Masculinizing top surgery removes unwanted breast tissue via a double mastectomy, to create a flatter or more male-looking chest.Â
The most commonly requested gender-affirming procedure by transmasculine or nonbinary people, masculinizing chest surgery can be combined with pec implants to create a more muscled look.
Nipples and areolas are typically left intact, though they can also be reduced and moved to a lower position, to look more proportional with your new chest contours.Â
Top surgery is also an option for nonbinary or gender-expansive people, who may want a flatter look than the traditional male aesthetic, according to doctors on RealSelf.Â
"Some want their breasts maximally reduced (or short of that, to be 'gender neutral,' which generally resulting in a braless small A-cup range), while others want their nipple-areolar complexes removed altogether as well," says Dr. Paul Steinwald, a plastic surgeon in Golden, Colorado. "An experienced top surgeon should be able to modify the procedure to satisfy the wishes of almost any patient seeking top surgery."
Pros
Cons
RealSelf Tip: Removing breast tissue is irreversible, so results are permanent. That's usually a good thing, but it also makes it even more important to choose an experienced surgeon who has the skill to create a result that aligns with your aesthetic goals, while reducing the potential for complications or a poor outcome.
This cost typically includes the consultation, surgeon's fee, facility fee, anesthesia fee, and follow-up care. It may also include a compression garment. Ask for a detailed cost estimate during your initial consultation with your surgeon, so you understand what's covered in your cost prior to your surgery.Â
Your cost will depend on your provider’s level of experience, their practice location, and the details of your procedure.
For instance, keyhole and periareolar top surgery procedures are typically less expensive than the double incision method by as much as $2,000, according to Dr. Jed Horowitz, a plastic surgeon in Newport Beach, California.Â
Top surgery may be covered by your health insurance plan, depending on the laws in your state. Unfortunately, insurance coverage for top surgery for either transmen or women is less likely to be available than coverage for facial masculinization or feminization.Â
If your chosen surgeon regularly offers gender-affirming surgery, their staff will likely be able to guide you through the process of requesting insurance coverage.
You can finance your treatment with CareCredit.
The masculinizing top surgery photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.
“There are a few options for gender-affirming mastectomy procedures, depending on your current anatomy and your goals for the procedure,” explains Dr. Patricia McGuire, a plastic surgeon in St. Louis. You can expect repositioning, reshaping, and possibly liposuction to help create your new contours.Â
"The creation of a proper masculine appearance for transmen involves much more than 'standard' mastectomies (as for cancer patients), breast reductions (which reduce the size of the breasts), or even male breast reduction surgery (aka gynecomastia surgery)," explains Dr. Tholen.
For instance, typically, the higher, more centrally placed female nipple areola position doesn't align with the traditional masculine aesthetic, which requires lower, more lateral placement.
Your natural breast size will play a role in your surgeon's technique: people with naturally small breasts usually need little to no skin removed during their surgery, while those with larger or more drooping breasts usually require removal of excess skin and fat.
The procedure typically takes 3–4 hours and is performed under general anesthesia, so you'll be asleep during the procedure. Surgical options include:Â
If you’re BRCA positive, it's safest to have all of your breast tissue removed, to significantly reduce your risk of developing breast cancer. (If the disease runs in your family and you haven’t yet been tested for the BRCA gene, your doctor may recommend doing this before your surgery.)
When it comes to choosing a surgical technique, Dr. Tholen says it's important to understand how your own anatomy comes into play. Every patients wants the fewest incisions and least noticeable scars, but "double-incision top surgery is always required with breasts above a certain size, and these sizes will differ with age, skin thickness, skin elasticity, and healing," he says. He cautions that undergoing the wrong type of surgical procedure could end with you asking, "how can this be fixed?"
RealSelf Tip: While it’s not required to undergo hormone therapy before top surgery, many transgender individuals do. Recent studies also say it’s OK to continue hormone therapies during surgery. Talk with your health care team about what's best for you.
Most people are able to return to a desk job within two weeks after top surgery. If you have a job that requires you to lift heavy objects or move frequently, you may need to be out for up to six weeks before safely returning to those duties.Â
Strenuous exercise or lifting more than 10 pounds can usually be resumed after six to eight weeks, but check with your doctor before doing any chest-focused weight lifting.
Here's what will happen in between your surgery and when you head back to work:
It typically takes three to six months for the swelling to resolve, so you can see the final results of your flatter or more masculine chest.
Performing weight-training exercises to build muscle mass both before surgery and after recovery can enhance your results.
If you want a stronger look, pectoral implants made of silicone gel or solid silicone can be surgically inserted, to create the appearance of highly developed chest muscles.
Top surgery results are considered permanent and aren't reversible. Patients who've undergone the procedure often worry that their breasts might "grow back" if they gain weight, but because it removes the breast tissue (not just fat tissue), you'd have to gain a substantial volume of weight before your chest looked feminine again.
One goal surgery is to minimize the appearance of scars and optimize their placement. Not surprisingly, removing larger breasts leaves larger scars.
A well-performed double incision surgery leaves scars on each side of the chest, but skillful incision placement can position the final faded scar along the lower edge of the pectoral muscles, following the natural contour. "This simulates normal male anatomic features, while making the scars less apparent," says Dr. Tholen.Â
For transmen who are on testosterone hormone therapy, new hair growth further conceals scars.Â
Proper wound healing, such as protecting the incision area from excessive activity for a few weeks, will help reduce bleeding, bruising, and the formation of seromas that can make scarring worse. Avoiding sun exposure during the period when scars are still pink and susceptible to hyperpigmentation also helps.
Scars are permanent but will fade over the course of a year. You can help this process along with scar treatments, including silicone sheets or scar gel, beginning two weeks after surgery. Your surgeon can advise you on which brands and size to purchase. Some even offer complimentary laser scar removal.Â
RealSelf Tip: Plastic surgeons who use "standard" bilateral mastectomy or breast reduction techniques will leave scars that are both unnecessary and unsatisfactory, says Dr. Tholen. "Careful measurement and precise skin closure in layers avoids the vertical scar patterns of female breast reduction operations," he says.Â
To avoid poor scarring, ask the plastic surgeons you consult with to show you before and after photos of their trans patients.
Masculinizing top surgery is considered safe and effective when it's performed by an experienced, board-certified plastic surgeon.Â
In follow-up studies, transgender men who have undergone the procedure report very low rates of complications and high rates of satisfaction. Scarring is generally within expected limits, and necrosis (tissue death) of nipple grafts is rare.Â
One report of 220 subcutaneous mastectomies in 110 transmasculine patients found that the overall mean aesthetic score was 4.07 of 5. For the 12 (11%) patients who underwent revisions, the aesthetic score increased from 1.88 following the first operation to 4.11 following the second operation.
In a study that compared transmen undergoing top surgery with cisgender male and female counterparts undergoing mastectomy for other indications, transgender males were not at an increased risk of adverse outcomes—including postoperative complications and readmissions.
"These favorable results should encourage surgeons to expand their offerings to transgender patients and reassure them as to the safety of chest masculinization as a component of gender affirmation," researchers concluded.
That said, any surgical procedure comes with potential complications, including bruising, swelling, nausea and vomiting, blood clots, infection, seroma (fluid build-up), and poor reaction to general anesthesia.Â
It's common to experience diminished chest or nipple sensation after the surgery, but patients usually retain some sensation. Most patients actually report increased sexual satisfaction following their procedure, likely due to enhanced body confidence.Â
Quality of life is also significantly higher among transgender men who've undergone chest reconstruction, compared to those who haven't. In combination with hormone therapy, the procedure is also more effective in alleviating gender dysphoria than hormones alone.
Updated December 3, 2021