Top Surgery with No Nipple Grafts

We’ve seen an increase of patients at The Gender Confirmation Center who want to get top surgery but do not want to keep their nipples. We’ve developed this content to raise awareness that this is a viable option and to communicate that choosing no nipples is a completely 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.

In short, Nipple Grafts is a term for nipples that have been removed from your chest during top surgery and then re-attached to the chest in the desired location. The areolas are usually cut down to about the size of a nickel (22 mm being the typical diameter of a cisgender male’s areolas) and then the nipples are shaved down so that they don’t project as much. The process of nipple reduction is explained in this animated video.

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

Why Some Patients Decide No Nipples

Dr. Mosser has performed multiple top surgery procedures in which the patient had requested no nipples. There are many different reasons why someone may decide on a no nipple aesthetic when getting top surgery, and we’d like to share just a few we’ve seen at his practice:

  • The patient doesn’t like how nipples look
  • The patient feels having nipples and a flat chest looks too similar to a cisgender male chest
  • The patient is gender neutral and feels that a no nipple aesthetic is congruent with their gender identity
  • The patient doesn’t like how nipple grafts look
  • The patient reports that the presence of nipples intensifies their dysphoria
  • The patient wants 3D nipple tattoos instead of real nipples
  • The patient doesn’t enjoy nipple sensation and would rather have them removed in order to not experience that
  • The CPT billing code for Nipple Grafts got denied by insurance and the patient would have to pay for nipples out of pocket. If you’re curious about this topic, click here and scroll down to “When Your Free Nipple Graft Code Gets Denied by Insurance.”

It’s more important to note that the reasons listed above are a fraction of why someone may choose on getting top surgery with no nipples. Everyone has their own reasons, and it’s a completely valid decision that both Dr. Mosser and Dr. Facque support.

What Can Top Surgery Look Like Without Nipples?

There are many factors that affect your surgical results, 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. Note that you must wait at least 5-6 months (if there are no complications with healing) to get these nipple tattoos.


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

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 ‘before’ picture, because the nipple has been sized to a typical cis male’s areola size. It’s important to note that areola size is a patient preference, so some patients opt for a 22-mm sized areola (cisgender male nipple size). 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.

Nipples before the nipples have been reconstructed:

Nipples after the nipples have been reconstructed:

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 advantages and disadvantages to each decision. Here are just a few outlined:

  • Some patients might like tattooed nipples because the placement of the nipple is more precise. On the other hand, having tattooed nipples means you might need to have them retouched over time to retain the same color intensity
  • Some patients might like having no nipples because of how it looks, or because it better aligns with their non-binary gender identity. However, they may not like the attention it draws while being shirtless in public
  • Rarely, some patients are not able to emotionally handle the concept that a material will be briefly removed from the body and then grafted to the body.  For those patients, a procedure without nipples (and later tattooing) or a procedure that avoids nipple grafts such as a buttonhole procedure might be appropriate.  Keep in mind that there are considerable trade-offs with buttonhole surgery types in terms of how flat of a chest one can obtain.

In conclusion, think about the bigger picture of what you want out of top surgery and the answer will reveal itself. If you really don’t want any nipples at all then you don’t have to! If you’d rather have tattooed nipples instead of reconstructed ones, that is a viable choice too.