Transgender Top Surgery
Transgender top surgery, also known as transmasculine top surgery or chest masculinization surgery, aims to achieve a nonbinary or masculine appearance on the chest by removing breast tissues. This procedure is regarded as gender-affirming surgery for individuals who seek to alter their chest area to align with their gender identity. As such, transgender top surgery can be a life-altering decision, and patients should coordinate with their plastic surgeons to help them better understand realistic expectations from this procedure.
What Is Transgender Top Surgery?
Transgender top surgery involves removing breast tissue and reshaping the chest to help create an aesthetic that matches a patient’s gender expression. This procedure is often confused with mastectomy, which also involves breast tissue removal. The difference lies in the goal: mastectomy is mainly for treating breast cancer, while top surgery is for achieving a desired aesthetic. Although mastectomy can be a part of transgender top surgery, not every top surgery involves a full mastectomy. The following are possible approaches to this surgery:
- Double incision approach for top surgery – this approach can remove moderate to large amounts of breast tissue and involves making incisions across the left and right side of the chest.
- Keyhole top surgery – this approach is suitable for patients with firm skin and small amounts of breast tissue. The breast tissue is extracted through an incision in the lower half of the areola.
Top surgery is suitable for patients diagnosed with persistent gender dysphoria, who meet the age and health criteria and have realistic expectations about the procedure. Patients may also be asked to provide a letter of recommendation from a mental health professional supporting their decision to undergo surgery.
What To Expect Before Top Surgery
After top surgery, some sensations in the chest will be reduced because of breast tissue removal. Some sensations may return over time. Note that the risk of developing breast cancer is not zero despite removing breast tissue, so examining yourself for suspicious breast lumps and working with your healthcare provider is important to your health in the long term.
Your surgeon may ask you to do the following to help you prepare for top surgery:
- Medical evaluation and lab work
- Get a letter of recommendation from your therapist
- Stop smoking and stop using recreational drugs
- Adjust your current medications or take other medications
- Avoid taking medications such as aspirin or drugs that can increase bleeding
During your consultation for possible top surgery, your surgeon will check your general health status, risk factors or pre-existing conditions. Your chest will be examined and measured in detail. Photos of the possible surgical site will also be taken for your surgeon’s reference. Your surgeon will thoroughly discuss the procedure’s risks, benefits, preparation and other details to help you set realistic expectations. They will recommend a treatment plan depending on your condition and goals. Take the consultation as an opportunity to ask questions about the procedure.
What To Expect During Top Surgery
Top surgery process generally follows these steps:
- You will be put under general anesthesia or intravenous sedation, depending on the doctor’s recommendation.
- A mastectomy will be performed to remove breast tissue. Excess skin may be removed.
- The remaining tissues will be repositioned to make a masculine contour to the chest.
- In some cases, the areola and nipple will be repositioned after mastectomy.
The entire surgery may take , depending on your surgeon’s technique and the amount of operation to be done. Bandages or gauze will be applied to your incisions following surgery. You will need to wear a support bra or elastic bandage to provide support and minimize swelling to your chest. A small, thin tube may be placed temporarily under your skin to drain excess fluid or blood.
What To Expect After Top Surgery
Your plastic surgeon will give instructions about caring for your surgical site, medications to take orally or apply to the skin, what to look out for possible complications and when to follow up with your surgeon. Get as much rest as possible and limit physical activity for several days after surgery. Acute pain post-surgery may subside within one week of surgery. You may experience swelling and soreness for a few weeks. Your doctor will tell you when returning to normal activities or resuming exercise is okay.
