Top surgery is a transformative procedure sought by transgender and nonbinary people to align the look of their chest with their gender identity. The Bookimed team has collected comprehensive information from experts at top global clinics to guide you through each step, address your fears, and help you feel more prepared.
Keep reading to find out more about:
- top surgery basics;
- top surgery results;
- types of top surgery;
- how to find the best specialist in top surgery;
- top surgery requirements;
- how to prepare for top surgery;
- top surgery process;
- top surgery recovery;
- top surgery risks and complications;
- and even more.
What is Top Surgery?
Top surgery is a type of sex reassignment surgery aimed at altering the chest's size, shape, and appearance to reflect an individual's gender identity. Performed by plastic surgeons with specialized training in transgender or gender-affirming procedures, this is a crucial step for many in their transition.
- Female-to-male (FTM)/female-to-nonbinary (MTN) top surgery removes breast tissue and reshapes the chest to achieve a flatter, more masculine appearance. It's typically chosen by those seeking to present a male or neutral gender expression.
- Male-to-female (MTF)/male-to-nonbinary (MTN) top surgery involves the placement of saline or silicone implants to enlarge the chest, aiming for a more feminine silhouette.
🤔Can I get top surgery without being trans? Yes, top surgery is also popular among non-binary individuals who want their chest to better align with their identity and comfort.
Who is the perfect candidate for top surgery?
Top surgery can significantly improve the well-being of individuals experiencing a distinct incongruence between their gender identity and the sex assigned at birth.
The ideal candidates for this surgery are those who:
- experience persistent, well-documented gender dysphoria;
- are capable of making informed and responsible medical decisions independently;
- have addressed any additional mental or physical health issues effectively;
- maintain a positive outlook and realistic expectations about the outcomes of the surgery.
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⚡️25% of trans people have an additional gender-affirming procedure after the top surgery. Want to learn more about other options? Read our Sex Reassignment Surgery Guide.
Top Surgery Results: High Patient Satisfaction
Top surgery has proven to be highly satisfactory among patients. According to a recent study published by the JAMA Surgery journal, the median satisfaction score was 5 out of 5, while the median regret score was 0 out of 100, suggesting that no patients regretted their decision to have the surgery.
According to the American Society of Plastic Surgeons, patients experience significant improvements in the quality of life, namely:
- 91% increase in self-confidence;
- 85% increase in social confidence;
- 83% increase in self-perceived attractiveness;
- 96% increase in feeling comfortable in clothes.
Types of Top Surgery
There are various approaches to top surgery. You and your surgeon will deliberate on the most suitable option for your body type, health, aesthetic preferences, and other factors.
Female-to-male (FTM) top surgery types
1. Double incision top surgery with nipple grafts
This is the most prevalent procedure for top surgery, suitable for individuals with moderate to large amounts of breast tissue. It involves making two horizontal incisions across the chest, removing excess breast tissue, reshaping the chest contours, and repositioning nipples.
💡Often used in top surgery, a free nipple graft involves completely detaching the nipple and areola from the underlying tissue and reattaching them in a new position.
👍Pros:
- ideal for large chests;
- allows for a flat chest contour;
- offers flexibility in nipple placement.
👎Cons:
- visible scarring along the chest base;
- potentially reduced or lost nipple sensation;
- requires extensive nipple care post-surgery.
2. Periareolar top surgery
Best for people with smaller chest sizes (A or B cup) and no excess skin, this method involves making incisions around the areola to remover breast tissue.
👍Pros:
- less visible scarring;
- likely retention of nipple sensation.
👎Cons:
- 40-60% of people require revision surgery to achieve a completely flat chest.
3. Keyhole top surgery
Keyhole top surgery is rare since it is only suitable for individuals with very small breasts and good skin elasticity. It involves a small incision along the lower border of the areola.
👍Pros:
- minimal scarring;
- maintains nipple sensation.
👎Cons:
- limited to those with small amounts of breast tissue;
- does not allow nipple repositioning.
4. Inverted T or T-anchor
This technique is suitable for transgender patients with larger breasts (B size or larger) who wish to retain maximal nipple sensation, as it preserves the nipple and areola attached to native tissue. In this top surgery procedure, the doctor creates two horizontal incisions along the pectoral muscle, accompanied by an additional vertical incision, hence why it's known as the inverted T technique.
👍Pros:
- high potential to retain nipple sensation;
- fewer complications than top surgery procedures with nipple grafts.
👎Cons:
- results in a non-flat chest, as more tissue is preserved to maintain blood supply to the nipples.
5. Buttonhole Technique
The buttonhole technique is similar to the inverted T but doesn’t require a vertical incision because it is performed on patients with less breast tissue and no excess skin.
👍Pros:
- allows to remove more breast tissue through a single incision than keyhole and peri-areolar methods;
- preserves nipple placement, sensation, and pigmentation.
👎Cons:
- less control over nipple placement;
- results in a non-flat chest appearance.
6. Fishmouth or “Batwing” incision surgery
This method produces a unique scar pattern radiating from the nipple. This a good choice for non-binary or gender-nonconforming people who don’t mind a non-anatomical scar layout.
👍Pros:
- flatness and tight chest appearance;
- better chance of sensation preservation.
👎Cons:
- the scar layout is more visible and higher on the chest.
Male-to-female (MTF) top surgery
Chest feminization involves the placement of implants to increase breast volume and improve shape. A surgeon inserts implants behind the breast tissue or beneath the pectoral muscle, positioning each one directly under the nipples. Patients have two main options for implants:
- Saline implants are filled with sterile salt water. They are less expensive and require smaller incisions due to being filled post-insertion.
- Silicone implants are known for their soft, natural feel. They are pre-filled and provide a more realistic texture.
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Selecting the Best Specialist in Top Surgery
Choosing the right surgeon for top surgery is crucial to ensuring your safety and satisfaction with the results. When selecting a surgeon, consider the following factors:
- certifications;
- experience in gender-affirming surgery procedures;
- affiliations with professional organizations;
- patient reviews;
- before and after photos.
Bookimed partners with 22 gender-affirming doctors around the world. Here are some of the best global specialists offering top surgery:
Dr. Pichet Rodchareon📍Bangkok, Thailand
Dr. Pichet Rodchareon is one of the most well-known gender surgeons in Thailand. He has over 30 years of experience in top surgery for transmasculine patients. Dr. Pichet is an active member of:
- The International Society of Aesthetic Plastic Surgery (ISAPS);
- The World Professional Association for Transgender Health (WPATH);
- The Society of Plastic and Reconstructive Surgeons of Thailand;
- The Society of Aesthetic Plastic Surgeons of Thailand.
Dr. Pichet excels in a variety of top surgeries, including double incision, peri-areolar, keyhole, and inverted-T techniques.
Bangkok Plastic Surgery is the clinic under the direction of board-certified surgeon Dr. Pichet Rodchareon. As one of Thailand’s top experts in aesthetic surgical operations and sex reassignment surgery, he and the highly skilled team provide optimal care for all patient´s needs. He has performed over 3,000 procedures with beautiful and functional results and remarkable patient satisfaction. He has dedicated his practice to the unique enhancement and preservation of each patient’s unique identity and approaches every patient differently. As an active member of the World Professional Association for Transgender Health (WPATH), Dr. Pichet is committed to providing high-quality care for patients seeking gender-affirming surgeries.
Hospital certificates and accreditation of quality
| Sex reassignment surgery | $10000 - $13000 |
📍Istanbul, Turkey
Dr. Özbaba is a prominent plastic surgeon with over 35 years of experience and more than 30,000 completed treatments. He specializes in plastic, reconstructive, and gender-affirming surgeries. Dr. Özbaba is a respected member of the Turkish Society of Aesthetic Plastic Surgery.
Kucukcekmece Hospital is a multidisciplinary clinic located in Istanbul, Türkiye. Its strongest specialties are plastic surgery, gender reassignment surgery, bariatric surgery, neurosurgery, orthopedics, and cardiology. Kucukcekmece Hospital excels in male-to-female (MTF) surgeries, including top surgery (breast augmentation), bottom surgery (vaginoplasty), facial feminization surgery (FFS), and voice feminization surgery. Kucukcekmece Hospital serves both adults and children. Every year, 45,000 patients choose the clinic for medical care.
Major international patient flow comes from the USA, Asia, Europe, Africa, and Arab League states.
Hospital certificates and accreditation of quality
Latest review
📍Istanbul, Turkey
With over 1,000 successful operations behind his belt, Dr. Teymur has 20+ years of experience in reconstructive plastic surgery, including transgender top surgery procedures. His expertise is certified by memberships in prestigious organizations, such as:
- The European Board of Plastic, Reconstructive and Aesthetic Surgery;
- The European Society of Aesthetic Plastic Surgery.
Dr. MED Clinic is a private multi-specialty medical center in Istanbul, Turkey. The team is dedicated to plastic surgery, sex reassignment surgery, aesthetic medicine, cosmetology, and weight loss surgery. The clinic's success rate for plastic surgery, including sex change operations, is 98%. Dr. MED specialists apply the latest technologies in plastic and reconstructive surgery, offering such gender-affirming options as top surgery, bottom surgery, and facial reconstructive surgery. Dr. MED Clinic serves only adults. Every year, more than 4,500 patients choose Dr. MED Clinic for medical care. Patients from Europe, the Commonwealth, the USA, Canada, Australia, and CIS visit the clinic most often.
Latest review
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Top Surgery Requirements
Most top surgery doctors follow the guidelines provided by the World Professional Association of Transgender Health (WPATH). According to these guidelines, you will need to provide a letter of readiness from a mental health professional that confirms:
- persistent, well-documented gender dysphoria;
- ability to make informed decisions and consent to the surgery;
- legal age;
- any major health or mental health issues are under control.
Some surgeons are adopting an informed consent model that does not require a referral letter. Instead, you’ll likely need to sign a legal release acknowledging that you understand the surgery details, risks, and aftercare. However, most insurance plans still demand adherence to WPATH standards for coverage.
🔞How old do you have to be to get top surgery?
The minimum age for top surgery varies depending on the country or state where it is performed. By age 18, most individuals can make medical decisions independently, including the decision to undergo top surgery or other gender-affirming procedures. In some places, you may be eligible for top surgery as young as age 16, provided you have consent from a parent or guardian.
How to Prepare for Top Surgery
There are several preemptive steps you can take to ensure a smooth process and successful surgery recovery:
- Avoid drinking alcohol for at least 1 week before your surgery.
- Stop smoking at least 3 weeks prior to surgery. Smoking can significantly impair the healing process and increase the risk of complications.
- Review all your current medications with your surgeon. You may need to adjust your intake before and after the operation to avoid side effects.
- Arrange transportation for your trip home from the hospital.
- Focus on eating a balanced diet, getting plenty of rest, and staying active 2 weeks before the procedure.
The night before surgery:
- Shower with antibacterial soap and a chlorhexidine scrub to reduce the risk of infection.
- Stock your home with easy-to-reach light foods and beverages.
- Pack comfortable, loose clothing that zips or buttons in the front.
- Pack your compression garment or vest.
👨How long do you have to be on testosterone before top surgery? Most surgeons do not require transgender men to be on testosterone before undergoing FTM top surgery, as hormone therapy does not typically impact the surgical outcome directly. However, some recommend starting testosterone therapy 6-12 months prior to surgery to build up chest muscle.
👩How long do you have to be on estrogen before top surgery? Surgeons recommend undergoing estrogen therapy for at least 12 months before the procedure. Estrogen naturally encourages breast and nipple growth. This means that by the time you are ready for surgery, half the work is already done—your body has created a natural foundation for further enhancements.
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Top Surgery Process
Top surgery, whether for chest masculinization or feminization, typically follows these steps:
- Before the surgery begins, the surgeon will make precise marks on your chest. These marks ensure the final results are symmetrical and appear as natural as possible.
- You will receive anesthesia through an IV, which will allow you to sleep comfortably throughout the procedure.
- You’ll lie on a table with extra padding around your arms to keep you still and comfortable.
- After the surgery, you will wake up with stitches and dressings on your chest area. You’ll also wear a compression garment to help prevent bleeding and reduce swelling.
- Top surgery is typically performed as outpatient surgery, meaning you won’t need to stay in the hospital overnight.
⏳How long does top surgery take? Generally speaking, FTM/FTN surgeries last 1.5 to 4 hours, while MTF/MTN surgery usually takes 1-2 hours.
💢Does top surgery hurt? Thanks to general anesthesia, you won’t feel any pain during the surgery. Post-surgery, initial discomfort typically fades within the first few days. Pain can be managed with common over-the-counter pain medications like acetaminophen or ibuprofen.
Top Surgery Recovery
Top surgery recovery timeline: week by week
🗓️Day 1-2: These initial days can be the most uncomfortable as the anesthesia wears off. You'll be wearing a compression binder or surgical bra to keep the dressings in place, which can add to the discomfort.
🗓️Day 6-7: Around this time, you'll likely have your first post-op appointment to monitor healing. Your dressing will be removed for the first time, allowing you to see your new chest. You will also have to sleep on your back for at least a week to avoid putting any pressure on the surgery site.
🗓️Week 2-3: This is when swelling should start to decrease. Avoid lifting your hands above your head to reduce the risk of increasing scarring.
🗓️Week 6-8: By this point, most patients can resume physical activities like sports and heavy lifting as long as they feel comfortable.
🗓️Month 4-6: The swelling will subside completely.
💼Depending on the nature of your job, you may feel well enough to return to work 1-2 weeks after surgery. However, if your job is physically demanding, waiting up to 4 weeks will be wise.
💘Avoid sexual activity for 1-2 weeks and strenuous activities for 3-4 weeks.
🕺You can fully resume social activities within 10-14 days.
Top surgery aftercare
When you leave the hospital, follow your surgeon's recommendations and instructions closely. Here are some essential top surgery recovery tips:
- Hold off on showering until your first postoperative appointment; in the meantime, use baby wipes and sponge baths to stay clean.
- Manage swelling and pain with ice packs, which can significantly reduce inflammation.
- Don't lift anything heavier than a full laundry basket during the first several weeks of surgery recovery. Light exercises such as short walks are fine if they don’t increase your heart rate.
- Resting, eating well, and refraining from smoking or drinking are sure ways to speed up the recovery.
- Use over-the-counter scar treatments to help reduce tissue redness and visibility.
- Keep all dressings and drains in place until your doctor removes them during a follow-up. If you have drains, carefully follow your doctor's instructions on how to manage them.
Common questions
🏊♀️How long after top surgery can I swim?
You can resume swimming approximately 6 weeks after the surgery. Though you will have to protect your scars from sun exposure, or apply a strong sunscreen, for at least 6 months after surgery.
🚘How long after top surgery can I drive?
You can usually start driving again once you stop taking pain medications, can comfortably wear a seatbelt, and perform necessary driving maneuvers without pain. This will take about 2 weeks.
🍼Can you breastfeed after top surgery?
Female-to-male top surgeries involve the removal of most or all breast tissue, including the milk ducts and glands necessary for lactation. Therefore, breastfeeding after these procedures is typically not possible. This is an important consideration for those considering pregnancy in the future.
Top Surgery Risks and Complications
For FTM top surgery, possible risks and complications include:
- Scarring. Scars may take up to 18 months to mature.
- Hematoma. Accumulation of blood under the skin can form clots, leading to pain, swelling, and increased infection risk. Hematomas occur in about 1-2% of top surgeries.
- Seroma. Fluid buildup under the skin that can be managed with drains and compression garments.
- Infection. Rare but possible, potentially requiring antibiotics and drainage.
- Nipple graft breakdown. Movement of nipples can sometimes lead to tissue death and necessitate further surgery.
- Reduced nipple sensitivity. Possible numbness or tingling due to nerve damage; full sensation recovery is not guaranteed.
- Top surgery revision. In some cases, additional surgeries may be necessary to correct issues like "dog ears" — small amounts of skin and fat that protrude at the ends of the incision lines. Revision surgery aims to refine the chest contour and address any aesthetic concerns from the initial operation.
Risks and complications specific to MTF top surgery include:
- loss of nipple sensation;
- inconsistent or asymmetric appearance of the implant;
- implant deflation or rupture;
- movement of the implant from its original surgical placement.
🤔Is top surgery dangerous?
No, top surgery is a safe and low-risk procedure when performed by an experienced and skilled surgeon. Like all surgeries, it carries some risks, but it's not inherently more dangerous than similar procedures in cisgender individuals, such as mastectomies or breast augmentations. It's crucial to discuss your medical history, any prior reactions to anesthesia, and family health history with your surgeon to mitigate risks.
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Takeaways
- Top surgery is a form of sex reassignment surgery that modifies the chest to align with an individual's gender identity. It includes chest masculinization (removing breast tissue) and chest feminization (using implants to enhance the chest).
- The procedure has a 5 out of 5 satisfaction rate, significantly improving confidence, comfort, and perceived attractiveness.
- Multiple surgical options exist for chest masculinization, ranging from double incision surgery for larger chests to less invasive techniques, like keyhole surgery, for small breasts.
- Patients wishing to undergo chest feminization can choose between less expensive saline implants and more naturally-feeling silicone implants.
- Top surgery is an outpatient procedure conducted under general anesthesia.
- Preparation includes abstaining from alcohol and smoking, adjusting medications, and arranging for post-surgery needs such as transportation and easy-to-manage clothing.
- The surgery recovery period involves pain management, physical activity restrictions, and taking care of dressings and drains. Postoperative care is essential to minimize swelling and prevent complications such as hematoma, seroma, or infection.
- While generally safe, top surgery may require revision surgeries, such as correcting “dog ears” or addressing implant issues.
Related Articles
- JAMA Surgery. (2023). Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy. https://jamanetwork.com/journals/jamasurgery/article-abstract/2808129
- Plastic and Reconstructive Surgery. (2019). Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study. https://journals.lww.com/plasreconsurg/abstract/2019/01000/assessing_quality_of_life_and_patient_reported.51.aspx
- Johns Hopkins Medicine. Top Surgery (Chest Feminization or Chest Masculinization). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/top-surgery