Top Surgery
Illustration by Samuel Luke Art
This procedure can result in decreased nipple sensation and significant scarring but these usually fade over time. It usually takes between 2 to 3 hours and the result is a flat chest with a horizontal scar on each side of the chest.
There is the option to do this procedure without the nipple grafts. The area can simply be stitched up and left bare, or followed by tattooing.
Periareolar Top Surgery (mastopexy where tissue is removed and tightened)
Also known as circumareolar top surgery, this procedure is usually recommended for people with small to medium sized breasts. It involves removing a doughnut-shaped piece of skin from around the areola, making an incision and removing chest tissue. The surgeon will then close the skin to bring the outer circle down to the diameter of the inner circle.
This can sometimes create a pleating affect around the areola because of the mismatch between the large circle and small circle. The pleating usually goes away a few weeks after surgery.
The result is a flatter appearing areola with minimal scarring around it. This procedure usually takes between 2 to 3 hours to complete.
Risks
FTM top surgery is a relatively safe surgery, but like all major surgeries there are some risks that people should be aware. Risks of infection, reactions to anaesthetic, bruising, bleeding and reactions to dressings may occur. These will all be managed for the individual to ensure the best outcome possible.
Recovery and Follow up care
The recovery process is focussed on ensuring you have the best long term outcome after this surgery. This means returning you to normal mobility of your upper body and minimising the visibility of surgical scars. You will be seen in hospital by a physiotherapist who will explain to you a range of exercises to graduate through as you heal from surgery. I will provide you with close management of your surgical incisions and will provide an individualised recommendation on dressings based on the surgery you underwent and your skin type. You can read more about wound care here.
For my patients, top surgery has supported them to live their most authentic lives. All trans and non-binary people deserve to look in the mirror and love who they are. I feel lucky to be a part of my patients journeys to self-love.
Dr Heidi Peverill, Specialist Breast, Melanoma & General Surgeon performs top surgery at Pindara Private Hospital.
More information
The gift of a lifetime: how trans 'top surgery' changed my life
I provide Top Surgery at Pindara Private Hospital.
‘Female-to-male (FTM) Top surgery’ or ‘reconstructive chest surgery’ is a safe and effective surgery that trans people, presumed female at birth, may choose to affirm their gender.
Type of top surgery, cost, risks, and benefits vary depending on the patient, their body and their goals. If you are considering top surgery, for best results I recommend seeing a specialist breast surgeon or plastic surgeon who has experience with gender-affirming surgeries. They should work with you to understand your goals, your body, and the best procedure for you.
Before you meet with your surgeon, you will usually need to be referred by your GP, seen at gender clinic and approved for surgery by psychiatrist as part of a collaborative decision. Once you have gone through this process, you can explore with your surgeon the type of top surgery that will work for you. I go through some of the options I provide to my patients on the Gold Coast below.
Options for FTM Top Surgery
Double incision Top Surgery with nipple grafts (mastectomy and nipple graft)
A mastectomy and nipple graft is usually recommended for people with larger chests and bodies. During this surgery, chest tissue and excess skin are removed, the nipples are removed and reduced in size, and then they are repositioned on the chest. This creates a masculine appearing chest.