  1. First Few Weeks:
  • You’ll likely have a follow-up appointment with your surgeon to monitor your healing progress.
  • Continue taking pain medication and any prescribed antibiotics as instructed.
  • Gradually start incorporating light activities and movements, as advised by your surgeon.
  • It’s essential to maintain proper hygiene and keep the surgical site clean.
  1. Wound Care:
  • Follow your surgeon’s recommendations for wound care, including changing dressings and cleaning the incision sites.
  • Some swelling, bruising, and discomfort are normal, but if you notice any signs of infection (increased redness, warmth, or pus), contact your surgeon immediately.
  1. Returning to Normal Activities:
  • You can typically return to light activities within a few weeks, but avoid heavy lifting and strenuous exercises for at least 4-6 weeks.
  • Listen to your body and don’t push yourself too hard, too soon.
  • Gradually reintroduce physical activities as your surgeon gives you the green light.
  1. Compression Garments:
  • Your surgeon might recommend wearing a compression garment to help minimize swelling and support the healing process.
  1. Follow-Up Appointments:
  • Regularly attend follow-up appointments with your surgeon to monitor your progress and address any concerns.
  1. Long-Term Care:
  • Over time, your scars will continue to fade, and your chest will take on a more natural appearance.
  • Continue to practice good self-care and follow a healthy lifestyle to promote overall well-being.


Top surgery is a transformative procedure that empowers transgender individuals on their journey to self-discovery and alignment. By understanding the different procedures, preparing thoroughly, prioritizing recovery, and seeking emotional support, you can navigate this process with confidence. Remember, each person’s journey is unique, and top surgery is a crucial step towards embracing your true self.


Q1: How long does the recovery period typically last? 

Ans: Recovery can range from a few weeks to a few months.

Q2: What are common postoperative care instructions? 

Ans: Follow wound care, garment usage, and activity restrictions as advised by your surgeon.

Q3: When can I resume exercise and physical activities? 

Ans: Gradual return to exercise is typically allowed after 4-6 weeks, depending on individual healing.

Q4: Will there be visible scars after top surgery? 

Ans: Scarring is common but can fade over time with proper care and may be concealed under clothing.

Q5: Can I undergo top surgery without hormone therapy? 

Ans: Hormone therapy is not always a prerequisite for top surgery, but individual requirements may vary.


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