Non-Binary Incisions and Chest Contouring
This content will first compare different top surgery incisions, and chest contouring techniques that are generally perceived as producing a binary male appearing chest. From there, we’ll explore how those same techniques can be modified to better suit the needs of someone who identifies as FTN (female to non-binary). If you’re generally unfamiliar with non-binary or haven’t heard of gender neutral top surgery as a viable option, please read the introduction to non-binary top surgery so you can get the most out of the content below.
Incisions: Shape and Location
Binary Male Appearing Chest Incisions
For patients interested in having a binary male appearing chest, there are some modifications to the shapes of incisions that could achieve this listed below:
- Very gently curved incision that runs as close to as possible along the lower border of the pectoralis major muscle
Curved incision example
- Straight incision lines instead of curved lines so their new chest doesn’t remind them of their chest before top surgery
Straight incision example
- Diagonal incision which runs upward along the outer border of the pectoralis major muscle up and toward the armpit. This is not a very usual request, but it is included here because it is not really a non-binary request and still fits within the realm of a masculine result
Diagonal incision example
Less Binary (or Non-Binary) Appearing Chest Incisions
Below are a few incisions requests we’ve received from patients who are interested in having more non-binary appearing incisions.
- Longer, higher, or lower than the position described above
- Incision not located anywhere close to the lower pectoralis major muscle line because of the perception that that is a distinctly male appearance for a mark that is on the chest
It’s important to note that the fish mouth procedure results in an incision across the very center of the chest horizontally. This could be a very popular non-binary procedure choice as most people don’t view the post-surgical results as a chest that was developed through an estrogenic or androgenic pubertal development period.
Fish Mouth incision example
Areola excision top surgery results in two horizontal scars about three times the length of the previous areola in the center of the chest. This procedure is ideal for patients who would also qualify for keyhole or periareolar incisions who do not want their nipples or areolas in their final surgery result and who are interested in a less binary post-surgical result.
Areola Excision example
Chest Tissue Amount and Chest Contour
Binary Male Appearing
A typical masculine chest has a fairly uniform requirement for contour. There should be a uniform thickness of tissue throughout the entire chest area, matching the surrounding regions which are beyond the area of surgery. Meaning:
- After a successful top surgery procedure, one should be able to pinch the tissue of the chest anywhere and have it be more or less the same thickness. This is a degree of thickness that not only will be in balance at the conclusion of surgery, but will likely serve the patient well in the future
- If the patient loses weight and gains muscle bulk, then just like anyone they would have a much more muscular defined chest
- If the patient gained weight, they would likely gain weight on their chest like they would gain weight elsewhere in their thorax and trunk
- A typical male result works to control the excess tissue that is present in the outer chest beneath the armpit and also in the upper outer front part of the chest. This is just next to the armpit on the front of the chest where there can be a small amount of puffy chest tissue that needs to be removed
Non-Binary Appearing
This may be one of the areas where there is the highest degree of variation among different procedure types. For example, with the Inverted T and Buttonhole procedure:
- Even when performed successfully, it may result in a considerable degree of left over chest tissue. A patient deciding on these procedures would need to be prepared to have a heavy male chest (something like a male chest appearance where that individual has gynecomastia). In some cases, the patient might have a result that looks like there are relatively small breasts on the chest
Degrees of fullness, mildly full, examples
Degrees of fullness, moderately full, examples
- This may be the most appropriate for individuals who may choose to present on varying spaces of the gender spectrum. However, some individuals who have considerable dysphoria of the chest due to chest tissue would not be satisfied with this sort of a result
- It’s important to note that the Double Incision procedure can also be performed in a way to maintain more than average tissue on the chest, and is more controllable than the inverted T/buttonhole procedures
In cases where a patient has a particular wish regarding the exact amount of chest tissue to be left over, I highly advise them to bring in photos of bodies that have the amount of chest tissue that they would be hoping to have at the conclusion of surgery. This helps to avoid any misunderstandings regarding what the procedures can offer and what the limitations of each procedure type are for a given body type are.
In Conclusion
Depending on the level of customization you are interested in to achieve a result that feels/appears most non-binary to you, here’s additional content on non-binary nipple and areola options.
To learn more about Dr. Mosser’s approach to non-binary surgery, check out the video below of his talk at the Philadelphia Trans Wellness Conference in 2019. This video covers how Dr. Mosser helping gender-expansive people achieve their gender-affirming surgery goals.
