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Non-Binary Surgery Overview

This content is going to cover the fundamentals of gender identity and the surgical techniques that Dr. Mosser has used with FTN (female to non-binary) identifying patients. This broad introduction will hopefully answer some important questions prior to getting into the specifics of each procedure type. For further information, you may view this hour-long lecture on non-binary identities and surgeries from the 2019 Philadelphia Trans Wellness Conference.

What Does Non-Binary Mean?  

In order to understand what it means for some people to identify as non-binary, it’s important to start with a basic definitions and distinguishing factors between assigned sex and gender identity:  

• Assigned Sex: When an infant is born, the physician will determine the infant ‘male,’ ‘female,’ or intersex (usually based on an examination of genitals, chromosomal features, and internal organs). Non-intersex babies are then referred to “assigned male at birth” (AMAB) or “assigned female at birth” (AFAB) to more accurately explain that it was the doctor(s) who assigned the sex of the baby at birth
• Gender Identity: Gender is not the same as assigned sex. Gender identity is an introspective experience and way of naming the gender one identifies with. There are many gender identities, including male/man, female/woman, non-binary, genderqueer, agender, etc. 
• Cisgender: Means you identify with the sex you were assigned at birth 
• Transgender: Means that you don’t identify with the sex you were assigned at birth, often referred to as an “umbrella” term for all gender identities other than cisgender
• Gender Binary: This is essentially a societal system that splits people into one of two set of gender roles, gender identities and physical attributes as either ‘male’ or ‘female’ 
• Non-Binary: Non-binary gender identity is any gender identity that does not fall exclusively within the binary of male or female 

It is important to note that non-binary gender identities are not ‘new identities’ or new concepts and have been recognized throughout the world for a very long time. Folks who identify as non-binary may use pronouns outside of the binary such as they/them. However, there are many other gender-neutral pronouns and pronoun combinations (such as he/they, she/they) that people use so it’s always best to ask what someone’s pronouns are when initiating a conversation for the first time.

Transitioning/aligning as a non-binary person can be medical (taking hormones, getting surgery) or non-medical (using different pronouns, binding, changing hair or clothing style), and some non-binary people choose not to transition at all. Since gender is a spectrum, someone who identifies as non-binary, genderqueer, agender, etc. may express their gender in neutral, masculine, or feminine ways, or some combination of all or none of these expressions. Despite current standards of care, there is flexibility in one’s medical alignment, which is what Dr. Mosser wants to shed light on. 

What does a non-binary surgical result look like?  

Technically, if someone identifies as non-binary, all aspects of their anatomy are non-binary. For example, if a non-binary person has chest tissue, their chest should NOT be referred to as a “female” chest. What we’re exploring is finding congruence between one’s non-binary identity and a physical presentation to the world through a gender affirming surgery. There’s no one answer to this question; what Dr. Mosser can provide are examples of all available surgical options. This way, the patient can make an informed decision on what surgical options may fit their needs.  

With over 1,500 top surgeries completed as of March 2020, Dr. Mosser has a great deal of perspective on the variance of body types and the different outcomes patients may desire. With this knowledge comes a deeper understanding of what people may consider as having a binary (male or female) or non-binary (not strictly male or female) appearing surgical result. 

You can think of gender-neutral top surgery results similarly. There are a huge number of valid expressions of gender which fall within the broad category of non-binary. Similarly, there are a number of top surgery features where the result could be modified to a patient’s liking so they hold the results toward whatever it is that they personally need to match their gender identity  

It can get a bit confusing to think about all the different components of a top surgery result, including the parts that  can be modified and what it means to have a particular result look more masculine or more gender-neutral. So, the best way of discussing gender neutral results is to start with what might be considered the ‘ideal binary male’ top surgery result. From there we can discuss its binary features and then how those features could be modified to an individual’s preference to express a more non-binary appearance.  

Incisions and Chest Contours, as well as content on Nipple and Areola Options are great starting places to begin learning more about non-binary top surgery. It’s important to note that this content has been developed around the identities and surgical needs of the non-binary and gender-neutral patients that Dr. Mosser has seen at his practice and are not a representation of what all gender-neutral individuals may want. 

 While exploring non-binary and gender-neutral content it’s important to keep in mind the following: 

• Gender neutrality is usually (and unfortunately) limited by social constructs that are binary (male or female). What feels and looks like a non-binary surgical result to you may still be seen as ‘male’ or ‘female’ to others 
• Surgical results that are more representative of a gender-neutral appearance will ideally allow for more flexibility and adaptation within our binary society which may help alleviate symptoms associated with gender dysphoria
• Although some folks chose surgery as a method of finding congruence in their gender identity, others do not, which is a completely valid decision