Top surgery refers to the surgical procedures on the breasts:
- Breast augmentation surgery.
- Sex reassignment surgery (female-to-male), may include bilateral mastectomy and male chest reconstruction.
Top surgery is a reconstructive surgery performed on the chest for those who wish to alter their chest size, shape, and overall appearance. This surgery is typically performed by a plastic surgeon that has specific training in transgender or gender-affirming surgeries.
This procedure can be done for individuals looking to achieve a more masculine or flat appearing chest, or for individuals seeking a more feminine sized and shaped chest.
- Female-to-male (FTM) or female-to-nonbinary (FTN) top surgery: This surgery involves removing breast tissue and contouring the chest to reflect a flat, masculine, or male appearance.
- Male-to-female (MTF) or male-to-nonbinary (MTN) top surgery:This surgery involves using saline or silicone implants to increase chest size and augment the shape in order to achieve a more feminine or female appearance.
FTM/FTN top surgery procedure
On average, an FTM or FTN top surgery procedure takes between 1.5 hours to 4 hours. There are a number of different procedures that can be used to achieve a more flat, masculine, or male looking chest. The most common techniques surgeons use are called double incision, periareolar, and keyhole.
Double incision top surgery with nipple grafts
Double incision top surgery with nipple grafts, also known as a bilateral mastectomy with nipple grafts, is a procedure typically recommended for people with larger chests and bodies. Key information includes:
- This specific procedure often results in decreased nipple sensation and more significant scarring.
- This procedure is usually an outpatient surgery that takes between 3 and 4 hours for the surgeon to perform.
- In this procedure, the nipples are removed, typically decreased in size, and positioned on the chest to match a more male or masculine appearance.
Periareolar top surgery
Periareolar top surgery, also known as peri or circumareolar, is a procedure typically recommended for people with smaller chest sizes (size A or B cup) prior to surgery. Key information includes:
- This procedure is usually an outpatient surgery that takes between 3 and 5 hours to complete.
- Most people are able to maintain most of or all of their nipple sensation after recovery — though the large majority of people experience decreased nipple sensation in the days immediately after surgery.
- While periareolar top surgery provides you with less visible and less significant scarring, people require revisions to achieve a completely flat chest around 40-60 percent of the time.
Keyhole top surgery
A keyhole incision is ideal for patients with small breasts and good skin elasticity. During this technique, a small incision is made under or across the lower border of the areola (the pigmented skin around the nipple). A keyhole incision can remove underlying tissue, but it cannot address excess skin.
A periareolar incision is ideal for patients with moderate breast tissue and good skin elasticity. A circular incision is made all the way around the edge of the areola to remove breast tissue. A slightly larger ring incision is then made to remove excess skin. The skin is pulled taut toward the center and the nipple is reattached. This effect mimics the act of pulling a drawstring bag closed. Another vertical incision that extends below the areola may also be necessary to target additional excess skin.
MTF/MTN top surgery procedure
MTF and MTN top surgery is also known as breast augmentation or augmentation mammoplasty. MTF and MTN top surgery typically takes between 1 and 2 hours. You are put under general anesthesia for the duration of the surgery. The breast augmentation procedure your surgeon uses will vary based on your desired chest size, the type of implant used, and the incision location. Key information includes:
- You’ll typically have a choice between saline implants (filled with saltwater) or silicone implants (filled with silicone gel).
- Silicone implants have the reputation of being softer and more natural appearing while saline implants are often less costly and can be inserted through a smaller incision.
- Incisions are most commonly located along the areola, under the armpit, or under the fold of skin where your chest meets your breast tissue.
- Once under general anesthesia, the surgeon makes an incision in the previously determined location and the implant is placed in the pocket above or below the pectoral muscle.
6 Things You Should Know Before Having Top Surgery
- Discuss your goals and expectations with your surgeon.
- Talk with your surgeon about techniques to reduce scarring.
- Be prepared to share your family history of breast cancer with your provider.
- If you have had free silicone injections administered, it’s very important to share this information with your healthcare provider.
- No matter their gender identity, all top surgery patients should perform regular breast and chest self-exams before and after surgery.
- If you were born with breasts, make sure you’re getting regular screenings for breast cancer. If you're taking hormones as part of your transition, you may need to be screened, too.
Recovery time for top surgery varies from person to person. People who get FTM or FTN top surgery generally return to work or school about two weeks after surgery. Those who get MTF or MTN top surgery can typically get back to work or school after one week.
Complications of FTM/FTN top surgery
The risks and complications that are specific to FTM and FTN top surgery include:
- loss of or reduced nipple sensation
- a failed nipple graft
- visible scarring
- the possibility of needing an additional surgery to obtain your desired result
complications of MTF/MTN top surgery
The risks and complications associated with MTF an MTN top surgery include:
- loss of nipple sensation
- inconsistencies in the appearance of the implant
- implant deflation or rupture
- implant displacement, which is when the implant moves from the location where it was positioned during surgery
- needing an additional surgery to obtain your desired result