About Top Surgery

Top surgery is the common name for patients seeking chest surgery to align their appearance with their gender identity.  

1. Transmale patients typically undergo chest masculinization surgery with mastectomies through a scar that is either aligned with the bottom edge of the pectoralis muscle (“double incision”) or around the areola (“keyhole”).  Free nipple grafting or contouring with liposuction may be added to improve the results.

2. Transfemale patients typically undergo chest feminization surgery with breast augmentation using implants or fat grafting.

Frequently Asked Questions

Am I a good candidate for top surgery?

All patients must meet the WPATH criteria for top surgery.  I prefer that patients have a letter from a therapist with whom they have a longstanding relationship to increase the chances of satisfaction with surgery and to ensure that other mental health issues such as anxiety or depression are properly managed prior to undergoing surgery.  The best candidates are non-smokers and at a healthy weight, as these patients have lower risks for surgical complications.

How can I reduce the scars after top surgery?

All surgeries will result in scars.  I try to reduce the visibility of scars by placing them in the natural location of the body’s shadows.  I recommend that patients use silicone scar treatment after surgery to reduce scarring.  Some patients may require additional treatments such as steroid injections to decrease scarring after top surgery.

Can I use my arms after top surgery?

Yes, I allow my patients to use their arms for most normal activities immediately after top surgery.  You will have your activities limited to no strenuous exertion and no lifting more than 10 pounds for approximately 4 weeks after surgery.

Will I have drains after top surgery?

Patients who have periareolar or “keyhole” mastectomy surgery will have drains for about 1 week after surgery.  Patients who have double incision mastectomy surgery may opt not to have drains if they wish (this makes recovery much easier).  Patients who have augmentation with implants or fat grafting will not have drains. 

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