Top surgery is a significant and transformative procedure for many transgender individuals. This surgery, which involves the alteration of the chest to align with one's gender identity, can greatly enhance a person's quality of life, self-esteem, and mental health. In this post one of our surgeons, Dr Seni Mylvaganam answers all your FAQs about this transitional surgery.
Top surgery refers to the surgical procedure performed to modify the chest area, typically for transgender men (female-to-male) and some non-binary individuals. The goal is to create a chest that aligns with the patient's gender identity. Mastectomy (Chest Masculinization Surgery) is for transgender men and involves the removal of breast tissue to create a more traditionally masculine chest. It may also include nipple and areola resizing and repositioning.
What happens during the Top Surgery procedure?
Removal of all breast tissue or a mastectomy is considered for adults where a decision has been made by an individual to permanently alter body parts associated with their biological sex. It is a decision made by adults with gender dysphoria in collaboration with a recognised gender dysphoria clinic. Based on the recommendation of a gender dysphoria clinic an individual will be referred or approved to approach a surgeon to consider this surgery when transitioning from female to male. Individuals should have socially transitioned to your preferred gender identity for at least a year before gender surgery is considered.
The Mastectomy procedure can take between 2-4 hours. Techniques may include;
Incision: An incision around the nipple and/or in the crease of the breast, depending on the technique used.
Removal of Breast Tissue: Removal of the breast tissue, and also removal of excess skin to achieve a flat chest.
Nipple and Areola Reshaping: If desired, the nipples and areolas can be resized and repositioned to create a more masculine appearance.
Drain Placement: Small tubes (drains) may be placed to remove excess fluid and reduce swelling.
Closing the Incision: The incisions are closed with sutures, and the chest is bandaged.
What happens to the nipple during Top Surgery?
When undertaking breast removal for gender dysphoria the nipple and areola will require movement to position it in the new correct position on the chest wall after all breast tissue and excess skin is removed. This can be done whilst it remains attached to the skin overlying the removed breast tissue or it can be cut out and replaced in the new required position with stitches in a procedure called a free nipple graft.
What does the recovery process look like?
Following surgery a patient is likely to be able to go home the same day. There will usually be the use of drains placed where the breast tissue has been removed and the patient will be able to go home with these drains with some simple training on how to look after them at home. These drains will be removed when the tissue fluid that can accumulate after surgery reduces sufficiently that the output from the drain dries up. Pain relief is provided on discharge and the level of discomfort may vary for different individuals but most individuals are quite comfortable and freely mobile and independent for day to day activities in the first days after surgery. You will be able to undertake most activities at home but avoiding any strain over the first two weeks with advice from your surgeon on when to progress those activities. The wounds will usually have healed within 2 weeks with dressings no longer needed after then. More specific aftercare will be provided if you have free nipple grafts.
At what age can an individual undergo Top Surgery?
An individual seeking this surgery alongside a gender dysphoria diagnosis must be an adult (18 and over) and have been previously assessed, treated, supported and advised by a gender dysphoria clinic.
Like any surgery, top surgery comes with risks, including infection, scarring, and dissatisfaction with the results. It's crucial to have realistic expectations and to choose a surgeon with extensive experience in transgender procedures.
Top surgery is a deeply personal and transformative procedure that can significantly enhance the lives of transgender individuals. By aligning one's physical appearance with their gender identity, many patients find increased happiness, confidence, and peace. As with any medical procedure, thorough research and consultation with experienced professionals are essential to ensure a safe and satisfactory outcome.
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