Some Things to Learn about Top Surgery
Top surgery is a reconstructive surgery performed on the chest, typically performed by a plastic surgeon that has specific training in transgender or gender-affirming surgeries. A lot of trans-masculine individuals get top surgery as a way to lessen their gender dysphoria.
There are a lot of questions when it comes to top surgeons, pricing, insurance, after-care, etc. So I made a list of FAQ listed below for informative purposes:
How much does FTM top surgery cost?
The cost of top surgery will vary depending on what procedure and what surgeon you have! In general, the cost of FTM Top Surgery ranges from $5000 - $10,000 USD. This may or may not include consultation fees. As far as your insurance goes, you should look into surgeons in your area that work with your specific insurance company and policy.
What kinds of procedures are available?
There are multiple kinds of top surgery depending on the size of your chest. Essentially top surgery is a subcutaneous mastectomy. Below are the different kinds of procedures you can get and the suggested size of chest that is recommended for each procedure.
Double Incision Procedure: Most widely-used technique and is ideal for those who are medium to large chested.
During this procedure, the skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. The skin gets pulled back and the breast tissue gets removed. Nipples are removed, re-sized, and then grafted onto the chest.
Buttonhole Technique: Ideal for those who prioritize nipple-areola size, positioning, sensation and pigmentation.
Very similar to double incision procedure however, instead of using nipple grafts, the nipple-areolar complex is re-sized and left attached to nerves and blood supply via a thin dermal pedicle, which preserves sensation.
Keyhole Procedure: Ideal for those who are smaller chested.
A small incision is made along the bottom of the areola, the breast tissue is removed with liposuction, and the nipple stalk is usually left intact. Some surgeons will resize the nipple itself but the areola is not resized. Nerve sensation is also maintained.
Inverted-T Top Surgery Procedure: Ideal for medium to large chested individuals who wish to retain the most sensation possible in the nipple-areola complex.
Very similar to double incision, however the nipple-areolar complex is reduced in size and repositioned via an extra vertical incision that runs from the bottom of the areola to the horizontal incision along the pectoral muscle.
The Peri-Areolar Top Surgery Procedure: Ideal for those who are small chested
An incision is made around the border of the areola and a second, larger concentric circle incision is made and the resulting ring of skin is removed. Breast tissue is then removed, and additional contouring with liposuction may be performed.
Minimal Scar Top Surgery: Ideal for very small chested individuals.
Involves small incisions on the side of the chest and part way around the areola. It is a very minimally-invasive procedure leaving nearly invisible scars after healing Nipple sensation is retained.
Do I need to be on testosterone before I can get Top Surgery?
No, WPATH Standards of Care do not require hormone therapy to be eligible for Top Surgery. However being on T can help with results by helping develop larger chest muscles. If you are on testosterone, depending on your surgeon, sometimes you have to stop your injections a week or two prior to surgery.
How do I prepare for Top Surgery?
Theres a couple things you can do to help improve results and make sure there’s no complications with surgery, Increasing muscle in your chest by working out and doing pushups before could help with results. If you smoke, it’s suggested you stop smoking at least 2 weeks prior. It’s also suggested you stop drinking alcohol two weeks prior to surgery as well. Eat a healthy, balanced diet and exercise as regularly as you can. Lastly, make sure you have a good environment to come home to for recovery.
What do I need for after Top Surgery?
Baby Wipes (Cleaning purposes - You may not be able to shower for a bit right after your surgery)
Comfortable button ups/flannels!
Comfortable set-up (I suggest a body pillow and even a neck pillow. You can’t roll over when sleeping!)
Stool softeners
Bendy straws
Wrap/Gauze for any drainage
Compression binder (Usually given to you by your surgeon)
Dry shampoo
Lots of healthy snacks
Caretaker!! (You will need someone to help with your drains and essentially help you with any physical activity. You will be pretty immobile, you don’t really realize how much your chest is involved in everyday activities like going to the bathroom. So you’ll need someone you trust to help you with that stuff!)
What are drains and will I have them?
This will depend on which procedure you have and what your surgeon recommends, but if you're having double incision or peri-areolar Top Surgery then you most likely will have drains. The drains draw out fluid that collects under your incisions after surgery. Ultimately, they are effective to reduce the risk of having a fluid collection under the skin after surgery. They will get removed about a week after surgery, depending on your surgeon.
How long is the procedure and how long is recovery?
It will vary depending on your surgeon and the specific procedure that is being taken place. Double Incision takes about 2-4 hours, Peri-Areolar 3-4 hours, and Keyhole 1.5-3 hours. As far as recovery goes, it varies. Generally speaking, recovery is anywhere from 4-6 weeks. Depending on the job you have, you will have to take about 2 weeks off from work (office job, student, etc) and 4-6 weeks for any job with lots of physical activity.
Let’s Talk About Scars…
After top surgery there’s a lot of care that goes into your scars. I’ve included a list of products that could be helpful in taking care of your scar tissue post surgery.
Scar Care
Silicone gel and sheets
Mederma Scar Gel, Bio Oil, Cocoa Butter are all good kinds of treatment for your scars
Massage!! - Spend about 5 minutes a day massaging with gentle circular motions at the top of the chest and then move your way from the middle of the chest to the sides and from the top of the chest down to the nipples and areolas and into the scars as well as below them too.
Silicone Scar tape or paper tape is good to keep on it in the summer when you go to the beach or in the water! (Cica Tape)
As far as when to start scar care, normally it is up to your surgeon but I would wait about 3 weeks until the chest is healed enough to begin your scar management.
Although my chest has had significant growth since I had top surgery a year ago (feel free to look at the comparison below) I’m still insecure about my scars. Always will be. Don’t get me wrong, I’m proud of my scars. They’re a part of who I am. But I hate that to someone else, they define me. I just assume the second someone sees them, they’re quick to judge. It takes time to love your body. Top surgery changed my life and truly made me love my body more than I thought I ever could. There’s always more work to do though.
The first photo above is pre-surgery, the second photos is one week post-op and the third photo is one year post-op.
