Top surgery is a gender-affirming surgical procedure primarily sought by transgender and non-binary individuals to alter their chest appearance. The specific procedure performed varies depending on the individual’s goals and desired results, typically falling into two categories: mastectomy for those assigned female at birth seeking a more traditionally masculine chest, and breast augmentation for those assigned male at birth seeking a more traditionally feminine chest. For transgender men and non-binary individuals assigned female at birth, the procedure involves the removal of breast tissue and reshaping the chest to create a flatter, more traditionally male or androgynous appearance. Techniques used may include the double incision method, which involves larger incisions and is suitable for larger breasts, or the keyhole or periareolar method, which involves smaller incisions and is suitable for smaller breasts. The choice of technique is influenced by factors such as chest size, skin elasticity, and personal preferences regarding scarring.

On the other hand, for transgender women and non-binary individuals assigned male at birth, top surgery can involve breast augmentation, which entails the insertion of breast implants to create a more traditionally feminine chest contour. The procedure typically involves making incisions in discreet locations such as the inframammary fold, around the areola, or through the armpit, through which silicone or saline implants are inserted. The choice of implant type, size, and incision site is tailored to the individual’s body type and aesthetic goals. Throughout both types of top surgery, a multi-disciplinary care approach is emphasized, often involving pre-operative consultations to discuss expectations, risks, and post-operative care. Post-operative recovery involves managing discomfort, swelling, and following specific care instructions to ensure optimal healing and results. Top surgery is a deeply personal procedure, offering profound psychological benefits by aligning an individual’s physical appearance with their gender identity.