No matter how you’d like your chest to look as a nonbinary person, options exist to help you achieve it.
When people talk about ‘top surgery,’ they’re mostly talking about gender-affirming surgeries that most accurately match someone’s chest closer to the gender they want to be perceived as.
Being transgender and nonbinary does not have a certain look or a specific set of rules when it comes to gender expression or decisions for gender-affirming care. Nonbinary people can and do have top surgery, but it’s not required to be considered part of the nonbinary or trans community.
During surgery consultations, you’re allowed to ask for what you want and to see the previous surgeries your surgeon has completed.
For more information on what top surgery can look like for nonbinary people, keep reading.
For anyone assigned female at birth (AFAB) who has gone through puberty, they may want to change the breast tissue that’s developed. They may be looking to remove it, reduce it, or make their chest look less masculine to better align with their gender (or help avoid being misgendered).
That said, not every nonbinary person is the same, and sometimes they might want to enhance their chest because that feels good for their gender as well.
There isn’t a wrong or right way to be trans or nonbinary, and here are the main options that AFAB folks would have for top surgery:
- Breast removal: People assigned female at birth would follow the steps of top surgery that transmasculine people would follow. Depending on your chest size, your own preferences, and your surgeon’s abilities, you have a range of options for what kind of scars you have, nipple sizing and placement, and whether you choose to keep them.
- Breast reduction: If you’re nonbinary or any gender, you have the option of getting a ‘radical reduction’ instead of removing breast tissue altogether. For example, going from a DD cup to an A cup would be a radical reduction. There are many reasons why people would not want to entirely masculinize their chest or leave some tissue.
- Breast enhancement: If you’re looking to increase the size of your chest surgically, following similar steps for breast augmentation, in general, would be your best bet. Wanting your chest to be bigger does not make anyone ‘less nonbinary’ compared to anyone who would want to decrease their chest size.
When it comes to nipple placement as a nonbinary person, you have options. You can opt out of having your nipples grafted back on altogether, you can have them placed in an area more often perceived “feminine” (see this comic by trans illustrator Kris for an example), or you can have them sized smaller, larger, or in any way.
Not all nonbinary people assigned male at birth (AMAB) are going to be transfeminine or adopt that label, but many people looking for top surgery who are AMAB could be or fit within the group of people looking for the same options.
Some people assigned male at birth may have taken HRT during their transition, which would increase the size of their breasts. But for people looking for other options in addition to HRT or apart from it, you may consider:
- Breast removal: Many males develop enlarged breast tissue (even without the use of HRT), and not everyone who is nonbinary or intersex and AMAB would want the appearance of breasts. Your process for removal is similar to those seeking out transmasculine top surgery or gynecomastia surgery.
- Breast reduction: You don’t have to have the entire removal of breast tissue for your top surgery. You can discuss with your surgeon what kind of sculpting (feminine, masculine, neutral) you want and how much tissue you would like to leave behind.
- Breast enhancement: Many nonbinary AMAB people desire to have a larger chest. For an introductory guide on transfeminine top surgery (augmentation), check out our guide for that process.
Some people may run into fatphobia while trying to access gender-affirming care.
If you have a larger chest, most people have the ‘double incision’ surgery to achieve full removal.
Here’s a nonexhaustive list of surgeons who have a high or no BMI limit.
Do you need to be on HRT before top surgery?
It depends. For AFAB people, it may not be a prerequisite. However, for AMAB people, the current WPATH Standards of Care recommend being on hormone therapy for at least 12 months before surgery. This allows for maximum breast growth prior to augmentation.
In addition, if you need to use insurance to pay for top surgery ― this may complicate things. The WPATH Standards of Care uses these guidelines for top surgery:
- persistent, well-documented gender dysphoria
- a capacity to make a fully informed decision and to consent to treatment
- age of majority in a given country (if younger, follow our guidelines for children and adolescents)
- if significant medical or mental health concerns are present, they must be reasonably well-controlled
HRT is often used as the baseline for the documentation of your gender dysphoria treatments. If this has not been a part of your care, talk with your doctor about other ways of providing this documentation.
For breast augmentation, see here for expected costs.
Since 2014, Medicare in the United States covers gender-affirming care. However, there may be a list of expectations to be met before approval. Your Medicare caseworker will have more information.
Ideally, your insurance company will cover your top surgery, but you will have to follow a lot of steps and expectations when going through insurance.
Recovery from nonbinary top surgery
Recovery from top surgery of any kind (removal, reduction, enhancement) is all very similar. Here’s a full guide on how to reduce scarring and tips for healing.
There are no rules to gender. If making your chest larger or smaller makes you feel better regardless of your gender assigned at birth, that is the right chest for you ― whether that means augmentation, removal, leaving some tissue, or considering no nipples.
There’s also no right or wrong way to be transgender or nonbinary. Whatever feels the most correct and aligns the best for your body is the right choice for you.
If top surgery is something you’re interested in, you have options!