Top Surgery with No Nipple Grafts

The Gender Confirmation Center has seen a growing number of patients who want to get top surgery, but do not want to keep their nipples. We have developed this content to raise awareness that this is a viable option and to communicate that choosing no nipples is a valid choice. To be clear, in this article we are referring to ‘nipples’ and ‘nipple grafts’ as the full nipple-areolar complex of tissue that is pigmented and ranges from round to slightly oval shaped. We also provide visual examples of possible post top surgery outcomes in those with no nipples, with nipple grafts, and with 3D tattooed nipples to help you decide on the procedure that best fits your goals. We also cover some of the reasons why folks may opt for no nipples and highlight the pros and cons of each choice.

Nipple grafts are nipples that have been removed from your chest during top surgery and then reattached to the chest in the desired location. The areolas are usually cut down to about the size of a nickel and then shaved down so that they don’t project as much. Patients can also opt for a composite nipple graft where both the areolas and the nipples are resized. The process of nipple reduction is explained in this animated video.

There are a variety of reasons folks opt for no nipples for their chest reconstruction top surgery procedure, which we’ll cover throughout this content.

What Can Chest Reconstruction Top Surgery

Look Like Without Nipples?

There are many factors that may affect your surgical outcome, so the example below isn’t a representation of what ALL no nipple top surgery results will look like. However, it will give you a visual of what it can look like.

The ‘before’ picture is a patient who had a double incision top surgery procedure but decided they wanted their nipples 3D tattooed instead. The ‘after’ picture was taken after the 3D nipples were tattooed, based on that patient’s preference for where they wanted the nipple tattoos placed. Please note, you must wait at least 5-6 months (if there are no complications with healing) to get nipple tattoos. Likewise, nipple tattoos are not actually 3-dimensional, but rather use shadowing techniques to give the tattoo a hyperrealistic appearance. We recommend that you see a trusted, experienced provider if you are interested in medical tattooing to create nipples or color correct your nipple grafts.


 Top surgery 3D nipple tattoo_1

Below is a close up of the left nipple that has been 3D tattooed:

Top surgery 3D nipple tattoo_2

Below is a close up of the right nipple that has been 3D tattooed:

What Top Surgery with Nipple Grafts Looks Like

Below is a before and after picture of someone who had double incision top surgery and decided they wanted to keep their nipples. You will see that the areolas on the ‘after’ picture are smaller than those on the ‘before’ picture. It is important to note that areola size is a patient preference. Some folks may not want their areolas resized at all but do request that their nipples be shaved down to a smaller size. If you’re curious as to what nipple reduction looks like, watch this animated video on the process.

Top surgery nipple graft before and after

Nipples before the nipples have been reconstructed:

Free nipple graft_before

Nipples after the nipples have been reconstructed:

Free nipple graft_after

Top Surgery: No Nipples, Nipple Grafts, or Tattooed Nipples?

Whether you’re deciding between nipple grafts, no nipples at all, or getting your nipples 3D tattooed, it’s important to think about what choice will serve you best right now and in the years to come. There are pros and cons depending on the individual for  each decision. Here are a few:

  • Some patients might like tattooed nipples because the placement of the nipple is more precise and it also means they do not have to deal with caring for nipple grafts. It is important to know you may need to have nipple tattoos retouched over time as the color may fade.
  • Some patients might like having no nipples because of how it looks, or because it better aligns with their gender identity.