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Non-Binary Surgery Options: What’s Right For You?

Medically reviewed by Jennifer Richman on December 8, 2025.

Gender-affirming surgery for non-binary patients offers a tailored approach to help patients experience greater gender alignment with their bodies. Not all non-binary people need surgery to affirm their gender. Similarly, not all non-binary people experience gender dysphoria because of their body.

Unlike male-to-female (MTF) or female-to-male transitions (FTM), non-binary surgery recognizes that many people may not fit into traditional gender categories. With options like top surgery, facial surgery, body contouring and bottom surgery, non-binary individuals can consult with a board-certified provider to create a unique surgical plan that meets your individual goals and anatomy.

What is Non-Binary Surgery?

Non-binary surgery encompasses a range of procedures aimed at helping patients treat their gender dysphoria and experience greater gender euphoria. Non-binary surgeries are thoughtfully personalized, offering options such as non-binary top surgery, bottom surgery, facial surgery, and body contouring. This approach celebrates the idea that gender is a personal journey. It encourages collaboration with surgeons to craft care plans that reflect each patient’s unique needs.

Surgery Beyond the Binary: Your Options Explained

Non-Binary Top Surgery

Non-binary top surgery encompasses a list of techniques that can give individuals a more androgynous, masculine, or feminine chest appearance.

• Patients who undergo a mastectomy or chest reconstruction can for less traditional nipple placement and nipple-areola dimension options, or to just have their nipples removed altogether.
• Patients who still want some volume left can opt for an aggressive breast reduction. Some patients describe having a smaller chest as giving them a more “gender-fluid” appearance: their breasts can be more easily concealed when desired.
• Patients interested in retaining heightened sensitivity in their nipples after top surgery can undergo a double incision nerve reconstruction (aka. neurotization), Inverted-T, buttonhole, periareolar, keyhole, or lollipop technique. Patients with a BMI under 30 have an 80% chance of retaining heightened sensation in their nipples post-op with these surgery types.

Breast Augmentation

Patients interested in having larger breasts can undergo breast implant augmentation surgery. In some cases, a fat transfer may be appropriate to augment the breasts or accentuate cleavage.

Bottom Surgery

Bottom surgery offers an array of options designed to help a patient’s genitals with their gender.

• For patients born with testicles, an orchiectomy and scrotectomy can remove the testicles and scrotal pouch, which will substantially decrease the body’s testosterone production. Please note that if you wish to undergo a vaginoplasty or vulvoplasty, you should keep your scrotal tissue in-tact after an orchiectomy.
• For patients born with a penis, bottom surgery can include vaginoplasty, where a vaginal canal and external vulvar structures are created, and vulvoplasty (or vulvaplasty), which focuses on constructing external vulvar structures without the formation of a vaginal canal. 
• Patients born with a vagina and/or uterus can choose to undergo a hysterectomy, vaginectomy, or other procedures to remove their natal genital organs.
• For patients born with a vulva and vagina metoidioplasty and phalloplasty construct a penis using existing genital tissue or donor tissue, catering to each person’s unique goals and preferences.
• Some individuals may also consider genital or gender nullification procedures.

Facial Surgery

Gender-affirming facial surgery options for non-binary patients include a wide range of techniques such as jawline contouring, jawline augmentation, nose reshaping, and cheek augmentation. Board-certified facial surgeons can provide customized options for enhancing facial harmony and fulfilling patients’ unique requests. For more information, click here.

Bottom Surgery

At the Gender Confirmation Center (GCC), patients can choose from liposuction, skin tightening, fat transfer, and silicone implants to help alter or sculpt the shape of their bodies. Body contouring can target a specific part of the body, like persistent fat deposits that do not go away with consistent exercise and diet changes, or aim to alter the overall frame and dimensions of the body through fat grafting or abdominoplasty.

Frequently Asked Questions: 

The following questions are what we commonly hear from non-binary patients inquiring about gender-affirming surgery.

Do I need to take hormone therapy for non-binary surgery?

At the Gender Confirmation Center (GCC), we do not require that patients take hormone replacement therapy (HRT) to be a candidate for surgery. For those who are currently taking hormones, waiting a year or two before undergoing surgery may help you optimize your results, such as breast growth, fat redistribution in the face and body, and bottom growth before a metoidioplasty.

Please note that many insurance providers require that patients be on continuous HRT for at least a year to cover procedures like breast augmentation, body contouring, facial surgery, and bottom surgery. Most insurance providers do not require HRT to cover chest reduction top surgery. For more insurance information, click here.

How do I find a qualified surgeon for non-binary surgery?

We encourage patients to find board-certified surgeons who specialize in caring for non-binary individuals. It is great to look for surgeons who have a strong history of successfully performing gender-affirming procedures and truly understand the needs of non-binary patients, such as the surgeons at the Gender Confirmation Center (GCC).

Additionally, reaching out to support groups, online communities, Reddit forums, or hearing directly from others who have undergone similar surgeries for recommendations can be helpful.

Can I breast/chestfeed after top surgery?

Patients who have breast-reduction surgery can often still breastfeed, though they may need to supplement with formula. Some patients have reported successfully chestfeeding following extensive breast reduction and inverted-T procedures; however, this does not apply to most types of top surgery.

Individuals receiving nipple grafts will not have their nipples linked to milk ducts, as milk ducts are often removed during these procedures. If breastfeeding or chestfeeding is a priority for you, we encourage you to discuss this in a free consultation with one of our board-certified surgeons.

Can I preserve the vaginal opening if I undergo metoidioplasty and phalloplasty?

At the GCC, Dr. Zara Ley (she/her/they) only requires patients to undergo a vaginectomy (removal of the vaginal canal) if they are undergoing a primary urethral lengthening (PUL). A PUL allows someone born with a vulva to more easily urinate while standing, by extending the urethra to the tip of the penis.

Since a PUL with vaginal preservation is associated with a high risk of urinary complications, Dr. Ley now requires a vaginectomy to be performed with a PUL. For metoidioplasty and phalloplasty procedures performed without a PUL, patients can preserve their vaginal canal.

Can I smoke or drink before or after surgery?

Patients must follow a policy of no smoking and no nicotine consumption for three weeks before and after surgery. This helps ensure a smoother recovery and reduces the chances of issues like nipple graft failure and anesthesia complications.

While nicotine is the main concern, smoking marijuana can also affect healing and anesthesia. We recommend considering edibles or CBD as alternatives and encourage open communication with your surgeon to keep the healing process on track.

Additionally, we suggest avoiding alcohol for one week before and after surgery and steering clear of it while taking prescription pain medication for a safe recovery.

Insurance and Costs

Access to gender-affirming surgery can truly transform lives, and for many patients, securing insurance coverage is essential to accessing this medically necessary care. Many insurance providers now offer coverage for these surgeries, but the details can vary. Generally speaking, if your provider offers gender benefits, you will need to provide a support letter from a licensed mental health provider to justify coverage.

We encourage you to reach out to your insurance company to ask about their policies, requirements, and limitations for covering gender-affirming surgery.  At the GCC, our insurance advocacy team has a 90% success rate in helping interested patients get coverage for their procedures.

Additional Resources

• BMI: Am I Eligible for Surgery?
• Chest Reduction Top Surgery Techniques
• Non-Binary Top Surgery
• Breast Augmentation
• Non-Binary Facial Surgery
• Non-Binary Body Contouring
• Bottom Surgery
• How to Afford the Costs of Surgery