Top surgery, or masculinising chest surgery, is the most commonly requested procedure among trans men. The chest is often one of the biggest sources of dysphoria, especially during social transition. Many trans men wear tight compression garments to flatten the chest, which can cause discomfort or even pain. However, these garments are not a permanent solution and can become an obstacle when wanting to go to the gym, swim, or wear fitted clothing.
Until a few years ago, national and international health systems often required a specific period of hormone treatment and/or legal adulthood to access top surgery. Nowadays, the approach is more flexible: emotional distress and gender dysphoria are prioritised over hormone duration or age. This is important because subcutaneous bilateral mastectomy is not an overly invasive surgery, yet it significantly improves the emotional and social quality of life for trans men.
Top Surgery Techniques for Trans Men
There are various surgical procedures, but they can be summarised into three main techniques:
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Areolar incision mastectomy
A small incision is made along the areola’s natural colour change, usually from 4–5 o’clock to 7–8 o’clock on a clock face. The breast gland is completely removed, and a masculine chest is sculpted. This method is suitable when no skin needs to be removed.
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Periareolar incision mastectomy
The incision is made around the entire areola to remove both the gland and a small amount of skin. It’s recommended when the skin is elastic enough to retract naturally, typically in younger patients. The scar is concealed in the areola’s colour transition.
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Standard mastectomy technique
This approach is used when the chest is more developed or larger. A horizontal incision is made based on the amount of gland and skin to remove. The nipple and areola are then resized and repositioned higher and more laterally to achieve a masculine appearance, near the edge of the pectoralis major.
In all cases, the aim is to keep the scars as discreet as possible to avoid visible stigmatisation. You can have a look at before-and-after results of top surgery performed by the IM GENDER team.This approach is used when the chest is more developed or larger. A horizontal incision is made based on the amount of gland and skin to remove. The nipple and areola are then resized and repositioned higher and more laterally to achieve a masculine appearance, near the edge of the pectoralis major.
In all cases, the aim is to keep the scars as discreet as possible to avoid visible stigmatisation. You can have a look at before-and-after results of top surgery performed by the IM GENDER team.
Recovery After Top Surgery
Depending on the technique used, the surgery lasts approximately 2 to 3 hours. Usually 1 or 2 nights in the hospital are required. Recovery typically takes one week, and patients must wear a compression vest for 2–3 weeks to help tissue adhesion. If liposuction is performed in combination, the patient may have to use compression wear for up to a month.
What Does Top Surgery Achieve for Trans Men?
Top surgery goes beyond removing breast tissue. The true goal is to masculinise the entire chest. The plastic surgeon must not only execute the removal with precision but also have an artistic eye and deep knowledge of sexual dimorphism to design a truly masculine chest. For example:
- Male areolas and nipples are smaller than female ones.
- They are positioned higher and more laterally.
A good surgeon considers all of these elements to achieve optimal results.
Additional Techniques for Chest Masculinisation
Sometimes, secondary procedures are needed for enhanced masculinisation:
- Liposuction to define the abdomen and chest areas, enhancing muscular contours. This is often done during the same surgery.
- Pectoral implants for trans men who want more muscle definition than they can naturally achieve through exercise.
Whether or not secondary techniques are used, the main objective is a chest that allows the trans man to feel comfortable, confident, and free in his private and social life.
Do you have questions about female to male top surgery?
You can request a first consultation or contact the IM GENDER team for further information.