From the Guidelines
Top surgery refers to surgical procedures that alter the appearance of the chest, most commonly performed as part of gender-affirming care for transgender individuals, and is considered medically necessary for many transgender individuals experiencing gender dysphoria, as it can significantly improve psychological well-being and quality of life by aligning physical characteristics with gender identity. For transgender men and nonbinary people assigned female at birth, top surgery typically involves the removal of breast tissue and reconstruction of the chest to create a more masculine appearance (mastectomy with chest contouring) 1. For transgender women, top surgery may involve breast augmentation to create or enhance breasts. The specific surgical techniques vary based on the individual's body type, amount of breast tissue, and desired outcome. Recovery typically takes 6-8 weeks, with restrictions on lifting and physical activity during the healing process. Most patients can return to desk work within 1-2 weeks. The procedure is typically performed by plastic surgeons or surgeons specializing in transgender healthcare, and patients usually require a mental health assessment and may need to meet certain criteria before surgery 1. It's also important to consider the individual's anatomy and gender identity when making cancer treatment decisions, as gender-affirming surgical care can influence cancer risk and treatment options 1. Some key points to consider include:
- The volume of breast tissue remaining after top surgery varies based on patient preferences for chest contouring and surgical decision making.
- Imaging, particularly breast magnetic resonance imaging, can help elucidate the volume of residual breast tissue, and this information is critical for surgical and radiation therapy decision making.
- A TGD individual's experiences of gender dysphoria may affect cancer treatment, and some individuals may find surgical procedures affirming or compromising their gender identities. Overall, top surgery is a crucial aspect of gender-affirming care for many transgender individuals, and it's essential to prioritize their physical and mental well-being when making treatment decisions.
From the Research
Definition of Top Surgery
- Top surgery refers to gender-affirming chest procedures, which include breast augmentation or mastectomy, aimed at aligning the physical appearance with gender identity 2, 3.
- The goal of top surgery is to improve psychological functioning, relieve distress from gender dysphoria symptoms, and achieve an outward appearance that closely aligns with the individual's gender identity 2.
Types of Top Surgery
- Breast augmentation for transfeminine patients, which involves the use of silicone implants or autologous fat grafting to create a feminine chest contour 3, 4.
- Mastectomy for transmasculine patients, which aims to create a smooth, masculine-contoured or neutral chest while preserving nipple sensation 3, 5, 6.
- Different surgical techniques are used depending on breast size, the degree of ptosis, and skin elasticity 3, 5, 6.
Benefits and Outcomes of Top Surgery
- Top surgery has been shown to lead to significant improvements in the well-being of individuals with gender incongruence 3.
- Patient satisfaction with surgical outcomes is consistently high, underscoring the importance of these procedures for improving quality of life 3, 4, 5.
- Complication rates are generally low, and complication rates decrease over time with experience 5.