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What is Masculinization Top Surgery?

Medically reviewed by Jennifer Richman on May 19th, 2025.

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.

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 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. 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.  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. Here you can find some of the most common risks associated with top surgery procedures and most other surgeries:

• 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

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. Our surgeons will be able to discuss the specifics of your health during preoperative consultations.  

Consultation and Preoperative Requirements

There are no requirements for an initial consultation with one of our surgeons. These consultations are free of charge and can be scheduled as a virtual meeting, phone call, or in-person visit. It’s a good idea to enter your top surgery consultation with a general idea of your goals in terms of aesthetics, sensitivity, and function. 

Hormone replacement therapy (HRT) is not a preoperative requirement for top surgery. 

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. Any medications and supplements that could interfere with anesthesia and/or pain medications should also be disclosed. 

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. Some patients are discharged immediately following surgery, while others 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. 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

Top surgery can represent a hallmark and significant turning point for many transgender, non-binary, and gender-nonconforming patients.

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

The first 6 weeks post-op are the most crucial for top surgery recovery, and persistent pain for most individuals besides minor discomfort typically should not last beyond this point. 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. 

Patients who undergo nerve reconstruction top surgery, also known as a double incision with neurotization, can expect to recover heightened levels of sensitivity in the nipples by around 3 months post-op. 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 any face or body be masculinized? 

Your specific gender congruence options may be limited by certain anatomical characteristics, existing health conditions, financial resources, and insurance coverage. That being said, our surgical options for gender affirmation are wide, varied, and very well adapted to various patient types, in keeping with the latest research and advances in the field. Our surgeons will always present to you all feasible and realistic options available for your specific case for both facial masculinization and body masculinization surgeries. 

What are the pros and cons of masculinization top surgery?

Many patients find that top surgery is a crucial turning point undertaken for significant alleviation of gender dysphoria. Several peer-reviewed studies have established that patients are overwhelmingly satisfied with their results and their effects on their mental health, body image, and overall quality of life.  

Any surgical procedure comes with inherent risks that may be compounded by certain health conditions. These risks include infection, hematomas, seromas, scarring, sensation loss, and more.

Can I still have children after masculine gender affirmation surgery?

Yes. Masculinization top surgery does not require patients to be on HRT, and does not involve reconstruction of the reproductive organs. Patients wanting to maintain the ability to have children generally do not face any barriers. In some cases, your surgeon can attempt to preserve your mammary glands so that you can chestfeed after surgery, although the risk of losing this ability is still high. On a case-by-case basis, careful and tailored consulting with our surgeons will balance your gender affirmation and aesthetic goals with any potential impacts on the ability to have children. 

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.

Other Procedures for Masculinization of the Face and Body

Masculinizing Surgeries may also include:

• Facial Surgery

• Bottom Surgery

• Body Contouring