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What is Top Surgery for Gender-Affirmation?

Medically reviewed by Jennifer Richman on Dec 8, 2025.

Top surgery encompasses a variety of surgical techniques designed to treat a patient’s gender dysphoria by bringing their upper-chest in greater alignment with their internal sense of gender.

• Chest reconstruction top surgery––sometimes called chest masculinization surgery or non-binary top surgery––removes breast tissue and any excess skin to flatten the chest.
• Breast reduction surgery for gender-affirmation significantly reduces the volume of the breasts for non-binary and transmasculine patients.
• Breast augmentation surgery, sometimes called feminization top surgery, increases the volume of the breasts through implants (silicone or saline) and/or liposuction fat grafting.

If you are interested in undergoing top surgery, you can meet with a board-certified surgeon in a free consultation to discuss your options, get answers to your questions, and receive a quote for your unique surgical plan.

Top Surgery Procedures Explained

Chest Reconstruction Top Surgery and Breast Reduction Options

Patients who undergo chest reconstruction top surgery have a number of techniques they can choose from. Anatomical factors like the amount of tissue and skin overhang you have, as well as your goals for surgery will help your surgeon determine in a free consultation which techniques would be right for you.

• Techniques ideal for patients with large to medium amounts of tissue include the double-incision, hockey stick double-incision, Inverted-T, buttonhole, and fishmouth incisions.
• Techniques ideal for patients with a small to medium amounts of tissue include the periareolar, keyhole, lollipop, and buttonhole incisions.
• Patients who are interested in maintaining 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.
• Patients can choose to have their nipple-areolar complexes re-sized and repositioned on the chest through free nipple grating. Patients can also choose to have their nipples kept the same, or removed entirely for a top surgery result with no nipples.

Breast Augmentation Top Surgery

Feminizing top surgery patients can choose from the following options:

• Patients can choose between silicone and saline implants. From our experience, most trans women and trans feminine non-binary patients choose silicone implants because they are less prone to rippling and have a reputation for providing a look and feel that is more similar to breasts that are not surgically augmented.
• Breast implants are measured in cubic centimeters: the amount of liquid or gel contained within the implant’s outer shell (200cc-500cc on average). Patients can try out the rice test at home to figure out what sized implants would suit them best.
• Patients can augment their breasts through liposuction fat transfer. Generally speaking, for transgender patients, this technique is not as successful when a large amount of volume is needed and the chest skin is tight. That said, patients often undergo a fat transfer to add medial cleavage to their breast implant augmentation.

Eligibility & Insurance Requirements

Qualifying for Top Surgery

To undergo top surgery, patients must be capable of fully participating in the informed consent process. From there, at the Gender Confirmation Center (GCC), we have no BMI limitations to undergo top surgery. Rather, we make the determination of surgical eligibility with a patient based on the risks present in their medical history. You can review the different variables we consider to reduce a patients’ risk for surgical complications here.

Insurance Coverage Requirements

Insurance providers that cover gender-affirming surgery may require patients to meet certain standards to qualify for full or partial coverage. These often include:

• Providing a support letter from a licensed mental health provider. This letter should confirm a diagnosis with gender dysphoria and discuss your eligibility for surgery.
• Patients who wish to get coverage for a breast augmentation surgery may need to have undergone 12 months of continuous hormone replacement therapy (HRT). HRT is most often not a requirement to undergo chest reconstruction or breast reduction top surgery.

The Benefits & Risks of Top Surgery

Benefits of Top Surgery

Several peer-reviewed studies have demonstrated that for both qualified trans men and non-binary patients, top surgery has an enormously high patient satisfaction rate. Patients often report:

• Improved overall quality of life
• Reduced mental health issues related to gender dysphoria
• Increased self-confidence
• Improved body image
• More comfortable engaging in physical activities

One of the key factors to long-term patient satisfaction after top surgery is having realistic expectations of results. During your free virtual or in-person consultation, you can speak with one of our board-certified surgeons about what a realistic result for you would be.

Risks

Your surgeon will discuss the risks inherent to your particular procedure, keeping your personal health history in mind. Here you can find some of the most common risks associated with top surgery procedures. They include:

• Infections
• Hematomas and seromas
• Reduced sensation or sensation loss
• Scarring, including hypertrophic scars and keloids
• Chest pain (this risk is increased when scar massage is not performed regularly)
• Ingrown hairs and cysts
• Pseudo-symmastia and symmastia
• Asymmetry, “dog ears,” and possible need for revision

Breast Cancer Risk for Breast Augmentation

Breast augmentation patients can avoid an increased risk for breast cancer by selecting smooth, rather than textured implants. After surgery, patients should still undergo frequent breast cancer screenings. When getting a mammogram, let the technician know in advance that you have implants.

In some cases, it may not be possible to perform a traditional mammogram, especially for those with implants placed directly behind the breast tissue (instead of beneath the chest muscle). In these instances, an MRI may be recommended to screen for breast cancer.

Breast Cancer Risk for Chest Reconstruction

Chest reconstruction top surgery patients 45 years of age and older should still schedule annual clinical exams for breast cancer screening, even though your risk will be significantly diminished after surgery. Please note that traditional mammography may not be possible following chest reconstruction top surgery due to a lack of tissue.

The Surgical Process

Undergoing top surgery involves multiple steps:

The Surgical Consultation

The first step in any surgical journey is requesting a consultation with a board-certified provider. At the GCC, we are able to offer free virtual and in-person consultations. Patients that request a phone consultation with our surgeons will be asked to submit photos of their chest beforehand so that our surgeon can analyze your anatomy and determine which procedures you will be eligible for.

In the video below. Dr. Daniel Jacobs (he/him/his), discusses how you can make the most out of your top surgery consultation.

Scheduling your Surgery Date

In order to schedule and keep a date for surgery, you may need to do the following:

• Complete a surgical consultation with a board-certified provider.
• Work with your primary care provider or specialist to monitor and treat any health conditions that put you at risk for surgery. Your providers may need to be in communication with your surgeon’s office about these points.
• Turn in all necessary documentation to request insurance coverage to your surgeon’s office. If you are a cash-pay patient—i.e., if you won’t be paying with insurance––this step won’t be necessary.
• Complete your financial obligation. At the GCC, patients must pay their part of the surgery 6 weeks prior to their scheduled date in order to keep it. No payment plans are made afterwards.

The Day of Surgery: What Happens?

On the morning of surgery, you should not eat or drink anything except for clear liquids, which you should stop four hours prior to your appointment. With the approval of your surgeon, you may take regular prescription medications with a small sip of water. These can include: blood pressure medications, thyroid medications, or birth control/hormone pills.

You may shower and wash your hair the morning before surgery but do not set or spray it. Do not use facial or body moisturizer. You may shave your face and use aftershave lotion. We ask that you brush your teeth with minimal water and use mouthwash. Avoid deodorant in the armpit region.

When you arrive at the hospital or surgical center, you will be checked-in to a pre-operative room. Your surgeon will greet you to review the plan for surgery and answer any last-minute questions you may have.

During top surgery, you will be placed under general anesthesia. This means that you will be asleep and not feel anything for the entirety of the procedure. Procedures often take 1.5-3 hours, unless a patient requests to undergo other procedures in the same surgery like body contouring.

You will wake up from the procedure with surgical dressings and a compression garment over your chest. Most often, drains will be placed during surgery as well. A nurse will go over recovery instructions with you. You will be discharged once you have stabilized after surgery and you have a care-person present to take you home.

Recovery: Healing and Final Results from Top Surgery

Generally speaking, it takes a full 12 months for the body to completely recover from surgery. This includes inflammation reducing and scars maturing. That said, patients should be able to see their results around 6 months post-op, depending on the kind of surgical technique you undergo. You can find more information on chest reconstruction recovery and breast augmentation recovery in the hyperlinked pages.

The First Week of Recovery

For the first week after surgery…

• You will need help with daily household tasks because your mobility will be limited.
• You will need plenty of rest so that your body can properly recover from surgery.
• You will need to wear your compression garment 24/7. Your care team will give you instructions on how to bathe yourself during this time.
• You should take light walks to help promote circulation and prevent blood clots from forming. Otherwise, you should avoid strenuous physical activity entirely.
• You should avoid using your arms to support your body or lift anything over 5 lbs (nothing heavier than a gallon of milk).
• Medications are taken on an as-needed-basis to manage pain within the first 1-2 weeks after surgery. Please note that you should not take ibuprofen, aspirin, or other NSAIDs (unless prescribed by your surgeon) two weeks before and one week after surgery to manage pain as these can cause bleeding complications.
• If you are sent home with surgical drains, your care team will instruct you on how to empty them.

Recovering Arm Mobility After Top Surgery

Patients who undergo chest reconstruction top surgery in particular often ask about the timeline for raising their arms after surgery and recovering upper-body mobility generally. You can revise this physical therapy guide here for answers to these questions.

Scar Care: Reducing Discoloration & Texture

After the first week of surgery, your incisions should close and become scars. Consistently practicing scar massage can help patients reduce the texture and discoloration of their scars, as well as reducing the risks of long-term chronic pain. Likewise, patients are advised to protect their scars from UV rays during the first year after surgery. You can find more information about scar care and scar revision procedures here.

Recovering Sensation after Top Surgery

It is normal for patients to experience feelings of tightness, numbness, tingling or altered sensation across their chest as they recover from gender-affirming top surgery. Usually, around 3-6 months post-op, uncomfortable sensations like tingling and itching will give way to recovering sensation. Still, it can take up to a year after surgery for nerves to fully regenerate.

With your surgeon’s approval, there are several nerve rehabilitation exercises that can help stimulate healing, encourage nerve regrowth and retrain the brain to recognize sensory input after top surgery. You can read more about these nerve rehabilitation exercises here.