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What is Masculinization Top Surgery?

Medically reviewed by Lin-Lin Liu, PA on June 29, 2026.

What is Masculinization Top Surgery?

Top surgery refers to a variety of chest reconstruction and breast reduction surgical procedures. These procedures are carefully designed by our board-certified top surgeons to align with each patient’s goals in support of the achievement of greater gender congruence or the alleviation of gender dysphoria.

Some patients prefer the terms “chest masculinization surgery,” “female to male (FTM) top surgery,” “non-binary top surgery,” and occasionally “chest gender nullification.” It’s important to note that some who opt for these procedures are seeking to masculinize their bodies, while others do not identify with that expressed goal. Our professionals take great care to ensure that the language you use to describe your gender identity, gender embodiment goals, name, and pronouns is respected and affirmed. You can speak with one of our board-certified surgeons in a free, virtual consultation to discuss your unique needs and goals.

Top Surgery Techniques

In a free consultation, one of our board-certified surgeons will evaluate your anatomy to determine which top surgery procedures you are eligible for. If you are outside of San Francisco, our surgeons can assess your skin elasticity and chest size in a virtual consultation, by evaluating photos of your chest. From there, we can discuss your goals for surgery to determine which incision type would be right for you.

Below, we cover three of the techniques that we most often receive inquiries about. For information about all of your surgical options, click here.

Double Incision

The double incision technique is the most frequently performed type of top surgery because it allows for a removal or large amounts of tissue and skin overhang, contouring the chest as flat as a patient would like. This procedure is known for leaving behind horizontal incisions at the base of the chest.

The hockeystick double incision technique curves the incisions upward so that they hug the pectoral muscles. Meanwhile, patients can undergo a double incision with nerve grafting (aka. neurotization), to preserve heightened sensation in the nipples after surgery.

Keyhole

The keyhole technique is one of the most solicited top surgery incisions because it leaves virtually no visible scarring. However, we estimate that only 5% of the population is eligible for this technique, since it requires a small amount of tissue to be removed and a high level of skin elasticity. This is because the procedure is conducted by creating only a small incision line through the lower, outer edge of the areolar.

Periareolar / Circumareolar

The periareolar is another top surgery technique that creates minimal to invisible scarring. It is ideal for patients with medium to minimal amounts of breast tissue to be removed, and a high level of skin elasticity. Like the keyhole, buttonhole, and inverted T techniques, the periareolar incision leaves patients with about an 80% chance of maintaining the same level of sensation in their nipples as before surgery.

Top Surgery Results: Choosing Between Volume & Flatness

In addition, many transgender men, non-binary, and gender-fluid patients opt to maintain a certain amount of chest fullness or chest/breast tissue through an aggressive breast reduction top surgery. Many of these patients have reported experiencing greater gender euphoria after choosing this surgical route, as having minimal leftover tissue allows them to have what they describe as a more gender fluid appearance, without needing to wear a chest binder. Some transmasculine patients want volume in their chest after top surgery so that it is proportional to the volume or fat deposits in the rest of their body. For those wishing to achieve non-flat chest results, our surgeons offer a variety of breast reduction and chest reconstruction options. For these patients, some important factors to consider while in consultation with your surgeon may include:

• The amount of movement or “bounce” in the chest area that you wish to maintain post-surgery
• Silicone pectoral implants or weight training options for the maintenance of chest volume
• The specifics and particularities of your body type and size
• The importance of maintaining sensitivity in your nipples
• The maintenance of the ability to chestfeed

You can read more about these options here.

Benefits and Risks

Benefits of Gender-Affirming Top Surgery

Several peer-reviewed studies have demonstrated that for both qualified trans men and qualified non-binary patients, chest reconstruction and breast reduction top surgery have an enormously high patient satisfaction rate. More concretely, a 2021 systematic review of 27 studies and 7,928 patients found a 1% regret rate after gender-affirming surgery — among the lowest of any surgical procedure.

After undergoing top surgery, patients often report:

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

One of the key factors to long-term patient satisfaction after top surgery is having realistic expectations of results. At the Gender Confirmation Center (GCC), our board-certified surgical team has years of experience helping thousands of patients meet their unique goals. We have been at the forefront of developing groundbreaking surgical techniques for non-binary patients and are one of the only surgical centers that does not discriminate on the basis of BMI for medically necessary, gender-affirming top surgery. That said, due to hospital limitations, patients with a BMI >60 may not receive approval to proceed with surgery based on safety concerns and functional limitations that may make it difficult to properly ventilate, i.e., provide adequate air to the lungs, during surgery.

During your free virtual or in-person top surgery consultation, we encourage you to discuss the following points to make sure you have realistic expectations of what surgery can do for you:

• Chest flatness: How much volume would you like in your chest after surgery?
• Top surgery scars: Are you ok with having any visible scars on your chest? Do you have examples of scar shape and/or placement that you would be okay with?
• Nipple sensation: Would you like to undergo a technique that allows you to preserve erogenous nipple sensitivity?
• Nipple placement and dimensions: Would you like the dimensions of the nipple-areola complex to be changed? Where would you like them to be placed on the chest?
• No nipples: Would you rather have no nipples on your chest after surgery?

Risks

Your surgeon will discuss the risks inherent to your particular procedure, keeping your personal health history in mind. Standard surgical risks include bleeding, infection, and adverse reactions to anesthesia. Other risks include:

• Hematomas and seromas
• Sensation loss
• Scarring, including hypertrophic scars and keloids
• Infections
• Chest pain (this risk is increased when scar massage is not performed regularly)
• Ingrown hairs and cysts
• Changes in areola pigment
• Asymmetry, “dog ears,” and possible need for revision

Some patients may request revision surgery to address complications such as asymmetry, dog ears or irregular scarring. If you undergo your initial top surgery at the GCC, we will waive the surgeon’s fee for any revision procedure you solicit within your first 12 months post-op.

Candidacy and Preoperative Requirements

Are You a Good Candidate?

While the Gender Confirmation Center is one of the only providers in the nation that does not discriminate on the basis of BMI for chest reconstruction top surgery, all patients do have to obtain general health clearance and prior medical approval in order to qualify for our procedures. Please note that patients with a BMI of 60 or higher may not receive hospital approval for surgery. Our surgeons will be able to discuss the specifics of your health during preoperative consultations.

Pre-Surgical Consultation

At the Gender Confirmation Center, our surgical consultations are free of charge to patients. Those that are not located in the San Francisco area can request a virtual or phone consultation.

During your consultation, your surgeon will evaluate your anatomy and medical history to craft a unique surgical plan that meets your gender embodiment goals. We encourage patients to come prepared to their top surgery consultation with a general idea of what they would like out of surgery in terms of aesthetics and nipple sensitivity. Bringing in pictures of chests that resemble what you would like yours to look like––even chests of cisgender men––if often very helpful.

Preoperative Requirements

To undergo top surgery at the GCC, please keep the following in mind:

• Hormone replacement therapy (HRT) is not a preoperative requirement for chest reconstruction top surgery, nor is it for insurance coverage.
• All patients should abstain from smoking and recreational drug use at least three weeks before their procedure, as this can aid in proper healing and lower your risk of complications.
• You will need to disclose your full medical history, including medications and supplements you are currently taking. This is because some medications and supplements could interfere with anesthesia and/or pain medications.
• At the GCC, for top surgery patients with a Body Mass Index (BMI) under 60, your BMI will not be a limiting factor in determining your eligibility for surgery.

Informed Consent

At the GCC, we offer top surgery only to adults who can provide informed consent, meaning they understand the risks, benefits, and expected outcomes. This means that we do not require a letter of support from a licensed mental health professional to qualify for surgery. However, it is a requirement to obtain insurance coverage for your gender-affirming procedure.

Masculinization Top Surgery Expectations & Results

Chest Contour

Broadly speaking, many patients approach the topic of chest contouring in top surgery in terms of flatness vs. volume. Some patients are aiming for a completely flat contour, while others wish to maintain a certain amount of tissue in the chest area. Your surgeon will work with you to determine which procedures and incisions are appropriate for your anatomy and goals. Generally, top surgery incision options designed to meet contouring goals will include:

For patients with smaller amounts of chest/breast tissue, you may qualify for one of the following incision types:

• Liposuction top surgery
• Keyhole incision top surgery
• Periareolar incision top surgery
• Buttonhole incision top surgery
• Lollipop incision top surgery

Patients with moderate to large amounts of chest/breast tissue will likely qualify for the following options:

• Double incision top surgery
• Double incision top surgery with nerve preservation
• Nipple sparing double incision top surgery
• Hockey stick double incision top surgery
• Inverted T/anchor incision top surgery
• Fishmouth incision top surgery

Nipple Grafting

In a nipple graft, skin is removed from one location and then transferred to another. Patients undergoing top surgery may opt for a nipple graft to resize and reposition the nipples and areolas.

This procedure carries an inherent risk of sensation loss because the nipples are removed from their original blood and nerve supply. Some patients prefer this sensation loss or reduction because it helps relieve gender dysphoria. Patients who wish to maintain heightened sensitivity in their nipples can opt for a nerve grafting or nerve reconstruction technique.

Alternatively, other top surgery incision options do not involve free nipple grafts and therefore leave the possibility of sensation preservation. These include:

• Periareolar incision
• Keyhole incision
• Buttonhole incision
• Inverted T incision
• Nipple-sparing double-incision
• Fishmouth incision
• Lollipop incision

Results & Recovery

Top surgery patients can expect to take about 6 weeks before being able to return to full physical activity. The first 3 weeks post-op entail the most discomfort, swelling, and restrictions, and are the most critical to the recovery process. Although each patient’s timeline will vary, many patients find that they are able to work 1-2 weeks after surgery. Patients can generally expect the following during their recovery:

• Week 1: Top surgery itself takes about 1-2 hours, but may be longer for patients undergoing simultaneous body contouring. Most patients are discharged immediately following surgery, while a select few might require overnight monitoring for pre-existing health conditions. Dressings and drains will be applied immediately post-op, and patients are instructed on how to monitor fluid output and empty drains.
• Week 2: Pain medications are also taken on an as-needed basis most typically during the first two weeks of post-op recovery. Ibuprofen, aspirin, and other NSAIDs should not be taken during this period, in order to avoid bleeding complications.
• Week 3:  Compression binders are worn for the first three weeks post-op in order to apply 24/7 compression (which should not be painful) to ensure proper healing. Fully submerging your chest in water should be avoided until after week 3, or until there is no more scabbing or open wounds present. Strenuous physical activities, cardio, and lifting anything more than 5 lbs should be avoided within the first 3 weeks after surgery. After week 3, patients can begin scar care and scar massage.
• Weeks 6-8: Patients whose work involves heavy lifting will need to wait 6 weeks after surgery before they can perform their job duties. Additionally, patients should avoid raising their arms above the level of the shoulders for the first six weeks after surgery to avoid tension on incisions that could affect healing and the appearance of scars. Many patients find that they are able to return to their normal physical activities at this point, given that they have maintained good recovery practices. Please note that scars can take up to 12 months to fully mature.

Frequently Asked Questions about Masculinization Top Surgery

What is the regret rate for top surgery?

Several peer-reviewed studies have demonstrated that regret rates for gender-affirming top surgery are consistently close to 1%.

How long does it take to recover from masculinization top surgery?

Many patients in sedentary professions find that they are able to return to work after week 2, while those with more physical work requirements may require 6 or more weeks of recovery before returning to work.

The final results of your chest reconstruction top surgery can take at least 6 months to 1 year to become visible, and full healing and recovery times will vary according to each patient’s specifics.

Can I still have children after masculine gender affirmation surgery?

Yes. Masculinization top surgery does not require patients to undergo medical procedures like HRT or bottom surgery that can compromise their fertility.

Is chest masculinization the same as top surgery?

Yes — chest masculinization surgery, FTM top surgery, and masculinization top surgery are all terms for the same family of chest reconstruction procedures.

What happens during top surgery?

During top surgery, while you are under general anesthesia, surgeons remove the breast tissue including mammary glands and fatty tissue to create a flatter, more masculine chest. The specific technique depends on chest size, skin elasticity, and your goals.

How painful is top surgery?

Since top surgery is conducted under general anesthesia, patients will be unconscious and will not feel anything. After surgery, most patients manage well with prescribed pain medication in the first few days. Patients typically stop needing even over-the-counter medications to manage pain within 1–2 weeks after surgery.

How much does masculinizing top surgery cost?

Chest reconstruction top surgery can cost $8,500 – $11,500, in addition to facility and other fees. Insurance coverage can significantly reduce the costs patients have to pay to undergo medically necessary gender-affirming surgery.

Is masculinization top surgery covered by insurance?

Yes, several insurance companies with gender benefits cover top surgery costs for qualified patients who present a support letter from a licensed mental health professional. Insurance companies that cover chest reconstruction top surgery do not require patients to be on HRT beforehand. Each patient will need to consult their specific policy to ascertain financial coverage for our procedures.

Our insurance advocacy team has a 90% success rate in securing coverage for interested patients with insurance. If the GCC is out of network, you may need a referral letter from a primary care provider or a support letter from a mental health provider. For questions, you can contact insurance@genderconfirmation.com.

How risky is FTM top surgery?

When performed by an experienced, board-certified surgeon with hospital privileges, complication rates are low. It is essential for patients to disclose their full medical history––including medications and supplements that they are consuming––so that your care team can create a surgical plan that effectively reduces your health risks for surgery.

Masculinization Top Surgery Before and After

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Other Masculinizing Gender-Affirming Surgeries

Masculinizing Surgeries may also include:

• Facial Surgery
• Bottom Surgery
• Body Contouring