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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Roughly one and a half million people identify as transgender in the United States. Thankfully, there are many ways for a person to align their body with their internal self-image, and medical treatments, including hormone therapy and surgeries, are becoming increasingly common (Cohen, 2019).
Studies of transgender people who have undergone gender-affirming surgeries have shown that surgical transition was important to their quality of life. Respondents all agreed that they were happy with their decision to undergo gender reassignment surgery (El-Hadi, 2018).
Gender confirmation surgeries are typically divided into “top surgeries” and “bottom surgeries.” This article will explore top surgery—what it is, different types, cost, and recovery.
What is top surgery?
Top surgery refers to the plastic surgical procedures performed on the chest to give a person a look that matches their gender identity. These can include masculine, feminine, or nonbinary looks. Not every transgender person wants to undergo surgery, but it is a powerful option that can greatly improve self-esteem and quality of life for those who do.
Having your chest match your gender identity can help relieve feelings of gender dysphoria. After having top surgery, transgender people often report feeling more comfortable with their sex partners, in healthcare settings, swimming pools, or the gym (WPATH, 2012).
Some medical reasons would prevent someone from having top surgery. These are similar to reasons that might prevent any type of plastic surgery and include (Hohman, 2021):
- Serious heart or lung disease
- Bleeding disorders
- Uncontrolled diabetes
- Untreated body dysmorphic disorder
- Current suicidal thoughts
If you smoke, it’s best to quit before undergoing surgery of any kind, and top surgery is no exception. Smoking causes problems with wound healing for all types of surgeries. In addition, smoking and taking estrogen therapy can increase your risk of blood clots, a risk that goes up when you are in bed recovering from surgery (Hohman, 2021).
What types of top surgery are there?
The World Professional Association for Transgender Health recommends the following criteria for anyone seeking top surgery (WPATH, 2012):
- Persistent, well-documented gender dysphoria
- Capacity to make a fully informed decision and to consent to treatment
- Age of majority (when the law recognizes a person as an adult)
- If significant medical or mental health concerns are present, they must be reasonably well-controlled.
Hormone therapy isn’t required but is recommended by some providers. It is also recommended that the person seeking surgery has lived in their desired gender role for at least a year before surgery. Counseling and social support are also strongly recommended (Garg, 2021).
The exact type of surgery you select will depend on your personal needs and goals (Hohman, 2021).
What is dysphoria? How is it related to gender dysphoria?
Female to male top (FTM) surgery
For transmasculine people, chest masculinizing surgery involves a subcutaneous mastectomy and male chest contouring. This surgical procedure involves removing the breast tissue and having chest reconstruction to create the desired look (Goethals, 2021).
Some excess skin may also need to be removed depending on the amount of breast tissue removed during FTM surgery. This can leave scarring, often called “double incision” scars. Your plastic surgeon can work with you to help minimize the amount of scarring and help you achieve the look you desire (WPATH, 2012).
Male to female top (MTF) surgery
For people transitioning from male to female, breast augmentation is the most common type of top surgery. This is a surgical procedure where the breast size is enhanced using an implant. Sometimes, the surgeon will transfer fat from other parts of the body to achieve an aesthetically pleasing contour. It is one of the most common plastic surgery procedures in the US (Garg, 2021; Fardo, 2021).
Although not required, it is recommended that anyone wanting MTF top surgery undergo a minimum of 12 months of hormone therapy prior to surgery. This will maximize natural breast tissue growth and better-looking results after surgery (WPATH, 2012).
Nonbinary top surgery
Nonbinary individuals don’t identify as exclusively male or female. Some nonbinary people also seek out chest surgery, particularly female to nonbinary persons. The surgical options are similar to FTM surgeries, but some nonbinary people may have different aesthetic goals. They may desire a result that doesn’t fully resemble a typical male or female chest.
A surgeon familiar with nonbinary top surgery can discuss options with you such as:
- Changes in the placement of incisions
- Contours that leave more chest tissue behind
- Changes in the areola, periareolar area, or nipples
- Changes in nipple placement or removal of nipples
Female to male transition: what is it, process, hormone therapy vs. surgery
How much does top surgery cost?
Like all surgeries, the exact cost of top surgery will depend on the procedures done, your location, and your insurance plan coverage.
Your total cost will include charges for the surgeon, the anesthesiologist, and the hospital stay. In general, you can expect total costs of $5,000 to $10,900 for FTM top surgery and $6,500 to $9,000 for MTF top surgery (Leis, 2022-a; Leis, 2022-b).
Your insurance might require specific criteria and documentation before covering all or part of your top surgery. Your healthcare provider can help you estimate these charges and navigate insurance coverage.
What is top surgery recovery like?
Most people tolerate top surgery very well and have few side effects. The recovery period depends on the procedures done, but most people return to light activities in a week or so and full activities within six weeks (Goethals, 2021; Fardo, 2021)
You may have surgical drains placed after top surgery. This helps prevent any fluid build-up and allows the surgical site to heal better. Your provider will show you how to care for these drains and record the amount of fluid they put out to track the progress of your healing (Goethals, 2021).
You will also likely have some restrictions on your activities immediately after surgery. These can include limits on driving, lifting objects, or other physical activities until your surgical sites start to heal. How long these restrictions last will depend on your procedures and how well your body is healing (Goethals, 2021).
The risk of complications from top surgery is low and is similar to any other major surgery. Some potential complications that you should be aware of include (Fardo, 2021):
- Fluid build-up
- Nipple sensation changes
Your surgeon will make you aware of these risks ahead of time and help you manage or prevent them.
Male to female transition: what is it, process, hormone therapy vs. surgery
Talking to your healthcare provider
The first step to having top surgery is finding a healthcare provider educated in transgender care. This can sometimes be difficult outside of urban areas, but you can ask friends for recommendations or search online for providers close to your area (Hohman, 2021).
Having gender-affirming surgery will usually involve meeting with an interdisciplinary team, including medical providers, mental health providers, and a surgeon specializing in plastic and reconstructive surgery. This team will support you and help you gather the required documentation for insurance coverage (Hohman, 2021).
Your surgeon will discuss the following with you (Hohman, 2021):
- Your goals for surgery
- Reasonable expectations for results
- What to expect before, during, and after surgery
- The risks of general anesthesia
- How to avoid surgical complications
With a supportive care team, you can ensure you get the results you want from your top surgery and can move forward with a body aligned with your self-image.
- Cohen, W. A., Sangalang, A. M., Dalena, M. M., Ayyala, H. S., & Keith, J. D. (2019). Navigating insurance policies in the United States for gender-affirming surgery. Plastic and Reconstructive Surgery. Global Open, 7(12), e2564. doi: 10.1097/GOX.0000000000002564. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288898/
- El-Hadi, H., Stone, J., Temple-Oberle, C., & Harrop, A. R. (2018). Gender-affirming surgery for transgender individuals: perceived satisfaction and barriers to care. Plastic Surgery (Oakville, Ont.), 26(4), 263–268. doi: 10.1177/2292550318767437. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236505/
- Fardo, D., Sequeira Campos, M., & Pensler, J. M. (2021). Breast augmentation. [Updated Oct 1, 2021]. In: StatPearls [Internet]. Retrieved on Jan. 31, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK482206/
- Garg, G., Elshimy, G., & Marwaha, R. (2021). Gender dysphoria. [Updated Jul 20, 2021]. In: StatPearls [Internet]. Retrieved on Jan. 31, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK532313/
- Goethals, A. & Rose, J. (2021). Mastectomy. [Updated Jul 31, 2021]. In: StatPearls [Internet]. Retrieved on Jan. 31, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK538212/
- Hohman, M. H. & Teixeira, J. (2021). Transgender surgery of the head and neck. [Updated Oct 18, 2021]. In: StatPearls [Internet]. Retrieved on Jan. 31, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK568729/
- Leis, S.-a. (2022). Male to female price list. The Philadelphia Center for Transgender Surgery. Retrieved on Jan. 31, 2022 from http://www.thetransgendercenter.com/index.php/maletofemale1/mtf-price-list.html
- Leis, S.-b. (2022). Female to male price list. The Philadelphia Center for Transgender Surgery. Retrieved on Jan. 31, 2022 from http://www.thetransgendercenter.com/index.php/femaletomale1/ftm-price-list.html
- WPATH. (2012). Standards of care for the health of transsexual, transgender, and gender- nonconforming people, version 7. World Professional Association for Transgender Health. Retrieved from https://www.wpath.org/publications/soc
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.