Top Surgery for

Gender Non-Binary Patients

 “Top surgery” or bilateral mastectomy with chest wall recontouring and nipple and areolar reconstruction is a procedure designed to remove breast tissue and reshape the nipple and areola in order to create a flattened chest appearance. Many non-binary patients do not choose to go on hormonal therapy, so top surgery may be the only medical intervention for their transition. Patients who opt for bilateral mastectomy can expect to experience a number of benefits, including a greater congruence between their outside appearance and experienced gender, improved self-esteem and self-image.

Before and After Photos of Top Surgery for Gender Non-Binary Patients

Top Surgery Procedure for Gender Non-Binary Patients

There are a number of surgical techniques that may be utilized to accomplish the desired breast tissue removal. The surgery procedure that will yield the best results needs to be customized for the patient based on many factors.  The amount of breast tissue, the degree of breast skin droop, the quality of breast skin, and your chest width - all need to be assessed.  Based on those factors as well as the patient's specific desires, a plan is made for top surgery.  For non-binary patients, we discuss explicitly their desires for shape, location and size of nipple and areola, as many non-binary patients do not desire the typical male placement of nipples but prefer a more typically female position.  Your surgical plan is customized and planned to achieve the desired chest appearance you have been wanting.

 

The most common technique is called a bilateral mastectomy with a double incision.  In this procedure the mastectomy (removal of the breast tissue) is performed through an incision that lies in the fold underneath the pectoralis major muscle in the horizontal direction.  The nipple is then reconstructed and the areola is resized and shaped and placed around the nipple. This technique allows for the removal of essentially all of the breast tissue (including milk ducts) and excess skin, along with proper placement and downsizing of the nipples. This technique is utilized most frequently because the majority of patients have a combination of excess skin and a naturally low nipple position.  

The peri-areolar, technique consists of breast tissue removal through a small incision around the nipple. This technique carries the advantage of significantly reduced scarring. However, a relatively small number of patients are considered good candidates for this procedure. The suitable candidate for this type of mastectomy is typically the young, slim patient with a small amount of breast tissue, no excess skin, and a nipple position that does not require major modification. 

Some patients have inquired about the possibility of using a “pedicled” technique to preserve sensation to the nipple; however, this technique has to leave a significant amount of breast tissue to preserve the nerves and usually results in some fullness that can still look like a breast.  

Patients who have a very large amount of breast tissue or chest wall fat tissue may benefit from combining lateral chest wall liposuction with their mastectomy. The decision as to whether or not this is needed can be  made at the time of the consultation.

Who is a Candidate for Top Surgery?

Candidates have a strong desire for top surgery and have seen a mental health professional who has given them the diagnosis of gender dysphoria.  Candidates do not need to be taking hormones.  Ideal candidate are in good, health, are non-smokers and near their ideal weight.  They should have support, both emotional and physical, for the post op care.

Post Surgery Recovery 

A special dressing stays on the nipple graft for 5- 7 days for the double incision procedure and drainage tubes. Peri-areolar patients have drains but no special dressing and may shower post op day 2. Postoperative discomfort is typically mild to moderate and is controlled by pain medication. Arm use should be restricted during the first week. This includes driving, lifting, or reaching. At one week, normal daily activities may be resumed; vigorous exercise and weight-lifting can start again at 3-6 weeks post-surgery. Scars are permanent, but they should fade gradually over the first year after surgery.  Dr. Hazen will develop both a post op scar and exercise routine to maximize your results.

Why Choose Dr. Hazen

Dr. Hazen is considered an expert in top surgery and has particular expertise and interest in non-binary patients.  Her staff makes you feel safe, respected and cared for.  Her technique allows for customizing your desires for chest wall re-contouring rather than a generic procedure.

What to Expect From Your Consultation

Dr. Hazen takes a detailed history of any medical issues and conditions, including hospitalizations and medications taken.  A physical exam is performed. Your goals and desires for surgery are explored and Dr. Hazen gives a comprehensive explanation of the surgical procedures that are possible for you, including complications and risks.  She describes your individual recovery process. Now you have the option to take your pre-operative photos (saves a visit).  Dr. Hazen and you may explore any issues that are blocking or interfering with the surgery actually happening, including anxieties around it.  Then a plan is made with a time line.  Should your procedure not be covered by insurance, you receive an estimated cost for the surgery and anesthesia.