Gender Affirming Plastic Surgery: What Is A Top Surgery?

Written By
Megan Apa
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October 6, 2022

As we build a more accepting society towards the 2SLGBTQ+ community, it is no surprise that the interest in gender affirming surgeries is on the rise. That being said, not every plastic surgery clinic offers the information or resources to make these procedures approachable for the trans community.

These procedures can be lifechanging, even moreso than a typical plastic surgery procedure like a rhinoplasty or BBL. For this reason, it is so important that trans and non binary patients receive the most accurate information about gender affirming procedures so that they can make informed decisions about their bodies.

There are so many cosmetic surgery options for trans and non binary people to feel more comfortable in their bodies. From body contouring procedures like liposuction and fat transfer to add curves, to jawline filler to add a more masculine structured appearance. That being said, some of the most popular procedures for trans men, women, and non binary people is Top Surgery, of which there are two main types.

Top Surgery for Trans Men and Non Binary People

This procedure involves the removal of breast tissue for a more masculinized chest. After the breast tissue is removed, the excess skin also needs to be taken in to create a smooth appearance. Depending on the amount of breast tissue and excess skin that needs to be removed, the surgeon can tackle this procedure with many different types of incisions. For some patients with a small amount of breast tissue, this can be as simple as a gynecomastia procedure. For most, the procedure is more invasive similar to a mastopexy or mastectomy. No matter the surgeons approach to the procedure, they will use special techniques to contour the body to create the patient’s desired appearance.

Some patients are hesitant to undergo this procedure for the scars. As the excess skin removal is a large part of the procedure, is very common for the scar to extend across the chest. While scars can be intimidating at first, it is important to remember that they will fade over time. By following post operative instructions and taking care of the scars, they can dramatically fade over the course of a few years.

On a positive note, there has been a lot of scar celebration in the 2SLGBTQ+ community. As more people become comfortable with sharing their stories, they have also made it more common to showcase scars instead of covering them up. Your scar can be a part of your story.

Transgender men and nonbinary people face the same risks as everyone else when it comes to surgery - including the risk of bleeding, infection and an adverse reaction to anesthesia. However, there may be some additional concerns for patients of large volume breast tissue removal, like fluid buildup, damaged tissue, and loss of feeling in the nipples. Talk to your surgeon about all of your risks and concerns before surgery so you can make an informed decision about whether or not it's right for you.

Top Surgery for Trans Women and Non Binary People

This procedure is essentially a Breast Augmentation, which involves the insertion of a breast implant to create a more full and round breast. The patient has tons of options about placement, size, and incision site in order to best suit their needs.

First, they must choose between a silicone or saline implant. A silicone implant is made up of a silicone shell filled with silicone gel. These implants are also known as cohesive gel or gummy bear implants, because the sticky gel will remain in shape even if the implant ruptures. The other option is a saline implant. These also have a silicone shell, but they are filled with saline, or salt water. If these implants ever rupture, saline is completely safe for the body. You will also know immediately, so that you can get them replaced. With either implant, ruptures are unlikey, but it is important to be aware of and prepared for these situations when deciding on your implant.

Next, there are some options when it comes to incision site: Transaxillary, Inframammary, and Peri Areolar. Transaxillary incisions are made through the armpit, and once healed the scar is indistinguishable from an armpit wrinkle. Inframammary incisions are made under the breast fold, which is generally reccomended if the breast fold is already very well defined. This is something to consider for patients who are working with little to no existing breast tissue. Periareolar incisions are made through the areola, and are less common but are excellent ways to hide scars.

Unlike top surgeries for men, this procedure has much smaller scars. The SixSurgery Clinic has mastered the Tiny Scar Breast Augmentation, which allows for 1” scars that become virtually invisible after the healing process.

Transgender women and non binary people also have the same risks assosciated with breast augmentations, like capsular contracture, pain, discfomfort, and implant rupture.

Find The Right Surgeon

Finding a surgeon who is knowledgeable and experienced in transgender and non binary surgery can be a huge step in your transition. Not only will you have someone to turn to for guidance, but you'll also have someone who understands the unique needs of the community. While not every surgeon has this level of expertise or compassion, there are a lot out there who are happy to support trans and non binary patients through their surgical journey. For example, SixSurgery’s Dr. Jacqueline Rose Makerewich, who is known for her compassionate approach to all patients. Additionally, she has several videos and articles explaininng the top surgery procedures that SixSurgery offers.