Top Surgery

Top surgery reshapes the chest to align with a patient’s gender identity. It is one of the most requested procedures in gender-affirming care, and one where the surgical plan differs entirely depending on the direction of the change — which is why “top surgery” is really two different operations wearing one name.

Dr. Low approaches each with the same anatomical grounding he brings to breast surgery generally: chest wall shape, skin elasticity, and nipple-areola position all inform the plan, not just the desired outcome.

What Is Top Surgery?

For transmasculine and nonbinary patients, top surgery removes breast tissue to create a flatter, more traditionally masculine chest contour, with technique chosen according to breast size and skin quality.

For transfeminine patients, top surgery instead refers to breast augmentation — using implants, fat transfer, or both — to build a fuller, more traditionally feminine chest, following the same principles as standard augmentation.

Techniques at YCL Plastic Surgery

Double incision with free nipple grafts

For larger chests or lower skin elasticity, removing tissue through a horizontal incision with the nipple-areola repositioned as a graft. The most common approach for significant tissue volume.

Periareolar (keyhole)

For smaller chests with good skin elasticity, removing tissue through an incision around the areola, preserving nipple sensation and blood supply. Limited to patients with modest tissue volume.

Augmentation

For transfeminine patients, following the same implant selection and placement principles used in standard breast augmentation — see Breast Augmentation.

Benefits

• Creates a chest contour that matches gender identity
• Removes or adds volume as appropriate to the patient’s goals
• Can be combined with liposuction to refine the chest wall and flanks
• Improves comfort in clothing and confidence in daily life
• Long-lasting, generally permanent results

Who Is a Candidate?

You may be a good candidate if you:

• Are seeking chest contouring as part of gender affirmation
• Are in good general health with realistic expectations
• Have completed any required mental health evaluation or letters of support your care plan requires
• Understand the technique appropriate to your chest size and skin quality, and accept the associated scar pattern

Recovery & Expectations

Most patients return to desk work within 1–2 weeks, with drains (where placed) removed within the first week or two. Upper-body exercise is generally restricted for 4–6 weeks.

Swelling and altered nipple sensation are common early and improve over several months. Final chest contour and scar appearance continue to refine over 6–12 months.

Scar Placement & Healing

Double-incision technique leaves horizontal scars across the chest, generally positioned along the natural pectoral fold. Periareolar technique confines scarring to the areolar border. Scars are firm and pink initially, softening over 12–18 months.

Dr. Low discusses scar pattern and expected appearance honestly at consultation, since it is a permanent trade-off patients should understand fully before choosing a technique.