Masculinizing surgery encompasses a range of procedures designed to align a person’s physical appearance with their gender identity. Among these, top surgery, or masculinizing chest surgery, is a significant step for many transgender men and non-binary individuals. Research indicates that gender-affirming surgeries, including top surgery, can substantially improve well-being and sexual function. This guide provides detailed information about top surgery, its various techniques, and what to expect.
Understanding Top Surgery
Top surgery aims to create a more typically male-contoured chest. It involves the removal of breast tissue and, in some cases, the reshaping or repositioning of the nipples. While not all individuals choose to undergo masculinizing surgeries due to factors like cost, potential risks, and the need for ongoing medical care, it’s a crucial procedure for those seeking congruence between their physical body and gender identity.
Why Consider Top Surgery?
Many individuals pursue masculinizing surgery as part of addressing gender dysphoria, the distress experienced when one’s gender identity differs from their sex assigned at birth. Top surgery can be a vital step in affirming one’s identity and enhancing their sense of self. However, the decision to undergo any surgery is personal, and everyone should make choices that best align with their individual needs and comfort levels.
Masculinizing surgery options, including top surgery, may involve:
- Surgical removal of breast tissue (Top Surgery): Creating a flatter, more masculine chest contour.
- Placement of pectoral implants: Augmenting the chest muscles for a more defined male appearance.
- Hysterectomy and/or Salpingo-oophorectomy: Removal of the uterus, cervix, fallopian tubes, and/or ovaries.
- Bottom Surgery: Procedures involving the vagina, scrotum, or penis.
- Body Contouring: Additional procedures to further masculinize the body shape.
Double incision mastectomy procedure to create a male-contoured chest.
Risks Associated with Top Surgery
Like all surgical procedures, top surgery carries potential risks, including:
- Bleeding
- Infection
- Adverse reactions to anesthesia
- Delayed wound healing
- Seroma (fluid accumulation under the skin)
- Hematoma (bruising)
- Changes in skin sensation (pain, tingling, numbness)
- Tissue necrosis (tissue death), particularly in the nipple area
- Blood clots (deep vein thrombosis or pulmonary embolism)
- Fistula (abnormal connection between body parts)
- Permanent scarring
- Loss of nipple sensation
Preparing for Top Surgery
Prior to surgery, thorough consultations with your surgical team are essential. This includes discussing your goals, the potential outcomes, and the specific surgical techniques available. The surgeon will also provide detailed instructions on how to prepare, which may include:
- Guidelines on eating and drinking
- Adjustments to medications
- Smoking cessation (including vaping and chewing tobacco)
Informed Consent
Due to the irreversible nature of top surgery, obtaining informed consent is crucial. This involves a comprehensive discussion of:
- Risks and benefits
- Costs
- Alternatives to surgery
- Expectations and goals
- Potential complications
- Impact on sexual function and fertility
Pre-Surgical Evaluation
A thorough medical evaluation is necessary to identify any underlying health conditions that could impact the surgery or your recovery. This evaluation might include:
- Review of medical history
- Physical examination
- Lab tests
- Review of hormone therapy
- Vaccination status
- Screening tests for various conditions
- Assessment of tobacco, drug, and alcohol use
- Discussion about birth control, fertility, and sexual function
A behavioral health evaluation by a professional specializing in transgender health may also be conducted to assess:
- Gender dysphoria
- Mental health concerns
- Sexual health concerns
- Impact of gender dysphoria on daily life
- Substance use
- Support system
- Treatment goals and expectations
- Post-operative care plan
Insurance Coverage
Coverage for masculinizing surgery varies significantly. Contact your insurance provider beforehand to understand your specific coverage.
Connecting with Others
Consider connecting with individuals who have undergone top surgery. Their experiences can provide valuable insights, help manage expectations, and offer support.
What to Expect During Top Surgery: Different Techniques
Several techniques are used in top surgery, and the most suitable approach depends on factors like chest size, skin elasticity, and individual goals.
1. Double Incision Mastectomy with Nipple Graft
This technique is often recommended for individuals with larger breasts. It involves:
- Incisions made above and below each breast.
- Removal of breast tissue and excess skin.
- Reshaping and repositioning of the nipples.
- Nipple grafts (reattaching the nipples in a more masculine position).
After this surgery, feeling in the nipples and areolas is not guaranteed.
Illustration of a Double Incision Top Surgery with Nipple Graft technique.
2. Subcutaneous Mastectomy with Nipple Preservation
This approach may be suitable for individuals with smaller chests and good skin elasticity. It involves:
- Incisions made under the breasts.
- Removal of breast tissue.
- Preservation of the nipples and areolas.
- Potential reshaping of the nipples.
- This method may preserve nipple sensation.
3. Periareolar Mastectomy (Keyhole)
This technique is often used for individuals with smaller breasts and minimal skin laxity. It involves:
- A small incision around the areola of each breast.
- Removal of breast tissue.
- Preservation of the nipples and areolas.
- This method may preserve nipple sensation.
Post-Operative Care
Following surgery, an overnight hospital stay may be necessary. Restrictions on upper body weight-bearing activities are typical for about six weeks. It’s important to follow your healthcare professional’s specific post-operative instructions carefully. After surgery, some breast tissue will still remain. Discuss breast cancer screenings with your doctor after surgery.
Genital Surgery (Bottom Surgery)
While the primary focus here is top surgery, it’s important to acknowledge other masculinizing surgical options, including:
Metoidioplasty
This procedure involves releasing the clitoris and potentially extending the urethra, resulting in a small, functional penis.
Phalloplasty
Phalloplasty creates a penis using skin grafts from other parts of the body. It often requires multiple stages and may include urethral lengthening, nerve grafting, and glansplasty.
Scrotoplasty
This procedure involves creating a scrotum using labial tissue and inserting testicular implants.
Positive Outcomes
Gender-affirming surgery, including top surgery, can significantly improve well-being and sexual function. Long-term health is best maintained by adhering to your healthcare professional’s advice for ongoing care and follow-up appointments. Talk with your healthcare team before surgery so you know what to expect after surgery.
Example of a typical post-operative result from Top Surgery, highlighting the masculine chest contour.
Conclusion
Top surgery is a transformative procedure that can significantly enhance the lives of transgender men and non-binary individuals seeking alignment between their bodies and their gender identities. By understanding the available techniques, potential risks, and the importance of thorough preparation and aftercare, individuals can make informed decisions and embark on this journey with confidence. Continued care after surgery is associated with good outcomes for long-term health.
