What is transmasculine top surgery?

The goal of transmasculine top surgery is to remove the breast tissue (mastectomy) from both breasts and create a masculine appearance to the chest. Top surgery is performed as a single stage procedure. There are many techniques used to perform top surgery, and many factors should be taken into consideration when choosing which technique is best:

• Amount of breast tissue

• Amount of excess skin

• Desire for nipple sensation

Who is a good candidate for transmasculine top surgery?

Transmasculine top surgery is a highly individualized procedure. You should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.

Transmasculine top surgery is a good option for you if:

• You have been diagnosed with persistent gender dysphoria

• You have been under the care of a mental health professional who can provide a letter of recommendation supporting your decision to undergo surgery

• You have been living as a member of your desired sex

• You are of the age to make consent

• You have a positive outlook and realistic expectations

• If significant medical or mental health concerns exist, they must be reasonably well-controlled

What should I expect during a consultation for transmasculine top surgery?

During your transmasculine top surgery consultation be prepared to discuss:

• Your transition process

• Your surgical goals

• Medical conditions, drug allergies and medical treatments

• Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use

• Previous surgeries

Your surgeon will also:

• Evaluate your general health status and any pre-existing health conditions or risk factors

• Examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolae

• Take photographs

• Discuss your options and recommend a course of treatment

• Discuss likely outcomes of top surgery and any risks or potential complications

Be sure to ask your plastic surgeon questions. It’s very important to understand all aspects of your top surgery. To help, we have prepared a checklist of questions to ask your plastic surgeon that you can take with you to your consultation.

It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

What are the steps of transmasculine top surgery?

Transmasculine top surgery includes the following steps:
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – Mastectomy to remove the breast tissue
A mastectomy will remove the breast tissue present on your chest. Sometimes, excess skin will need to be removed as well.

Step 3 – Creating a masculine shape
After the breast tissue and any excess skin is removed, the remaining tissues must be repositioned to create a masculine contour to the chest.

Step 4 – Repositioning the nipple and areola
Sometimes the nipple and the areola need to be reduced and/or repositioned on the chest after the mastectomy is performed. The nipple and areola tend to be smaller and lie slightly more lateral and inferior on the male chest.

What results should I expect after transmasculine top surgery?

The final results of transmasculine top surgery can help alleviate the feelings of gender dysphoria that some individuals may experience.

The removal of the female breast tissue typically also removes some sensation in the chest. Over time, some sensation to the chest skin and nipples may return, and scar lines will improve, although they'll never disappear completely. There are trade-offs, but most transmen feel these are small compared to the large improvement in their quality of life and the ability to look and feel like a man.

Although the breast tissue is removed during the procedure, and growth of breast tissue is suppressed by testosterone therapy, the risk of developing breast cancer is not zero. Careful monitoring of breast health through self-exam is essential to your long-term health.

When you go home, if you experience shortness of breath, chest pains, or unusual heartbeats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Following your physician's instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.