Top Surgery

An Overview of Top Surgery

Top surgery refers to alterations in the breasts for people going through gender reassignment surgery. For male to female (MTF) patients, this refers to breast augmentation. For female to male (FTM) patients, this refers to a mastectomy and/or other alterations to the chest to make it appear more masculine. Not every gender reassignment patient chooses to have top surgery, but many find it to be a necessary part of the aesthetic transformation into the gender with which they identify.

When it comes to breast implants, historically there have been three types used in top surgery: saline implants, silicone implants and implants filled with other substances, such as polypropylene string or soy oil. Today, though, only saline and silicone implants are manufactured.

Saline implants first were used as a prosthetic device in 1964, but today’s models have thicker shells that are composed of a room temperature vulcanized silicone elastomer shell. The upside of using saline implants is that the incisions for implantation are smaller. The surgeon inserts empty implants into small incisions in the breasts and then fills them with sterile saline solution while they are already inside. This leaves smaller incision scars after the procedure is over. Some modern saline implants do leak a small amount, but in the majority of cases, saline implants create a look similar to silicone implants, and they feel softer to the touch from the outside of the breast than silicone.

Today’s silicone gel implants do not have the degree of leakage risk that led to warnings from the U.S. Food and Drug Administration that had made earlier generations harder for American patients to acquire. The semi-solid gel used in modern implants generally eliminates the possibility of leakage — or of silicone moving from the implants to other parts of the body. The silicone implant does feel harder inside the breast, but it also retains its shape longer as time goes by.

Hormone replacement therapy alone only produces breast growth in trans women to about one or two cup sizes smaller than the patient’s female relatives, such as a sister or mother. For those who desire a larger chest, the practitioners listed on provide this form of top surgery to many clients each year and can provide you with the best advice for your personal situation.

For FTM patients, there are two common types of top surgery: mastectomy, to remove the breasts, and male chest reconstruction, which provides the chest with an appearance more like that of a biological man. In trans men, male chest reconstruction generally comes before genital surgery because breast contours that protrude are one of the secondary sexual characteristics of a woman. For FTM patients who have naturally small breasts, simply removing some skin around the areolas is all that is necessary. However, in patients with larger breasts, a common surgery is the keyhole procedure. This involves removing the fatty and glandular tissue that makes up the mass of the breast as well as the additional skin on top of it. In some cases, areola grafts are used to make a nipple that looks more masculine.

When FTM patients choose mastectomy as part of their top surgery, the whole breast tissue generally comes out. The decision to remove fatty tissue and lymph nodes depends on aesthetics — as well as a family history of breast cancer. However, the pectoral muscles remain in place, as those are necessary to retain a masculine appearance. In most cases, the surgeon operates subcutaneously in order to spare the nipple. Even if a graft is later necessary, having the existing nipple in place to work with makes the process less invasive and more likely to be a success.

For many gender reassignment patients (both FTM and MTF), the practitioners at have provided top surgery services that have been aesthetically pleasing. The chest area — for both men and women — is an important part of their appearance, and getting the best care in this area is a crucial part of physically transforming into the sexual identity that patients have felt all their lives — but are just now getting to experience.

For more information, click here to search for a top surgery doctor.