Cosmetic Surgery Tips

Breast Reduction Surgery For Gender Dysphoria

Breast reduction surgery is a procedure that removes excess breast tissue, skin, and fat. It can help alleviate symptoms of gender dysphoria, the feeling that your physical body doesn’t match your gender identity.

Breast reduction surgery isn’t the only way to treat gender dysphoria, but it can be a powerful option for some people. The best candidates are those who have significant discomfort with their breasts and their size. They should also be healthy enough to undergo surgery without complications. In this article, we’ll answer question like non binary breast reduction and non binary top surgery results.

Breast Reduction Surgery For Gender Dysphoria

Gender Affirming Top Surgery

Dr. Christine Hamori and Dr. Christine DiEdwardo have been performing breast augmentation and breast reduction and nipple surgery for 24+ years. This has included gender affirming breast surgery, or top surgery, for patients transitioning from male to female or female to male.

Our surgeons bring expertise and compassion to meet their transgender patients’ needs with customized solutions for each individual’s anatomy and desired goals. Procedures they perform include:

Gender affirming female surgery

  • Breast augmentation with implants
  • Breast lift (mastopexy)
  • Nipple enhancement

Gender affirming male surgery

  • Breast reduction
  • Breast removal (subcutaneous mastectomy) – removing most breast tissue and preserving nipple-areola complex
  • Chest contouring
  • Nipple reduction
  • Breast implant removal

What is gender affirming surgery?

Gender affirming surgery address the needs of persons diagnosed with gender dysphoria, whose identity does not match the sex assigned to them at birth. Our surgeons  provide “top surgery” for transgender male and female patients — which includes breast surgery, body countouring of the chest with liposuction, removal of breast tissue with or without skin removal, and free nipple grafting. Dr. Hamori and Dr. DiEdwardo do not offer “bottom” surgery.

Drs. Hamori and DiEdwardo understand the important role that gender affirming procedures play in helping gender diverse persons realize and live their true identities.

Who is a candidate for transgender top surgery?

To be eligible for the surgery, patients must be diagnosed with gender dysphoria or gender nonconformity, who have been evaluated by a healthcare provider with experience in gender issues and recommends that gender affirming procedures can be considered.

How long is the surgery and typical recovery?

The length of gender reaffirming surgery varies between patients. For example, in transitioning male patients with large breasts, a significant breast reduction with a free nipple graft is necessary to achieve a masculine chest appearance. This may take up to 4 hours depending upon the size of the breasts. However, in smaller breasted transitioning males, liposuction and areolar reduction of the breasts may be all that is necessary to achieve the desired aesthetic.

Recovery from breast reduction and liposuction is usually just a few days of discomfort requiring pain medication followed by lifting restrictions for 3 weeks. Laser scar treatments commence at week 3 post op to smooth out any visible scaring.

In transitioning female patients, breast enlargement is most commonly performed with breast implants. These surgeries take about an hour and a half under general anesthesia. We perform a narcotic-free, rapid-recovery breast augmentation where patients are able to shower after they go home and are encouraged to go for a walk, out to lunch or shopping. Gentle arm exercises are helpful in reducing any spasm of the pectoral muscles. Patients return for complementary scar laser treatments beginning at week 3 post op. Fat grafting is also used to create a more feminine cleavage. In these cases, after the breast augmentation, liposuction is performed on the waist or upper arms and the fat is then grafted along the central portion of either breast creating a softer more natural cleavage.

Purpose of Top Surgery

(Gender Affirming Chest Reconstruction)

Top surgery, or gender affirming chest reconstruction, is a procedure used to create a masculine chest contour for transmasculine individuals (those assigned female at birth with a more masculine gender identity.) There are several steps to this procedure:

  • Mastectomy, or removal of the breasts
  • Removing and resizing the nipples and areolae, as male nipples are usually smaller
  • Replacing the nipples in a more masculine location, towards the outer edges of the chest
  • Contouring of the chest wall
Top Surgery Steps
Brianna Gilmartin / Verywell

Not all top surgery patients will need all procedure elements described above. Plastic surgeons use different approaches and techniques for top surgery, and different people have different body shapes and contouring concerns.

However, it is important to be clear that top surgery is not an elective surgery. Top surgery is a medically necessary procedure for individuals who experience gender dysphoria related to their chest.

Top Surgery for Women?

Top surgery is most often used to describe gender affirming chest reconstruction for transgender men and non-binary people who are assigned female at birth. However, some transgender women also refer to breast augmentation as top surgery.

In this article, we are solely discussing top surgery for transmasculine individuals, not transfeminine breast augmentation.

Diagnosis Related to Top Surgery

The sole indication for top surgery is gender dysphoria. This is generally coded as an F64.* diagnosis. Gender dysphoria is when a person experiences psychological distress because their body does not reflect their internal sense of themselves.

Top surgery is appropriate for individuals assigned female at birth who have a non-binary or male gender identity and experience dysphoria related to the size and/or shape of their chest.

Criteria

Access to top surgery is generally regulated by the World Professional Association of Transgender Health’s Standards of Care (WPATH).1 These standards are followed by most insurance companies to determine coverage.2 In general, for someone to access top surgery, they are expected to meet the following criteria:

  • Diagnosis of gender dysphoria
  • Capacity to make a fully informed decision and to consent for treatment
  • If significant medical or mental health concerns are present, they must be reasonably well controlled.

One referral is needed for masculinizing chest surgery per WPATH. It is usually to confirm the diagnosis of gender dysphoria so it is often from a mental health provider or can be from the PCP or doctor providing hormones.

The letter requirement for top surgery is considered to be a form of gatekeeping by many individuals in the transgender community, as similar letters are not required for similar surgeries among cisgender individuals.

This may indeed be the case, but they also provide documentation of the requirements for surgery, which may not be easily measurable by a consulting surgeon.

Eligibility for Breast Reduction vs. Chest Reconstruction

Breast reduction is a similar, but not identical, surgery to chest reconstruction. In order to determine eligibility for breast reduction, surgeons must document that the patient has a significant history of pain and there is a large enough volume of breast tissue they intend to remove.

In contrast, for gender affirming chest reconstruction, the documentation is around gender dysphoria, rather than any physical characteristics or discomfort.3

Tests and Labs

In general, there are no specific tests or labs required for top surgery. However, some surgeons may require a cotinine test for individuals who have a history of nicotine use. This is because top surgery involves a free-flap transfer (removing and replacing the nipples), and nicotine in the system can compromise blood flow and make complications more likely.4

Different surgeons have different requirements around when individuals have to stop using nicotine prior to surgery and for how long they have to stay nicotine free after surgery.

Individuals with other health conditions may require clearance related to those specific conditions prior to surgery. Your top surgeon may ask you to get a note from any specialists who you see on a regular basis in order to clear you for surgery. You may also be asked to see a specialist, such as a cardiologist, if you have a history of certain medical problems but no ongoing care.

Acne Medication and Surgery

Individuals who are taking the acne medication isotretinoin (Accutane) will often be asked to discontinue use for several months prior to surgery. There is limited, low-quality evidence that use of this drug in the six to 12 months prior to surgery may increase the risk of abnormal scarring and/or delayed wound healing.5

As scar appearance can be linked to patient satisfaction with top surgery, many surgeons are particularly cautious around the timing of this procedure.

If you take any systemic acne medication it is important to discuss this with your surgeon prior to scheduling your procedure. It is also good to discuss your use of any topical medications for acne on your chest. You should also let your surgeon know if you use other products for chest rashes or skin breakdown.

A Word From Verywell

Top surgery is a medically necessary procedure to address gender dysphoria in transmasculine people. It has been shown to have substantial benefits for health and wellbeing.6 Although not all transmasculine individuals are interested in top surgery, those who want it can experience significant benefits.

The major expected downsides of top surgery are loss of nipple sensation and inability to chest feed (breastfeed) should a person become pregnant. (Although there are reports of individuals able to chest feed after certain types of top surgery, this ability should not be assumed.)7

There are some transmasculine individuals who think of top surgery not as a way to get rid of gender dysphoria but to increase gender euphoria. Gender euphoria is the idea of being excited and happy that the body you are in reflects your gender identity.

Some people see gender euphoria as a less pathologizing framework than gender dysphoria when looking at gender surgeries and other forms of gender affirmation.8 However, realistically, gender euphoria and gender dysphoria describe different experiences and either or both may feel more relevant to any given individual.

Non Binary Breast Reduction

Gender dysphoria, also known as gender incongruence, is a condition where a person’s gender identity does not align with their biological sex. This can cause significant distress and discomfort for the individual and may impact their mental health and overall well-being. For some individuals with gender dysphoria, medical interventions such as top surgery may be considered as part of their transition to their identified gender.

Top surgery, also known as chest surgery or breast augmentation surgery, is a common procedure for transgender women and nonbinary people who wish to align their physical appearance with their gender identity. This surgical procedure involves altering the chest to create a more masculine or feminine silhouette, depending on the individual’s desired outcome.

For transgender women, top surgery typically involves the removal of breast tissue (mastectomy) and the reshaping of the chest to create a flatter, more masculine contour. This procedure can help transgender women alleviate feelings of dysphoria related to their chest and enhance their overall sense of gender identity.

Nonbinary individuals may also choose to undergo top surgery to achieve a chest appearance that aligns with their gender expression. Some nonbinary individuals may opt for a more subtle or androgynous chest contour, while others may choose a more masculinizing or feminizing appearance, depending on their unique gender identity.

It is important for individuals considering top surgery to consult with a qualified healthcare provider who is experienced in transgender healthcare. The healthcare provider can assess the individual’s overall health, discuss the risks and benefits of the surgery, and help develop a personalized treatment plan that aligns with the individual’s goals and preferences.

Before undergoing top surgery, individuals may be required to undergo a thorough evaluation to ensure they are mentally and emotionally prepared for the procedure. This evaluation may include counseling, hormone therapy, and other medical interventions to help individuals navigate their gender transition journey successfully.

Overall, top surgery can be a life-changing procedure for individuals with gender dysphoria, allowing them to achieve a more authentic and comfortable sense of self. By working with qualified healthcare providers and engaging in comprehensive care, individuals can navigate the process of transitioning to their identified gender with confidence and support.

By choosing to undergo top surgery, transgender women and nonbinary individuals can take an important step towards aligning their physical appearance with their gender identity, ultimately enhancing their quality of life and well-being.

Non Binary Top Surgery Results

Transgender men and nonbinary people can benefit greatly from top surgery in terms of alleviating gender dysphoria and enhancing their quality of life.

Results from surveys and studies indicate that the vast majority of trans men and nonbinary people are pleased with the outcomes of their transition surgeries.

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