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Male chest reconstruction, or top surgery, is a key step for transgender and nonbinary people wanting a more masculine look. It involves altering the chest to appear male. This surgery is vital for those dealing with gender dysphoria, aiming to boost their confidence and happiness. There are different types of top surgery. For instance, chest masculinization and chest feminization. They vary based on what each person wants and needs.

Male Chest Reconstruction: Transforming Your Body 2

Key Takeaways:

  • Male chest reconstruction, or top surgery, is a transformative procedure for transgender and nonbinaryindividuals seeking a more masculine appearance.
  • It involves removing or augmenting breast tissue and reshaping the chest to align with the patient’s gender identity.
  • Chest masculinization and chest feminization are two types of top surgery tailored to meet individual needs and goals.
  • Top surgery is an important element of gender affirmation treatment, enhancing body confidence and overall well-being.
  • Specialized surgeons and medical centers offer expertise and understanding for optimal results and patient satisfaction.

What is Top Surgery?

Top surgery is a big step for many in their journey to affirm their gender. It helps people feel more at peace with their body by removing or adding breast tissue. This makes their chest look more like they feel inside – either more masculine or feminine.

There are different kinds of top surgery, each based on what a person needs. The most usual one is the Double Incision Mastectomy. This surgery is for people wanting a more male-looking chest. It removes a lot of breast tissue. There’s also a method called the Buttonhole Technique for those who want to keep their nipple feeling. But, how well the nipple feels after varies from person to person.

For those aiming for a smaller and slightly feminine chest, there’s the Gender-Affirming Breast Reduction. It’s done through a long incision, similar to the double incision surgery. But it aims for a different result. Then, there’s Chest Feminization. This requires breast implants and might need a year of taking estrogen before some doctors and insurances will approve it.

Top surgeries usually last for two to three hours and don’t need a hospital overnight. After the surgery, patients need to be careful. They shouldn’t lift their arms too high or lift heavy things for a few weeks to make sure they heal well.

After surgery, scars can take up to 18 months to fade completely. Some people may choose to have more surgery to make their scars less visible. It’s a good idea to protect the scars from the sun as they heal.

In the end, top surgery is a very important part of the journey for many transgender and nonbinary people. It helps them live more closely to how they feel inside and boosts their confidence.

Types of Top Surgery for Chest Masculinization

Thinking about chest masculinization presents several surgical methods. These techniques aim to create a more masculine chest look. They are customised to fit each person’s specific needs for the best results.

The double incision mastectomy is often suggested for people with big chests or much drooping. In this surgery, two cuts are made across the chest. This removes breast tissue and reforms the nipples. It is a complete change, helping people get the chest they dream of.

Keyhole top surgery is better for those with small chests and stretchy skin. This method involves small cuts at the edge of the areola to take out breast tissue. It’s great for those who need just a little change and want to avoid big scars.

The buttonhole technique aims to keep the nipple feeling while creating a masculine chest shape. It uses cuts around the areola and under the skin to remove extra tissue. This method balances keeping nipple feeling with the desired look.

In some cases, people with larger chests and extra skin choose the inverted T (anchor) incision or the buttonhole incisionto save nipple feeling. These methods allow access to remove breast tissue and keep the nipple and areola healthy. The inverted T includes a vertical cut from the nipple to the chest’s lower part. It creates an anchor-like scar. The buttonhole method adds a circular cut around the areola to the double incision approach.

Although rare, there are also the lollipop and two-stage periareolar techniques. The lollipop method includes a vertical cut from the nipple to the chest’s base. It suits those with mid-size chest tissue and flexible skin. Two-stage procedures are not common and spread the surgery over two steps, allowing for slower changes and scar control.

After surgery, making the nipple look natural might need nipple grafts. This includes moving the nipple and areola to a new chest spot. It can help in creating a better-looking nipple.

Scars can happen after top surgery and they depend on the procedure and each person’s healing. It’s key to follow the after-surgery care and quit smoking, which slows healing. Scars get better over 12-18 months, looking more natural.

The top surgery method picked for chest masculinization varies based on factors like body shape, chest size, and skin stretchiness. Meeting with a skilled plastic surgeon who does gender surgery helps decide the best strategy for the results you want.

Top Surgery TechniqueIdeal Candidates
Double incision mastectomyPatients with large chests or significant sagging
Keyhole top surgerySmall-chested individuals with high skin elasticity
Buttonhole techniqueIndividuals seeking nipple preservation and sensation
Inverted T (anchor) incisionLarge-chested individuals with inelastic skin
Lollipop techniquePatients with moderate chest tissue and appropriate skin elasticity
Two-stage periareolarIndividuals preferring a gradual approach and scar management

Gender-Affirming Breast Reduction

Gender-affirming breast reduction surgery is for those wanting a smaller, more androgynous chest. It removes breast tissue, aiming to keep nipple sensation. The chest gets a round shape with a vertical cut, leaving an anchor scar. Even with tissue gone, the cancer risk stays, especially for those at high risk.

For trans men with small chests, a circular surgery might be best. Those with tight skin and a bit of chest can still get surgery without removing extra skin. For trans and nonbinary people, compared to cis women, more tissue often needs to go during gender-affirming breast reduction. Their mastectomy surgeries also focus on resizing the NAC for a natural look on a flat chest.

For transmasculine top surgery, liposuction helps shape the chest more like what’s seen as masculine. Most patients can leave the same day, but they need someone to take them home. After surgery, it takes four to six weeks to fully get back to normal. During this time, avoid lifting anything over your head.

Chest surgery swelling can take months to go down completely. In places like California, insurance might help with the cost. But, you need to meet certain health criteria and submit the right paperwork.

Chest Feminization

Chest feminization is a surgery that makes the chest look more feminine. It helps transgender women and non-binary people feel more like their true selves. This surgery is a key step towards their gender identity alignment.

In this surgery, breast size is increased. Surgeons put implants either behind the breast or under the muscle. This makes the chest seem more feminine. It is an important part of their gender transition.

Some may grow natural breasts through hormone therapy. Surgeons might ask for time on estrogen before doing the surgery. This lets the breasts develop first.

Before surgery, a mammogram is often advised to check breast health. This helps find and treat any health problems early. It’s a step to make sure the patient is safe during the surgery.

Choosing to have this surgery is a big step. It needs emotional strength and support. Talking to a specialized surgeon is very important. They will make a plan that fits the patient’s needs and helps them reach their goals.

The surgery process starts with a detailed evaluation. The surgeon looks at the patient’s body and needs. They then plan the surgery just for them. This way, the surgery is more likely to succeed.

After the surgery, proper care is crucial. This includes managing pain, following movement limits, and allowing time to heal. Doing what the surgeon says helps healing and reduces risks.

As with any surgery, there are risks and things to watch out for. This includes infections, bleeding, and problems with the anesthesia. Also, there could be issues like scar problems, changes in nipple feeling, or differences between the breasts. Knowing these risks and talking about them with the surgeon is important. Deciding for the surgery should be well thought out, with a clear understanding of what to expect.

What Happens during Top Surgery

Top surgery is a big step that makes how people look match how they feel inside. It’s not the same for everyone. The surgeon picks the best methods for each person. This includes making marks for surgery and picking the right anaesthesia. The way people heal after surgery starts a new, positive phase in their lives.

Usually, top surgery happens outside a hospital and takes about two to three hours. Before it starts, the surgeon marks the chest area. This makes sure things look right. The marks are like a map for the surgery.

The surgery happens while the patient is asleep, thanks to general anaesthesia. This keeps the patient from feeling any pain. It also helps the surgeons do their job well. After surgery, the patient wakes up slowly and is taken to rest.

After waking, patients find they have stitches and dressings, and wear a tight garment on their chest. This garment helps the area heal correctly and stops problems. Patients wear it for a while after surgery for the best results.

Doing what the doctor says is really important during recovery. This means taking care of the wound, going for check-ups, and not doing too much. How quickly someone feels okay again can change; for many, it’s about two weeks. But, everyone’s body is different, so it needs time to heal properly.

While top surgery can change life for the better, things can go wrong. For example, a pus-filled spot called an abscess can form. If this happens, it might need special care, like draining it or medicine.

Having uneven nipples or noticeable scars can also occur. If this bothers someone, more surgery might be an option. Scars usually get better with time. But, sometimes, they might not go away completely without more help.

Numbness in the chest or nipples after surgery is quite common. It’s okay to talk to the doctor about any worries you have about this. Very rarely, the top part of the nipple might not get enough blood and die. This needs quick medical help to fix.

Top surgery is more likely to work well in people with a BMI under 30. But, even those with a higher BMI might still be okay to have it. Being healthy and keeping your weight in check is good before surgery. It can help you heal better and get the results you want.

Last, getting ready for top surgery means staying away from nicotine and certain drugs. These can make healing harder and could even mean the surgery isn’t safe. It’s also wise to cut down on weed before surgery because it can cause problems with anaesthesia and surgery safety.

ProcedureIdeal CandidatesDurations
Keyhole Top SurgeryIndividuals with A cup-size and ample chest skin elasticityApproximately 2 to 3 hours for the procedure
Peri-areolar/Concentric CircleThose with B-cup size or a C-cup size and moderate-to-great chest skin elasticityTypically takes between 1.5 to 4 hours for the procedure
Double Incision/Bilateral MastectomyIndividuals with a C-cup size and reduced skin elasticity or a D-cup sizeGenerally takes between 1 and 2 hours for the procedure

Recovering from Top Surgery

Recovering from top surgery is key in changing your body. A smooth recovery is vital. Follow the advice given by your surgical team. This phase can last several weeks. During this time, you must be careful to heal well and avoid problems.

After top surgery, be careful with physical activities. It usually takes 6 weeks to fully go back to everything. But, you could go back to work or school in 1-2 weeks, with some restrictions. Don’t lift heavy things for 3-6 weeks after the surgery.

Wearing a special garment is important for your recovery. It helps with swelling and supports your chest. Make sure to wear it as the doctors tell you.

Dealing with pain is a big part of getting better after the surgery. You might feel sore. Use painkillers the doctors suggest to feel better.

After the operation, you might have dressings and drains. Always follow your doctor’s advice on caring for them. They will only be taken out at your next check-up.

Keeping clean is also very important for recovery. Always shower or bathe as your doctor says. You can’t shower until the dressings and drains have been taken out, which could be between 3 to 7 days.

Everyone’s recovery is different. It depends on your health and the type of surgery you had. To recover well, stick to what your doctors say. Keep in touch with them and go to your check-ups.

Postoperative InstructionsEstimated Recovery Time
Avoid lifting heavy objects3-6 weeks
Return to work or school1-2 weeks
Full physical activityApproximately 6 weeks
Sedentary work and light physical activity7 to 9 days

Watch out for any symptoms that worry you. Things like not being able to breathe, feeling like you might faint, chest pain, or very swollen legs. If you have these, call 911. Also, tell your doctor about anything strange during your recovery for advice.

Doing what your doctors tell you, wearing the right clothes, handling pain, keeping clean, and attending check-ups help a lot. They make your recovery smoother and give you the results you want. Good luck!

Risks and Complications of Top Surgery

Top surgery is a big operation with its own set of risks. Everyone thinking about it must know these dangers. They should talk about them a lot with their surgeon before deciding.

Early Complications

Some issues can show up right after the surgery. These include problems with healing, swelling of fluid, and bad bruising. They might slow down getting better and need more medical help.

Skin Flap and Incisional Complications

The surgeon cuts the skin to change the chest during top surgery. But, sometimes, the skin might not heal right. Bad healing or the skin coming apart needs more surgery to fix.


Getting an infection after surgery is not common, but it can happen. It’s really important to follow all the care steps after surgery. Tell the surgeon right away if you feel hotter than normal, see more redness, or feel more pain.

Nipple Complications

Nipple problems are a possible issue. This could mean less feeling or losing a nipple. Talk in detail with your surgeon about what could happen to your nipples after the operation.


Scars are part of top surgery, but their size can change. Surgeons work hard to make scars as small as they can. They also give tips on how to make scars look better. Remember, scars get better over time, usually in three to six months.

Understanding the Risks

Other risks are blood clots, big bruises, or even death, though very rare. It’s key for patients to fully understand what could happen. The surgeon will carefully check if the person is ready for surgery to lower risks.

Choosing a top surgeon is critical for those wanting surgery. Talking openly with the surgeon and knowing every risk is vital. Following all care steps can lower chances of problems and help make the surgery a success.

Postoperative Care in the Primary and Urgent Care Setting

After top surgery, care is key to good healing and recovery. It helps with issues like wound separation and slow healing, and improves scars’ look. All these make the surgery’s result better.

Wound separation happens when the cut opens. This can be from tough healing. It’s vital to teach patients to look after their wounds well. Keeping an eye on healing helps catch infections early.

Helping wounds heal is vital for recovery. Healthcare teams give advice. It includes keeping the cut clean, not overworking it, and eating well to help your body heal.

Looking after scars well is key after top surgery too. Those who often get big scars could focus more on this. They can try scar massage and use special gels or sheets. This makes scars look better and less noticeable.

In the primary and urgent care, knowing top surgery’s special needs is important. Professionals should guide on wound care and check healing. They should be ready to help with any issues. This quick help makes recovery smoother.

Postoperative Care Guidelines for Top Surgery

Here are some tips for after top surgery:

  1. Keep the cuts clean and dry to avoid infection.
  2. Take your medicines as told, including for pain and to stop infection if needed.
  3. Don’t do hard work, lift heavy things, or stress the cuts for 4-6 weeks.
  4. Wait 3 weeks before swimming in lakes or pools after surgery.
  5. Go back to work or school when your team says it’s okay.
  6. Keep your next check-up to make sure you’re healing well and ask any questions.
  7. If you feel very bad, like if you bleed a lot, see red lines near the cuts, or have a high fever, call for help right away.
Wound ClassificationRisk of Infection
CleanLess than 2%

Looking after wounds well stops infection, especially for those with dirty wounds. Patients should know what a bad infection looks like and ask for help if needed.

Postoperative Complications Related to Wound Healing

Sometimes healing after top surgeries is tough. Wounds could open because of many reasons. It’s vital to watch healing closely. This stops big problems like open wounds.

Some may get hernias after surgery. It’s when the belly wall weakens. This might happen within 6-8 weeks after surgery. Knowing the signs and seeking help quickly is important.

Postoperative Fever and Infection Risks

Getting a fever after surgery is common. It can be from many things. Knowing these causes helps doctors treat you better and avoid serious issues.

Stopping infections after surgery is very important. Doing wound care right, spotting infections early, and getting help soon are key parts of treatment and prevention.

Skin Flap and Incisional Complications and Scarring

Top surgery raises thin skin flaps that can cause issues. Sometimes, their healing comes with problems, leading to issues like delayed healing. Also, the skin on these flaps might die, causing necrosis. To avoid serious scarring, it’s key to not stress the surgery sites too much.

Stats show a 31.5% complication rate within 2.1 months post-op. Common problems are losing part or all of a nipple, fluid build-up (seroma), blood clots (hematoma), and infections. The good news is that these often don’t need further surgery. But keeping a close eye on how you heal is really important.

It’s normal for scars to look worse at first and darker skinned individuals may have more visible scars. Your genes also affect scar formation. You may see the full scar change after a year. Genes can also impact whether your scars get unusually light, thick, or form keloids.

To avoid bad scar tissue, limit arm movement for a few weeks after your operation. This is to stop your scars from stretching too much. Age and pregnancy play a part too. Working with a physiotherapist and sticking to a rehab plan can help you get better faster.

Looking after your scars is vital for how they’ll look. Avoid cigarettes and nicotine, as they mess up wound healing. Do what your doctor suggests, like using silicone on your scars and stepping out of the sun, to manage them properly.

If your scars don’t heal well, treatments like steroid shots, tiny needle pricks, light and laser therapy, and even tattooing can help. In rare cases, you might need another surgery 6–12 months after the first. This can fix scars caused by too much tension during early recovery.

Summary of Statistical Data

Statistical DataReference
Mean BMI of obese FtM patients who underwent bilateral chest masculinization: 39.2 kg/m2 (SD 5.2)
Overall rate of complications: 31.5% at a median follow-up of 2.1 months
Partial nipple graft loss: 18.5%
Total nipple graft loss: 5.6%
Seroma: 3.7%
Hematoma: 3.7%
Infection: 2.9%
Incisions from top surgery can take up to 12 months to fully heal and develop into mature scars
Scars may appear more noticeable in people of color due to skin pigmentation
Genetic predispositions can contribute to abnormal scarring
Patients may be advised to limit arm movements to reduce stretching forces on incisions
Consulting with physical therapists and following prescribed rehabilitation guidelines is recommended
Avoid smoking or nicotine use for proper wound healing and scar formation
Non-surgical treatments for abnormal scarring may include steroid injections, microneedling, microchanneling, BBL, laser therapy, and medical tattooing
Scar revision surgery can be considered 6-12 months after the initial top surgery


Hematoma, Seroma, and Infection

After top surgery, there’s a chance of problems like hematomaseroma, and infection. These issues can slow down healing. They might need more medical help to fix.


Hematoma can happen after the surgery. It’s when blood collects under the skin. To fix this, sometimes the blood has to be removed to keep the skin okay.


Seroma is when fluid gathers under the skin after the surgery. Even if drains are used, it might still happen. This can slow down healing and needs care to get better.


Infection is a rare issue after surgery. It shows as redness or swelling of the skin. But, it can usually be fixed with antibiotics if found quickly.

The chances of getting hematoma or seroma might depend on the surgery. For example, surgeries on the abdomen might see this in 10% to 45% of people. For face surgeries, it’s less, around 8% to 13%.

Research tells us that seroma can make healing harder. But, some treatments like tissue sealants can help in plastic surgeries. Such treatments improve how wounds heal after the surgery.

In the end, hematoma, seroma, and infection are possible after top surgery. Spotting and treating these issues early is very important. This helps healing well, reduces risk, and gives good looks.

ComplicationIncidence Rate
Hematoma10% to 45% in abdominoplasty procedures; 8% to 13% in rhytidectomy procedures
SeromaVaries; occurs in approximately 15% or more of patients undergoing male chest reconstruction for gynecomastia treatment
InfectionBelow 1% in elective plastic surgery procedures


  1. Hematoma or seroma formation has been reported in between 10% and 45% of patients undergoing abdominoplasty procedures. Hematoma or seroma occurrence rates range from 8% to 13% in rhytidectomy procedures. Complications such as seroma formation have been documented to negatively correlate with wound infection and alter normal wound healing. Studies have shown a positive impact on wound healing with tissue sealants such as fibrin glue and platelet gels in oral, orthopedic, and plastic surgery procedures. Animal models have demonstrated a decrease in seroma formation with the use of tissue sealants like fibrin glue.
  2. Complications associated with plastic surgery have a serious complication risk of less than half of one percent. The mortality rate associated with plastic surgery is less than one in 50,000 patients. The incidence of infection after elective plastic surgery procedures is well below 1%. Nausea and vomiting are common side effects after surgery due to anesthesia. Blood clots can occur post-surgery due to immobility. Seroma, a watery fluid build-up complication, may occur during recovery. Tissue death (necrosis) risk increases significantly for smokers undergoing surgery. Health risks associated with anesthesia include airway obstruction, abnormal heart rhythm, allergic reaction, brain damage, stroke, and death. Loss of or reduced nipple sensation is a common risk of chest reconstruction top surgery. Scarring is inevitable with chest reconstruction top surgery; the extent depends on techniques and body’s scarring propensity. Revision surgery may be required for asymmetric nipple placement, undesirable size/appearance, or prominent scarring. Older patients have higher risk due to varied medical histories, but overall health is a better indicator of risk than age.
  3. Seromas occur in approximately 15% or more of patients undergoing male chest reconstruction for gynecomastia treatment. Seromas can potentially be resolved on their own with little risk of infection for some patients. There is a higher susceptibility to developing seromas in some patients for reasons that are not fully understood. Seromas are more commonly found close to the nipple-areola complex due to the primary location of gynecomastia tissue treated during the procedure. Aspiration techniques are generally used to manage seromas that appear within one month of surgery. Older seromas lasting beyond a month may require excision treatment. Seromas can lead to contour irregularities or the formation of scar tissue, which may affect the aesthetic outcome of gynecomastia contouring. Limiting fluid intake and wearing compression garments are recommended to help seromas dissipate. Most seromas eventually resolve, and patience is key in dealing with this issue. Insurance coverage for seroma treatment is variable and dependent on individual provider policies.


Male chest reconstruction, known as top surgery, changes lives. It helps with body confidence and gender affirmation in transgender and nonbinary people. It targets each person’s specific needs. This includes making chests look more masculine or feminine.

Knowing the risks of top surgery is vital. Yet, its positive effects are more significant. In a study, 10% of male patients aged 12 to 21 had early issues. Hematomas and slight infections were common. But, after surgery, 34.3% faced at least one complication. This included leftover tissue and shape irregularities. Still, it boosted their self-esteem and quality of life. Both groups, those with and without complications, showed big improvements in many areas. These include physical and mental well-being after the surgery. It’s interesting that how the surgery is done, the severity of gynecomastia, and the patient’s weight didn’t change the surgery’s advantage.

Thanks to better surgeries, more individuals can match their appearance with their gender. This helps them feel more like themselves and improves their well-being. Following the surgery, taking good care of oneself and talking openly with the medical team are key. They help surgery go smoothly and boost recovery. Male chest reconstruction gives people power on their journey to self-acceptance and confidence. It greatly helps in confirming their gender journey.


What is male chest reconstruction?

Male chest reconstruction, or top surgery, helps make a chest look more masculine. It’s for transgender and nonbinary people. It involves removing or adding breast tissue.

Why do people choose top surgery?

Transgender and nonbinary people pick top surgery to feel more like themselves. It helps with gender issues and makes them happier.

What are the types of top surgery for chest masculinization?

Top surgery includes different methods like double incision mastectomy and keyhole top surgery. Also, the buttonhole technique is used.

What is gender-affirming breast reduction?

Gender-affirming breast reduction makes a chest smaller and somewhat feminine. It takes out breast tissue but keeps nipple feeling.

What is chest feminization?

Chest feminization adds breast implants. It makes a chest more feminine looking.

What happens during top surgery?

Top surgery happens in an operating room and takes a few hours. The surgeon makes the chest look more masculine or feminine. This is done under general anesthesia.

How long does it take to recover from top surgery?

Recovery from top surgery takes time. You must follow the doctor’s advice, wear a compression garment, and avoid activities that could harm your chest. It’s key to listen to the doctors for the best healing.

What are the risks and complications of top surgery?

Top surgery could have some issues like slow wound healing, fluid under the skin, skin feel changes, and possible infections. Problems with the chest and nipples may happen too.

How should I care for my incisions after top surgery?

After top surgery, you need to follow all the care tips the doctors give you. This includes watching for any big issues, keeping the wounds clean, and knowing how to handle scars. Tell your doctors if you’re worried about something.

What are the potential complications of top surgery?

Top surgery could have issues like blood clots, too much fluid under the skin, and infections. It’s important to spot and treat these problems early for the best outcome. 

How does male chest reconstruction improve body confidence?

For many transgender and nonbinary people, male chest surgery changes how they feel about themselves. It can majorly boost their confidence. It helps with gender issues.

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