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What Is a Top Surgery for Transgender People?

Medically Reviewed by Dan Brennan, MD on April 15, 2021

Transgender people, whose gender identity doesn't match their bodies, may be uncomfortable with the body they were born with. So, they may want to change their appearance to affirm their identity.

Some trans people use clothing and make-up to look the way they want, whereas others opt for plastic surgery, as part of gender reassignment, for a more complete change.

Top surgery is one such surgery. Here, the size of breasts is changed. These operations are among the most common gender-confirming or gender-reassignment procedures. This type of surgery is generally safe and can be performed by qualified plastic surgeons. Trans people who get top surgery say it has a positive effect on their quality of life.

Let’s learn more about top surgery and how it works.

What Does Transgender Mean?

People use the word transgender to describe people whose gender identity or gender expression doesn't match the sex they were assigned at birth. Doctors and parents usually look at a new baby's genitals and assume what their gender is.

While that's typically correct, in some cases, people grow up and realize that their sense of gender identity isn't aligned with how their bodies look. These people are called transgender.

Some trans people identify as the opposite gender of what they were assigned at birth. For example, a child assigned female at birth may self-identify as male. Other people identify as "non-binary" or "genderqueer," meaning that they don't feel exactly male or female.

The sense of your body not matching your gender identity is also known as gender dysphoria.

Gender expression has to do with styling your outward appearance to align with your internal sense of identity. In many cases, trans people pick their clothing, hairstyles, or make-up to express how they feel inside.

Other trans people might use hormone therapy to refine their secondary sex characteristics or choose surgery that can change their bodies and faces permanently.

What Is Top Surgery?

Top surgery is a general term to describe an operation that changes the look of a trans person's chest.

Because breasts are associated with female bodies, trans men or people who were assigned to be female at birth might want to have their breasts removed or significantly reduced in size. On the other hand, trans women or people who were assigned to be male at birth but identify as more feminine can choose to have breast augmentation surgery to create a fuller figure.

Transmasculine top surgery. ‌Transmasculine top surgery is an operation to make the chest look more masculine. The operation involved here is called mastectomy, where the breast tissue is removed. It's the same procedure doctors might recommend for treating breast cancer.

‌‌The surgeon will resize the breasts and remove any excess skin to make a flatter contour to the chest. The doctor might make changes to the size and placement of the nipple and areola as part of the operation.

‌‌Some trans men also get contouring procedures such as liposuction to refine the look of the whole torso area.

Transfeminine top surgery.‌ Surgery to increase the size of the breasts is called transfeminine top surgery. In many cases, this procedure is a lot like surgery for breast augmentation or reconstruction after breast cancer. Doctors use breast implants and insert them under the skin through an incision (i.e., a cut) on the chest.

Some people choose to have fat grafting instead of implants or in addition to implants. Doctors take fat tissue from other parts of the body and inject it into the breast area to help create the desired look.

Other Considerations About Top Surgery

Talk to your doctor about the recovery from top surgery. You will need follow-up care in the weeks after the operation. You may also need someone to help you around the house, and you may not be able to drive for a few days.

Top surgery is major surgery, so it's important to discuss your health with your doctor. If you have other health conditions that make treatment unsafe, you might have to delay top surgery. Your doctor can help you decide when the best time for surgery will be.

Who Can Have Top Surgery?

Many doctors who offer top surgery follow the World Professional Association of Transgender Health (WPATH) standards of care criteria. Your surgeon may ask you to demonstrate that you:

  • Have well-documented gender dysphoria
  • Have the capacity to make a fully informed decision and to consent to treatment
  • Be of legal age to make health care decisions
  • Have other health conditions well-controlled
  • Undergo appropriate hormone therapy for your gender goals

Some insurance plans cover top surgery as part of transgender care. In other cases, you will have to pay for the procedure out of pocket. Call your insurer to find out what costs they will cover.

WebMD Medical Reference

Sources

SOURCES:

American Psychological Association: "What does transgender mean?"

Human Rights Campaign: "Finding Insurance for Transgender-Related Healthcare."

Mayo Clinic: "Top surgery for transgender men."

Plastic and Reconstructive Surgery: "Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study."

UCSF Transgender Care: "Breast Augmentation,"  "Masculinizing Chest Reconstruction ('Top Surgery')."‌

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