Top surgery is a procedure done for transgender men and nonbinary people to remove breast tissue, it’s also sometimes referred to as masculinizing chest surgery.
If the chest area is small, then surgery may be able to be performed that salvages your skin, nipple and areola. This type of surgery is called nipple-sparing subcutaneous mastectomy.
However, if you have a larger chest, you may need to have your nipples and areolas taken off, resized and put back into position.
Top surgery is usually done as a process to treat gender dysphoria, this is where a person may feel a sense of unease because of a mismatch between their biological sex and their gender identity.
This procedure can help transgender men and nonbinary people transition to their self-affirmed gender.
Why Is It Done?
Transgender men and nonbinary people who seek top surgery may have feelings of discomfort due to their gender identity not matching the gender they where assigned to at birth. This is called gender dysphoria.
For some transgender men and nonbinary people, top surgery is a vital step in transitioning and is important to themselves.
But, not having top surgery doesn’t make someone any less transgender or nonbinary, many people will choose not have it.
People will have different decisions regarding their own bodies and it’s their choice to decide what will best suit their needs.
Before top surgery happens, most surgeons will require one letter of support from a mental health worker that is competent in transgender health.
The mental health worker will determine whether you meet the World Proffessional Association of Transgender Health standards of care criteria.
The criteria states that you must:
- Be managing any significant medical or mental health concerns
- Have well documented gender dysphoria
- Have reached the legal age to make healthcare decisions in your country (age of majority or age 18 in the US)
Of course, with any major surgery, there are always some risks to be aware of. Mainly bleeding, infection and an adverse reaction to anesthesia.
Some other complications to be aware of are:
- An imbalance of chest tissue
- Not being satisfied with your appearance after surgery
- Poor wound healing
- Fluid buildup beneath the skin
- Damaged or dead tissue, particularly in the nipple
- A solid swelling of clotted blood within your tissues
How You Would Prepare
Top surgery is usually deferred until adulthood, as you’ll be permanently altering your appearance.
Hormone therapy isn’t usually required before top surgery for transgender men and nonbinary people. But, for some people, waiting for the muscle growth that comes with testosterone therapy may give the best surgical result.
If you have been taking hormone therapy, a blood test will be administered before your surgery to ensure that the testosterone level is in your target range.
Before the surgery occurs, you’ll meet with your surgeon. Make sure you’ve chosen a reputable surgeon who is board certified and has experience in this field, you surgeon will then discuss options and potential results you can expect.
The surgeon will give you information regarding anesthetic, the location of the surgery and any follow-up procedures that may be necessary.
You should be given instructions on preparing for your surgery from your healthcare provider, this will detail guidelines on eating, drinking, smoking and adjusting current medications.
As well as this, you’ll have to meet certain criteria to be eligible for top surgery. Your healthcare provider will start by evaluating your health to ensure there’s no conditions that may affect the surgery or rule it out completely.
The evaluation may include:
- A physical exam
- Identification and management of any tobacco use, drug abuse or alcohol abuse
- Age and sex appropriate screenings
- Blood tests that measure your testosterone levels
- A review of your personal and family medical history
- Testing for HIV and other sexually transmitted diseases and providing treatment, if necessary
Like we mentioned earlier, the surgeon will need a letter of support from a mental health worker in line with the World Professional Association of Transgender Health standardsd of care criteria.
The health evaluation may include:
- Reviews of your gender identity and gender dysphoria
- Your goals, the risks and expectations of the surgery and your future care plans
- The impact of your gender identity at work, school, home and social environments. Involving issues related to discrimination, relationship abuse and miniority stress.
- Any sexual health concerns
- Protective factors such as social support from family, friends and peers
- Mood or any other mental health concerns
- Any risk taking behaviors, such as substance use and unapproved hormone therapy or supplements.
When deciding whether to have top surgery or not, it must be thoroughly understood by anyone wanting it that it will come with irreversible physical changes, you must give informed consent after thoroughly discussing.
- Alternatives to surgery
- Potential complications
- The surgery is irreversible
- Social and legal implications
It also must be known that health insurance may not cover top surgery, as it may be considered cosmetic for the general population, even though this surgery may be vital in alleviating your gender dysphoria.
It might also be useful to talk to other transgender men and nonbinary people who have undergone top surgery before making this step.
It can help to give you real life experiences of people who’ve had it and it can help to manage your expectations of what can be achieved.
The results should usually always be well received, of course in some cases, people who’ve undergone top surgery aren’t happy, but as long as you’re sure it’s what you want it should be vital in alleviating any feelings of gender dysphoria.
By the end of the procedure, you will have a masculine looking chest but it’s important to follow the aftercare instructions.
Research suggests that most transgender men and nonbinary people are satisfied with the results of their surgery and in a 2021 review of studies of transgender men who had chest surgery, the satisfaction with the procedure was high.