Top Surgery
Top or chest surgery is a transformative procedure that helps align one's external appearance with their gender identity, allowing for a more authentic and comfortable expression of self, ultimately promoting a sense of gender affirmation and empowerment.
MASCULINIZING CHEST SURGERY | GENDER-AFFIRMING MASTECTOMY | TOP SURGERY |
If you’re thinking about having a gender-affirming mastectomy, also known as top surgery, you’re not alone. This type of surgery is a meaningful step for many transmasculine and nonbinary people who want to align their body to their gender identity and feel more confident about their appearance. Taking this important step can have tremendous social, psychological, emotional, personal and professional benefits to improve overall quality of life. It can support a more comfortable relationship with your body and, for some, help reduce gender dysphoria.
Getting access to affirming care is important. Affirming care means working with healthcare providers who respect your gender identity, use your correct name and pronouns, and support your personal goals. This kind of care can make a big difference not just physically, but emotionally and mentally as well.
In fact, studies have shown that top surgery can greatly improve mental health for trans and nonbinary people.
For example, a 2021 study published in JAMA Surgery found that gender-affirming top surgery was linked to lower levels of anxiety, depression, and suicidal thoughts in transmasculine individuals. As you explore your options, remember that this is your journey. You deserve care that honors who you are and supports your well-being at every step.
Editor’s note: In our article, we may use terms that are culturally outdated, as many of our patients still rely on them when searching for information. We want to ensure we remain visible to this audience as well.
PATIENT STORIES
Choosing Align Surgical for your gender-affirming care means entrusting your health and identity to a skilled, compassionate team. Hear firsthand from patients who’ve experienced expert care from our renowned doctors.
WHAT IS MASCULINIZING CHEST SURGERY
(GENDER-AFFIRMING MASTECTOMY)?
Masculinizing chest surgery, also known as top surgery or gender-affirming mastectomy, is a type of chest surgery that removes breast tissue to create a flatter, more “masculine” or gender-neutral chest. This surgery is part of what’s known as masculinizing chest surgery, and it’s done to help people feel more at home in their bodies.
This is different from a traditional mastectomy, which is usually done to treat or prevent breast cancer. The techniques for traditional, cancer-treating mastectomy are different from the techniques used to affirm a person’s gender identity. Gender-affirming top surgery helps those with gender dysphoria or who have different embodiment goals than what is available with a traditional mastectomy procedure.
People choose to get top surgery for many personal reasons. Some have gender dysphoria, which is the distress that can come from a mismatch between their body and their gender identity. Others simply want to feel more confident and comfortable without needing to bind their chest or hide their body. And for many, it’s about having full control over their body and how they want it to look: this is called body autonomy.
This surgery isn’t just for one type of person. It can be for:
- Transmasculine individuals (those who were assigned female at birth but identify on the masculine spectrum)
- Nonbinary people (who may not identify strictly as male or female)
- Other gender-diverse individuals who want a chest that better reflects who they are
No matter the identity, masculinizing top surgery (also known as FTM top surgery) nonbinary chest surgery, and other forms of masculinizing chest surgery can all help people feel more at peace in their own skin. If you’re considering top surgery, know that you’re not alone. You deserve compassionate care that respects your identity every step of the way. Schedule a consultation with Align Surgical Associates.
TYPES OF TOP SURGERY TECHNIQUES
There are different types of top surgery techniques, and the right one for you depends on your body, chest size, skin elasticity, and your personal goals. Your surgeon will help you decide which method is best for you, but it’s helpful to understand the basics.
Here are the most common types of gender-affirming top surgery:
Each of these surgeries can result in top surgery scars, which fade over time and can often be cared for with proper scar treatments or even covered with tattoos if desired.
Choosing the right type of surgery is a personal decision and should be made with support from a qualified surgeon who understands your goals. What matters most is finding an option that helps you feel comfortable, confident, and aligned with your identity.
TOP SURGERY CONSULTATION: WHAT TO EXPECT
DOUBLE INCISION
PERIAREOLAR INCISION (KEYHOLE)
INVERTED
BUTTON HOLE
DOUBLE INCISION TOP SURGERY (WITH NIPPLE GRAFTS)
This is one of the most common types of masculinizing chest surgery, especially for people with medium to large chests.
How it works:
The surgeon makes two horizontal incisions across the chest to remove breast tissue. The nipples are removed and then grafted back onto the chest in a more masculine position.
Pros:
- Works well for larger chests
- Allows more control over chest shape and nipple placement
- Often creates a flat, defined chest
Cons:
- Leaves two visible scars across the chest
- Some loss of nipple sensation is common
PERI-AREOLAR (KEYHOLE) TOP SURGERY
This method is best for people with smaller chests and good skin elasticity.
How it works:
A small incision is made around the edges of the areola (nipple area), and the breast tissue is removed through this opening. Since the nipple stays attached, nipple sensation is more likely to be preserved.
Pros:
- Smaller scars that blend with the edge of the areola
- May preserve more nipple sensation
- No need for nipple grafts
Cons:
- Not ideal for larger chests
- Less control over chest contour and nipple size.
INVERTED-T OR ANCHOR INCISION SURGERY
This option is sometimes used for people with very large chests or extra skin, or in those patients who desire a reduction of breast size, rather than a more flattened contour.
How it works:
It combines a vertical incision from the nipple down to the chest crease with a horizontal incision along the bottom of the chest, forming an anchor-like shape.
Pros:
- Can remove more tissue and excess skin
- Helps reshape the chest more dramatically when needed
Cons
- Results in more scarring (anchor-shaped)
- Longer healing time and slightly more complex recovery
BUTTONHOLE TECHNIQUE
This method is ideal for people with small to moderate chests who want to attempt to preserve nipple sensation, though results are unpredictable and can vary widely.
How it works:
It involves removing chest tissue through incisions at the base of the chest and creating a small opening (the “buttonhole”) to reposition the nipple while keeping it attached to nerves and blood supply. This can theoretically help maintain sensation.
Pros:
- Better change of preserving nipple sensation
- More natural nipple appearance and color over time
- Avoids vertical scar between nipple and chest crease
Cons:
- Not ideal for very large chests or heavy tissue
- Slightly more complex surgery and healing
Before getting top surgery, you’ll need to have a consultation with your surgeon. This is your chance to talk about your goals, learn more about the surgery, and ask any questions you may have. It’s totally normal to feel nervous, but remember, this appointment is for you. You’re taking an important step toward a more comfortable and confident future.
HOW TO PREPARE FOR YOUR CONSULTATION
To make the most of your top surgery consultation, it helps to be prepared.
Here are a few tips:
- KNOW YOUR GOALSThink about how you want your chest to look and feel after surgery.
- MAKE A LIST OF QUESTIONSWrite them down so you don’t forget anything.
- BRING MEDICAL INFORMATIONIf you have any past medical records or medications, bring those with you.
- HAVE A SUPPORT PERSON (IF YOU WANT)A trusted friend, partner, or family member can come with you if it helps you feel more comfortable.
Your surgeon will likely go over your medical history, check your chest and skin, and talk about which surgery technique might be best for your body and goals.
QUESTIONS TO ASK YOUR SURGEON
Here are a few beneficial questions to ask during your consultation:
- What type of top surgery do you recommend for me?
- How much experience do you have with gender-affirming surgery?
- What will my scars look like?
- How long is the recovery?
- What are the risks or possible complications?
- Can I see before-and-after photos of past patients?
- What kind of results can I realistically expect?
These questions can help you feel more informed and confident about your decision.
MENTAL HEALTH EVALUATIONS OR LETTERS
Depending on where you live or the clinic’s policies, you might need a mental health letter from a licensed therapist or psychologist. This letter usually confirms that:
- You understand what the surgery involves
- You’re mentally and emotionally ready for the procedure
- The surgery is a medically necessary part of your gender-affirming care
Some clinics don’t require this if you give informed consent, while others may still follow older requirements. Your surgeon or clinic should let you know exactly what’s needed.
SURGERY DAY AND RECOVERY TIMELINE
Getting ready for top surgery is exciting and it’s completely normal to have some nerves, too. Knowing what to expect on the day of surgery and during the healing process can help you feel more confident and prepared.
WHAT HAPPENS ON THE DAY OF THE SURGERY
On the day of your top surgery, you’ll arrive at the clinic or hospital and meet with your care team. They’ll go over the procedure again, answer any last-minute questions, and get you ready for surgery.
You’ll be put under general anesthesia, which means you’ll be asleep and won’t feel anything during the operation. The surgery usually takes 2 to 4 hours, depending on the technique used and your specific needs. Afterward, you’ll spend some time in recovery while the anesthesia wears off. Most people go home the same day, though some may stay overnight depending on the clinic.
You’ll leave with bandages, chest dressings, and possibly drain tubes to help remove fluid from your body as it heals.
PAIN MANAGEMENT AND AFTERCARE
It’s common to feel sore and tired after surgery. Your doctor will give you pain medications to help keep you comfortable. You may also be prescribed antibiotics to prevent infection.
Here’s what you can expect with top surgery aftercare:
- - You’ll likely wear a compression binder or vest to reduce swelling and support your chest as it heals.
- - If you have drain tubes, your care team will show you how to clean and manage them. They’re usually removed within a week or two.
- - Avoid lifting your arms above shoulder level, heavy lifting, or intense movement for several weeks.
- - Follow your surgeon’s instructions closely to avoid complications and promote healing.
HEALING TIMELINE: WEEK-BY-WEEK
Recovery is different for everyone, but here’s a general idea of what to expect:
WEEK 1
- Soreness, swelling, and bruising are common
- You’ll need plenty of rest
- Drain tubes may still be in place
- Short, slow walks are encouraged to promote circulation
WEEK 2
- Drain tubes (if used) are often removed
- You may feel more mobile but should still avoid stretching or lifting
- Follow-up appointment with your surgeon
WEEK 3-4
- Most people feel better by this point
- Stitches dissolve or are removed
- Swelling begins to go down
- You may return to light activities depending on your doctor’s advice
WEEK 5-6
- Scars begin to settle
- You can likely return to work (if not physically demanding) and resume more normal activities
- Still avoid strenuous workouts unless cleared by your surgeon
AFTER 6 WEEKS
- Many people resume most activities
- Chest appearance continues to improve over the next few months
- Scars may fade with proper care
TIPS FOR OPTIMAL HEALING
- Follow your surgeon’s instructions: they know your body and procedure best
- Rest and hydrate: healing takes energy
- Take pain meds as directed: don’t try to “tough it out”
- Sleep on your back with your upper body slightly elevated
- Don’t smoke or vape, as this can slow healing
- Wear your compression garment exactly as advised
- Stay in touch with your care team if anything feels off or unusual
LIFE-CHANGING TESTIMONIALS
Our mission is to align body and mind through compassion and surgical excellence so that all people can experience the freedom of living as their true gender.
INCLUSIVE CARE AND SAFE PRACTICES
It’s essential to choose a surgeon who practices inclusive care and understands the unique needs of transgender and gender-diverse individuals. This means your surgeon should be knowledgeable about the mental, emotional, and physical aspects of gender-affirming surgery.
An informed approach means the surgeon is sensitive to the potential emotional and psychological challenges you may have faced throughout your life. They should create an environment where you feel safe, heard, and respected.
Make sure your surgeon takes time to listen to your concerns, explain the procedure in detail, and respects your gender identity and individual needs. You deserve a provider who sees you as a whole person, not just a patient undergoing surgery.
Align Surgical Associates is proud of its affirming and LGBTQIA2S+ inclusive care. Our surgeons are specifically trained to provide gender-affirming surgeries with empathy and professionalism.
CLINIC VALUES THAT SUPPORT LGBTQIA2S+ IDENTITIES
In addition to finding a skilled surgeon, it’s important to choose a clinic that values and supports LGBTQIA2S+ identities. A clinic that fosters a welcoming environment will make your experience more comfortable.
Look for clinics that openly advertise their commitment to LGBTQIA2S+ care, such as:
- Non-discrimination policies that explicitly include gender identity and sexual orientation.
- Staff training in cultural competency and understanding the unique needs of transgender patients.
- Respectful language: The clinic should use correct pronouns and be respectful of all gender identities.
Align Surgical Associates prides itself on being a 100% dedicated gender-affirming care clinic that celebrates diversity and provides comprehensive care for LGBTQIA2S+ individuals. Our mission is to offer compassionate and respectful treatment throughout the entire surgical process.
No. 1 Gender Affirming Surgeons in Los Angeles and San Francisco
“An incredibly professional, welcoming, supportive, and affirming experience”