A growing number of transgender and nonbinary Americans are taking the next step in affirming their identity by seeking chest contouring surgery, or top surgery.
Top surgery for nonbinary patients can fall along any gender spectrum and is driven by a patient’s goals. Depending on these goals, top surgery can be used to feminize or masculinize the chest. One form of top surgery, gender-affirming mastectomies, typically involve the removal of breast tissue and the reconstruction of a patient’s chest to give a more masculine appearance. Augmentation top surgery typically includes the use of breast implants to give a more female appearance.
All of these surgeries can help ease the anguish a person feels due to a mismatch between their gender identity and their sex assigned at birth, also known as gender incongruence.
“Affirming surgery is just that – affirmation of the person and their identity. This is deeply satisfying work; it eases the patient’s distress with their own body,” says Brodie Parent, MD, MS, a reconstructive plastic surgeon at UPMC Passavant–McCandless and UPMC Passavant–Cranberry.
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Who Qualifies for Top Surgery?
Generally, board-certified plastic and reconstructive surgeons will consider this procedure for people who meet three requirements, including:
- Be at least 18 years old or have legal guardian consent.
- Have been diagnosed with gender incongruence.
- Provide a letter of support from a mental health provider, according to the American Society of Plastic Surgeons.
Providers may request that patients undergo lab testing and medical evaluations, as well as stop taking certain medications and stop smoking before this surgery. Your surgeon may also recommend waiting one year after beginning gender-affirming hormone therapy to move forward with top surgery to promote the best results.
What To Expect During Top Surgery
Gender-affirming mastectomy is usually an outpatient procedure performed under general anesthesia. It may take between two to four hours to perform, depending on the size of the patient’s chest and desired results.
For those with less chest tissue to remove, Dr. Parent often offers a “keyhole” mastectomy, or a periareolar mastectomy, during which he makes incisions around the nipple to remove most of the breast gland. The benefits of a keyhole mastectomy include a limited incision that minimizes potential scarring and maintains sensation to the nipple. It does, however, limit the surgeon’s ability to fully contour the chest, he says.
In other patients with more tissue, Dr. Parent performs what’s traditionally described as a double-incision mastectomy with a free nipple graft. Here, the surgeon contours the chest to create a more masculine look by removing the nipple and grafting it in a higher location.
Gender-affirming augmentation is also an outpatient procedure performed under general anesthesia, taking between two to three hours to perform. Dr. Parent typically performs augmentation with silicone or saline implants through a small incision under the breast.
Top Surgery Risks and Recovery
As with most procedures, top surgery complications are rare but possible. According to the American Society of Plastic Surgeons, risks include:
- Damaged body tissue, including nearby nerves.
- Excess tissue or poor contour or indentation.
- Fluid buildup.
- Inability to breast feed.
- Negative reaction to anesthesia.
- Poor healing or scarring.
- Poor nipple position.
Dr. Parent says patients rarely have serious complications or are unhappy with their results. He does offer revision surgeries for those who are displeased with their results from a past provider.
“Revision surgeries for chest surgery are usually related to poor nipple positioning, a failed nipple graft, prominent scar, or extra tissue,” Dr. Parent says. “These revision surgeries are generally rare.”
The recovery time for chest surgery is generally four to six weeks. During that time, patients are advised to avoid lifting more than five pounds in order to protect the sutures. After that, patients can usually return to their normal lifestyles, as long as they have no complications or wound healing issues.
Top surgery patients should not expect to see final results for at least four to six months, and some may need to wait as long as one year before their skin fully smooths and softens, according to Dr. Parent.
“Patients should wait before they judge the results,” he says. “After the procedure, there is a lot of redness and swelling, and it can take time for the skin to heal. The scar remodels pretty dramatically – especially in the first three months – but it can take time.”
To schedule an appointment with Dr. Parent, call 412-367-8998.
About Plastic Surgery
Plastic surgery is an option for both cosmetic and reconstructive needs, and the UPMC Department of Plastic Surgery can help with both. Whatever improvement you seek, we can create an individualized treatment plan to help you achieve your desired results. Through our research and clinical trials, we have used cutting-edge techniques in our treatments for more than 70 years. We also have one of the largest academic plastic surgery departments in the United States and operate one of the region’s top centers for restorative medicine.
Plastic surgery is an option for both cosmetic and reconstructive needs. The UPMC Department of Plastic Surgery can help with both. We will work with you to create an individualized treatment plan to help you achieve your desired results. Through our research and clinical trials, we have used cutting-edge techniques in our treatments for more than 70 years. We also have one of the largest academic plastic surgery departments in the United States and operate one of the region’s top centers for restorative medicine. Our goal is to improve your quality of life. Find a provider near you.