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What is Top Surgery?

Medically reviewed by Brianna Smith on April 6, 2026.

Top surgery is an umbrella term that encompasses different gender-affirming surgeries that help treat the gender dysphoria that transgender, non-binary and gender-expansive patients feel with their chest. Top surgery includes:

• Chest reconstruction top surgery: Sometimes called FTM, chest masculinization surgery or non-binary top surgery, it involves the removal breast tissue and any excess skin to flatten the chest.
• Breast reduction surgery: The volume of the breasts is significantly reduced for non-binary and transmasculine patients.
• Breast augmentation surgery: Sometimes called MTF top surgery, we increase the volume of the breasts with 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.

Types of Top Surgery

Chest Reconstruction and Breast Reduction Top Surgery

Patients who undergo chest reconstruction top surgery have a number of techniques they can choose from. Requesting a free consultation with one of our board-certified surgeons is the best way to determine which procedure would be best suited for your unique anatomy and goals.

• 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

Patients interested in chest feminization 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.

Who Qualifies for Top Surgery?

Eligibility Requirements

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. Likewise, age and being on hormone replacement therapy (HRT) are not factors we take into account to determine if you can undergo top surgery. Rather, we make the determination of surgical eligibility based on an assessment of 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 for Top Surgery

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 not a requirement to undergo chest reconstruction or breast reduction top surgery.

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 of Top Surgery

Please note that complication risk varies by procedure type and the risk factors in an individual’s medical history. At the Gender Confirmation Center (GCC), your board-certified surgeon will review this information and discuss if any risks will be taken into account to craft your unique surgical plan. Be assured that we have plenty of experience making adjustments and working with patients and their other healthcare providers to lower risk levels. 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 & Breast Reduction

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. 

In the video below, Dr. Mosser discusses breast cancer risk reduction & detection after a chest reconstruction or breast reduction top surgery:

What to Expect: Top Surgery Step-by-Step

Undergoing top surgery involves multiple steps:

Your Top Surgery 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

For the night before and the morning of surgery, you will be asked to follow a number of instructions. These include limiting food and beverage intake and hygienic precautions. For example, you will only be allowed to take prescription medications––such as blood pressure medications, thyroid medications, or birth control/hormone pills––the morning before surgery if your surgeon gives you explicit approval.

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 and Final Results

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. Generally speaking, we recommend patients to avoid raising their arms above the level of the shoulders for the first six weeks after surgery. Doing so may create unwanted tension on the incisions that could affect your healing and the appearance of scars. After the third week of recovery, it is common for surgeons to provide individualized instructions based on their experiences and the patient’s specific needs (e.g., balancing concerns about shoulder mobility vs. scar stretching). You can revise this physical therapy guide here for more specific information.

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.

Top Surgery FAQ

• What is top surgery?

• Top surgery encompasses a broad range of surgical techniques that help individuals experience greater gender congruence with their chest. Top surgery can involve reducing or increasing the volume of the chest.

• How much does top surgery cost?

• Please note that the cost of top surgery varies based on procedure type, surgeon experience, insurance coverage and other fees. Generally speaking, at the GCC, our quotes come out to $8,500-$11,500 for patients who are paying for their procedure without insurance. This estimate does not include other associated costs like facility and hospital fees. After your free consultation, we can give you a more precise quote.

• Does top surgery require hormones?

• At the GCC, HRT is not a requirement for any top surgery procedure. That said, we encourage patients taking estrogen to wait 1.5-2 years on HRT before undergoing a breast augmentation to wait for breasts to develop.

  On the other hand, insurance providers that cover gender-affirming medical care tend not to require patients to take testosterone HRT to qualify for coverage. However, being on continuous estrogen HRT––unless there is a medical contradiction––for at least 12 months is often a requirement to get a breast augmentation covered. 

  In the video below, Dr. Facque discusses why taking feminizing HRT before undergoing a breast augmentation can be advantageous:

  https://www.youtube.com/watch?v=zlHTbUHmQPU

• How long does top surgery take?

• Patients often spend 1.5-3 hours under general anesthesia for top surgery. The duration varies depending on technique, and whether top surgery is combined with other procedures––most often, body contouring.

• Is top surgery permanent?

• Yes, top surgery results are permanent. Patients can request a revision surgery if they are not satisfied with their results. GCC patients that request a revision within the first 12 months after their initial top surgery will get the surgeon’s fee waived.