What Is Top Surgery For Transgender

For many trans women, the top surgery — removal of the breasts through an incision at the base of the neck where the collarbone meets the shoulders — is often considered the most important surgical step they’ll ever take in their lives. The reason? It can make it possible for them to pass as cisgender when out in public without wearing a prosthetic bra. This is especially true if they intend to transition with facial hair, which requires a more pronounced bust line.

“The main goal of top surgery is to create a male-looking cleavage,” says Dr. Nicole Maines, medical director of gender services for Mount Sinai Health System in New York City. “It allows you to have your chest look like a man’s chest.”

Breast implants don’t provide that effect because the implant itself creates a flat surface. To achieve the illusion of a cleavage, surgeons will need to go under the skin and cut away fat and connective tissues. They may even need to reshape the nipple and areola.

In order to perform this kind of surgery on someone who hasn’t had any prior surgeries, there needs to be enough room between the clavicle and the first rib for access to both sides of the chest cavity. Surgeons usually do what’s known as a subclavicular approach. This involves making a small vertical incision just below the clavicle and then cutting down underneath the pectoral muscles toward the nipples. From there, they can use curved scissors to separate the fatty tissue from the muscle, eventually working their way around to the other side of the body. There, they can excise the mammary glands using a scalpel. They can also lift up the skin flap using sutures. When all the tissue has been removed, the surgeon can stitch the flaps back together. Finally, he or she can place drains near the area to keep the wound clean.

But not every person who wants to undergo top surgery is interested in passing as a man. Some want to enhance their existing female features, while others simply wish to increase their self-esteem or improve how they feel about themselves. While some trans women choose to pursue top surgery only after they’ve begun hormone therapy, others decide to get it done before starting HRT.

To help patients understand why they might want to have this surgery, doctors recommend asking questions such as these:

Why did you come to see me?
How long have you felt you looked feminine since childhood?
Do you think you’d be happier if you were closer to your authentic gender expression?
Are you looking for a surgical option that doesn’t involve taking hormones?

Most trans women seeking top surgery start by seeing a plastic surgeon, but some opt instead to work with a cosmetic surgeon. Both types of physicians typically offer similar procedures, though each one specializes in specific areas of medicine.

Plastic surgeons tend to focus on reconstructing the external appearance of the breasts. A common technique is to use implants made of silicone gel filled with water. These implants are placed beneath the chest skin and gradually inflated through special valves. As the breasts grow bigger over time, additional layers of skin are added to give the breast form and contour.

Cosmetic surgeons, on the other hand, generally deal with those whose bodies aren’t going to respond well to traditional methods of augmentation. In this case, they’re more likely to use liposuction to reduce fat from the abdomen and thighs so that the patient looks proportionally larger. Then they’ll fill in the new space created by removing fat with injectable collagen. Once the breasts are enlarged, surgeons will shape them into a more natural state using dermal filler.

Surgery isn’t right for everyone; here are some things to consider before deciding whether to go ahead with it.

Transitioning With Top Surgery
While top surgery can help some trans women pass in public, it’s not always necessary. Not every trans woman feels comfortable walking down the street while showing her chest, and some prefer to avoid doing so altogether. Others simply aren’t ready to fully accept their true selves yet. If you’re one of these people, you should talk to a therapist about the best ways to move forward.
Also, while it can definitely boost confidence, top surgery won’t necessarily change your overall sense of identity. Instead, it can serve as a stepping stone toward becoming fully transitioned. Ultimately, you still need to find a way to embrace yourself without having to show off your body parts.
If you plan to have top surgery, it’s important to discuss with your doctor how long you expect it to take for you to begin noticing results. Typically, this process takes somewhere between six months and two years, depending on the individual.

Finally, if you’re considering top surgery because you hope to start transitioning soon, there are a few things you should know. First, it’s not advisable to have top surgery if you haven’t started Hormone Replacement Therapy (HRT) yet. Second, getting top surgery alone doesn’t mean you’ll automatically pass as a man. And third, no matter what you decide to do, it’s never too late to change your mind.
Nonbinary individuals who desire a masculine look but don’t identify strongly as either male or female can sometimes benefit from top surgery. However, this decision needs to be carefully thought through. People with less developed chests may struggle to wear bras and tops comfortably once they’ve undergone the procedure. Also, while this type of surgery does allow for full visibility of the body, it doesn’t address concerns regarding certain secondary sex characteristics.

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