Top Surgery

Alternative Names: Gender-Affirming Surgery, FTM, Chest Feminization, Chest Masculinization

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Summary of Top Surgery

Cost :
Surgery Length:
1 - 3.5 Hours
Anesthesia :
Local or General Anesthesia
Recovery :
4-5 Days off of work
1 - 4 Weeks - Full Activity
Gender affirming top surgery is a procedure to alter the appearance of the chest in creation of a more masculine or feminine appearance for transgender and non-binary people.  The goal of this surgery is to allow body to look and feel more aligned with your gender identity. 

Although top surgery is the most commonly performed gender affirming surgery, there are many other body contouring procedures that we offer that can help create or remove curves to help the physical body better align with one’s gender identity.

What is Gender Affirming Top Surgery?

Transgender Female: 
Gender affirming top surgery for a transgender female involves the use of breast implants to create a breast mound.  In terms of desired outcome, transgender patients have the same opportunities as with a standard breast augmentation to create a natural and more subtle breast, or a more full and voluptuous look.  There are many options available for incision placement, implant size, and implant placement.  

Patients are able to choose between a silicone or a saline implant.  A silicone implant is made up of a silicone shell filled with silicone gel for a natural feel.  These implants are also known as cohesive gel or gummy bear implants because the gel will remain in shape even if the implant ruptures.  A saline implant consists of a silicone shell filled with saline, or salt water.  If these implants ever rupture saline is completely safe for the body, and you will also know immediately so that the implants can be replaced.

With either implant ruptures are unlikely, but it is important to be aware of and prepared for these situations when deciding on your implant.
Transgender Male: 
Gender affirming top surgery for a transgender male involves removing breast tissue through natural looking scars in the inframammary fold and around the areola, creating 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 approach this procedure with many different types of incisions.

For some patients with a small amount of breast tissue, creation of a masculinized chest can be achieved through a small peri-areolar incision. For most, the procedure is similar to a mastopexy or mastectomy where significant breast tissue and skin are removed.  Your surgeon will tailor the surgical approach to your specific anatomy to create the most natural looking chest possible.


Transaxillary, Inframammary, and Peri Areolar. Next, there are some options when it comes to incision site:
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.

Finding The Right Surgeon

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.

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 explaining the top surgery procedures that SixSurgery offers.


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.

Potential Risks and Complications

Transgender men, women, 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.