Top Surgery: Techniques, Scars, Risks and Recovery

Top surgery is an umbrella term, not a single operation. It covers masculinising chest surgery and feminising chest surgery, and within each there are several techniques that produce different scars, different sensation and different limits. The right one depends on your anatomy and goals, and is decided at assessment.

Planning from South Africa? Our guide to top surgery in Turkey for South African patients covers flights from Johannesburg and Cape Town, the e-Visa and how long to stay before flying home.

Masculinising chest surgery: the techniques

Double incision with free nipple grafts. Breast tissue and excess skin are removed through horizontal incisions, and the nipple and areola are resized and grafted back into position. It suits larger chests and skin with less elasticity, gives the flattest and most predictable contour, and leaves two long horizontal scars. Because the nipple is grafted, erotic sensation in it is usually lost, and some pigment change or partial graft loss is possible.

Periareolar (keyhole with a circular incision). Tissue is removed through an incision around the areola, which is then reduced and tightened. It suits smaller chests with good skin elasticity, keeps the nipple attached with its blood supply and more of its sensation, and leaves a circular scar. It carries a higher revision rate, because skin redraping is less predictable.

Keyhole. Tissue is removed through a small incision at the lower edge of the areola, with no skin excision. Only suitable for small chests with excellent elasticity and a nipple already well positioned.

Inverted-T or other patterns may be proposed where skin excess and nipple position call for it.

Feminising chest surgery

Breast augmentation with implants, or in selected cases fat transfer. Planning differs from augmentation in a cisgender chest: the chest is often wider, the breast footprint and nipple position sit differently, and the skin envelope may be tighter. Implant size is limited by what the tissue will safely accommodate, not by what is requested.

Where oestrogen therapy has been taken, surgeons usually want breast development to have plateaued before operating, because further growth can change the result. Fat transfer requires enough donor fat and gives a smaller, less predictable volume increase, with some of the transferred fat reabsorbing.

What decides which technique

Chest size and skin quality, skin elasticity, nipple and areola size and position, degree of asymmetry, body mass, whether you have taken testosterone or oestrogen and for how long, previous chest surgery or scarring, smoking, and what result you want. Two people who want the same outcome are often offered different operations.

Smoking matters more here than patients expect. It impairs healing and raises the risk of nipple graft failure and wound breakdown; most surgeons require you to stop well before surgery.

Scars and sensation

Every technique leaves a scar. Scars are red or dark and firm for the first months, then gradually flatten and fade over a year or more; final appearance depends on your skin and healing, not only on the surgeon’s technique. Scar position and length can be predicted; final quality cannot be promised.

Sensation is altered in all techniques. With free nipple grafts, nipple sensation is usually substantially reduced or lost. With nipple-preserving techniques, sensation is more often retained but may still change, and numbness across the chest is normal for months.

Risks

Bleeding and haematoma, infection, seroma, delayed healing or wound breakdown, partial or complete nipple graft loss, asymmetry, contour irregularity or residual tissue, “dog ears” at the ends of incisions, altered or lost sensation, hypertrophic or keloid scarring, implant-related complications where implants are used, blood clots, and dissatisfaction with the result. Revision is not uncommon, particularly after periareolar techniques.

Recovery, realistically

Expect a compression binder for several weeks, drains in some cases for the first days, and restricted arm and shoulder movement early on. Desk work is often possible within one to two weeks; lifting, gym and overhead work take considerably longer. Swelling settles over months, and the final contour is judged at six to twelve months, not at six weeks.

If you are travelling, plan the flight home around your surgeon’s advice rather than a fixed date, and arrange who reviews you once you are back.

Before you book: questions to ask

• Which technique is proposed for me, and why that one rather than the alternatives?
• Where exactly will the scars sit, and what will they look like at six and twelve months?
• What will happen to nipple sensation with this technique?
• What is this surgeon’s revision rate for this operation, in their own patients?
• Who is the operating surgeon, what is their registration, and which hospital is used?
• What is the policy if revision is needed, and who pays?
• Who reviews me after I return home, and how are complications handled at distance?

The answers belong in a written treatment plan.

Where this is set out on our site

Our top surgery page covers the procedures and assessment route, and top surgery scars explains healing in more detail. Where genital surgery is also being considered, see FTM bottom surgery and the FTM bottom surgery page. Feminising chest surgery shares planning considerations with the breast implants and fat transfer breast augmentation pages.

Treatment arranged through Revitalize takes place in Izmir. The surgeon and the hospital are contracted providers named in your written treatment plan, so their registration and experience can be checked before you travel. See our contracted surgeons and specialists and contracted hospitals pages, the treatment process page, and the treatment guarantee page for the limited written warranty that applies.

Whether surgery is appropriate, and which technique, is a clinical decision made with you after assessment — not something that can be settled from a price list or a photograph.

For financial planning after clinical assessment, read Revitalize’s itemised guide to top surgery price factors, quotation inclusions and exclusions.