Top Surgery

Medically reviewed by Janet Brito, PhD, LCSW, CST on November 7, 2017Written by Mere Abrams, MSW, ASW

Overview

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.

Cost

Top surgery cost varies greatly depending on insurance coverage, where you live, and the surgeon you use.

The average range for cost of FTM and FTN top surgery is currently between $3,000 and $10,000.

The average cost range for MTF and MTN top surgery varies greatly depending on factors such as body size, body shape, and desired breast size. The average cost range for this surgery is between $5,000 and $10,000. There’s typically a hospital or facility fee and anesthesiologist fee added to the total bill.

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

Keyhole top surgery is only recommended for people with very small chests and tight chest skin. Key information includes:

  • Very few people are good candidates for keyhole top surgery because no excess skin is removed.
  • In order for this technique to result in an aesthetically pleasing and flat result, you must meet the criteria of having a small chest and tight chest skin.
  • This procedure is typically an outpatient surgery that takes between 1.5 and 3 hours.
  • This procedure results in very little visible scarring and preserves nipple sensation, but doesn’t provide the opportunity for the nipple to be repositioned on the chest.

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.

How to prepare

There are a number of things you should do to prepare for top surgery. Some tips include:

  • Avoid alcohol. Avoid alcohol the week leading up to your surgery.
  • Stop smoking. If you’re a smoker (of any kind) it’s recommended you stop three weeks prior to surgery, as smoking can interfere and cause complications with healing.
  • Discuss medications. You should always discuss any medications you’re taking with your surgeon and ask if it’s recommended you continue their use before and after the surgery.
  • Set up transportation. Prepare your transportation from the hospital after your surgery.
  • Dress prepared. Bring comfortable, loose clothes that zip or button in the front to make getting dressed (and undressed) easier after your surgery.

Recovery

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.

Recovery timeline

  • Day 1 and 2 of recovery are often the most uncomfortable. This discomfort can be a result of the anesthesia wearing off as well as the compression binder or surgical bra, which is holding the dressing over the incisions or grafts tightly in place.
  • To ensure there’s no added pressure or weight on the surgery site, you will have to sleep on your back for at least the first week after surgery.
  • About 6 or 7 days after surgery, you will likely have your postoperative appointment. This is often the first time the dressing comes off and many people get to see their chest.
  • The swelling generally decreases within 2 or 3 weeks, but for some, this can take up to 4-6 months.
  • You should be careful not to lift your hands above your head for at least 2 to 3 weeks after surgery. Movements such as reaching and lifting can increase scarring. After 6 or 8 weeks, you can typically resume physical exercise such as sports, lifting, and running.

Recovery tips

  • Don’t shower. Many surgeons instruct you not to shower until your postoperative appointment when the dressing is removed. Baby wipes and sponge baths are often two of the best and easiest ways to say clean in the meantime.
  • Use ice packs. Most people experience some swelling and bruising after surgery, but the extent of the swelling and bruising varies greatly. Ice packs can help to decrease the inflammation and manage pain.
  • Don’t lift or do strenuous exercise. Lifting anything heavier than a gallon of milk isn’t recommended in the first week of recovery. You will be able to resume light exercise such as walking as soon as you feel up to it, just be careful not to do anything that will result in an increased heart rate.
  • Take care of yourself. The best things you can do to speed up the healing process is to rest, eat healthy, refrain from smoking and drinking, and listen to your body.
  • Use scar treatments. Over-the-counter scar treatments can also expedite the healing process as well as decrease scar tissue and redness.

Complications and risks

The large majority of the complications and risks associated with all top surgeries are the same as those associated with any surgery, such as reactions to anesthesia, blood clots, and infection.

FTM/FTN top surgery complications

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

MTF/MTN top surgery complications

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

Outlook

Research shows us that very few (if any) trans people regret the decision to get top surgery, and the large majority report decreased gender dysphoria and an increased sense of self-confidence and comfort in their body after completing this step in their transition or alignment process.

For many trans and nonbinary people, this is more than just a surgery. It’s a necessary step in order to feel whole and better align with one’s gender and body. This can be an emotional and challenging process to go through, even if it’s something you know you want and need. Due to the personal nature of this surgery for many people, it’s critical you find a surgeon who you’re comfortable with and who has proper training in transgender and gender affirming surgeries.


Mere Abrams is a nonbinary writer, speaker, educator, and advocate. Mere's vision and voice bring a deeper understanding of gender to our world. Collaborating with the The San Francisco Department of Public Health and The UCSF Child and Adolescent Gender Center, Mere develops programs and resources for trans and nonbinary youth. Mere’s perspective, writing, and advocacy can be found on social media, at conferences across the United States, and in books on gender identity.

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