Debunking The Top 6 Top Surgery Myths

Medically reviewed by Jennifer Richman on December 23, 2025.

Here, we debunk the most common 6 myths we hear about gender-affirming top surgery. If you are interested in undergoing surgery yourself, or are curious and supporting a loved one through their own journey, you deserve to know the facts on these issues.

Myth 1: Most Patients Will Regret Getting Top Surgery

Regret rates for gender-affirming top surgery are quite low and vary from 0-4% of patients. To the contrary, several peer-reviewed studies have demonstrated that for qualified trans men and non-binary patients, chest reconstruction and breast reduction top surgery have an enormously high patient satisfaction rate. Overall, satisfaction rates for top surgery soar above those of comparable cosmetic and reconstructive surgeries. Patients report: improved overall quality of life, increased self-confidence, improved body image, reduced mental health issues related to gender dysphoria, and greater comfort engaging in physical activities.

When patients express feelings of disappointment with their surgery, it is almost never because they regret undergoing medical transition. Rather, patient dissatisfaction most often comes from surgical complications or sub-optimal results. Even in cases where the surgical result isn’t optimal, in most cases, patients still experience an improved quality of life.

Rare cases of top surgery regret are often due to:

• A patient’s unrealistic expectations
• Not choosing the procedure type they’d prefer
• Rare surgery complications
• Poor results executed by an inexperienced surgeon

Ways to minimize a rare case of top surgery regret:

• Setting realistic expectations: Do your research so you can manage your expectations realistically, complications happen and a perfect result is not guaranteed. During your consultation, your surgeon should clarify what you can realistically expect as a result from surgery.

• Sharing accurate information about your medical history: It is essential that you share accurate information about your medical history with your care team before surgery. This will help your board-certified surgeon make an accurate assessment of what steps need to be taken to minimize the risk of surgical complications.

• Selecting a good surgeon: Your surgeon should be certified by the American Board of Surgery, have hospital privileges (meaning they have an agreement with a nearby hospital to take their patients if needed), and have experience working with trans and non-binary patients. Looking up the surgeon’s results for gender-affirming top surgery and patient experiences online can help you determine if this surgeon is qualified to provide you this service.

Myth 2: You Have to Be on Testosterone in Order to Get FTM/N Top Surgery

At the Gender Confirmation Center (GCC), we do not require that a patient undergo hormone replacement therapy identify as a certain gender identity in order to receive top surgery. Due to our gender inclusive healthcare model, many of our patients get top surgery without having been on testosterone.

As more trans affirmative care research comes out the more FTM/N top surgeons are realizing that being on testosterone shouldn’t be a requirement for getting top surgery. Although many insurance providers that cover gender-affirming surgery require hormone replacement therapy for coverage, this is almost never the case for surgery eligibility.

The myth of having to be on testosterone to get FTM/N top surgery could be due to:

• Outdated Knowledge: Previous versions of the Standards of Care (SOC) created by the World Professional Association of Transgender Health (WPATH) did state that you had to live as a certain gender identity or be on hormones for a certain amount of time in order to be approved. Thankfully with the new SOC 8 these are no longer a requirement
• Breast Tissue Growth: A common misconception is that without testosterone, breast tissue will grow back. That, however, is not the case. That said, studies have shown that some top surgery patients experience breast tissue growth during pregnancy because of hormonal fluctuations.

Myth 3: Gender-Affirming Top Surgery is Not Covered by Health Insurance

The American Medical Association, World Professional Association for Transgender Health (WPATH), and many other important actors in healthcare consider gender-affirming surgery to be medically necessary and non-cosmetic. More and more insurance companies in the U.S. are accepting the medical necessity of gender-affirming care and covering top surgery.

Having said that, denials do occur but getting approved is much more common. If you do get denied there’s always an appeal process which sometimes results in an overturn of their initial decision. It’s best practice to stay positive, always try to obtain approval if you do have insurance, and appeal if you do get denied.

Insurance coverage for top surgery, minimizing the likelihood of a denial:

Research your insurance company and look at your policies so you can take proactive actions before beginning the approval process. We suggest that you search for your insurance provider’s name and “transgender benefits” in an online search engine. You can also call your insurance provider with specific questions about your plan. For example, if your insurance company requires that you live in a certain gender identity for X amount of time, ensure that your therapist is aware of this so they can write an appropriate letter. You can read more about therapist letter insurance requirements here.

Myth 4: You Have to Get a Therapy Letter to be Eligible for Top Surgery

While some surgeons do require a support letter from a licensed mental health professional to determine surgical eligibility, at the GCC, we use the informed consent model for top surgery. This means that our surgeons determine eligibility for surgery by a patient’s ability to understand the benefits and risks of surgery, and make an informed decision for themselves on that basis.

The WPATH SOC 8 doesn’t require capable adults to have a therapist letter in order to get top surgery. Please note, however, that most insurance providers do require a support letter to cover surgery.

Myth 5: Patients Above a Certain BMI Are Ineligible for Surgery

When it comes to top surgery, weight alone is not a factor that increases the risk of serious complications for patients with a BMI over 30. At the Gender Confirmation Center (GCC), no one is ruled-out of surgery because of a single numeric factor like BMI. Instead, our surgeons take a holistic approach to work with patients on a case-by-case basis to determine what considerations or accommodations we will need to ensure someone’s safety through surgery. BMI is still a considered factor in the eligibility requirements of the different hospitals and surgery centers.

Myth 6: Top Surgery Eliminates the Risk of Breast Cancer

This seems to be a popular myth among all FTM/N chest reconstruction procedure types, especially when it comes to double incision bilateral mastectomy. Most top surgery procedures do not remove 100% of the breast tissue. It significantly reduces your risk of developing breast cancer, but you should still routinely check for breast cancer with your primary care physician.

Conclusion

There are other myths to dispel around top surgery but we chose the above as they seem to be the most prevalent misconceptions.

• Regret
  • Regret is rarely reported from qualified patients who have received top surgery from qualified providers
• You can’t have a high weight or BMI to get top surgery
  • This isn’t always the case, there are surgeons who will operate on folks with higher weight or BMIs
• You do not have to be on testosterone in order to get top surgery.
  • Although some insurance companies or surgeons may require it this conception should be challenged
• Your top surgery won’t be covered by insurance.
  • Although sometimes that is the case it is always worth trying, or appealing (if it gets denied).
• You do not have to have a therapist letter in order to get top surgery from an FTM/N top surgeon. If the surgeon uses the informed consent model that means that they do not
  • You would need a therapist letter if you were seeking FTM/N top surgery insurance approval
• Getting FTM/N top surgery does not eliminate your risk of breast cancer.
  • Since top surgery doesn’t remove 100 % of the breast tissue, you are still at risk