What is FTM Top Surgery?
Top surgery is a transmasculine operation to create a masculine chest contour. Medically called a mastectomy, it involves the surgical removal of breast tissue. For trans men and non-binary individuals, it's one of the most common and life-changing gender-affirming procedures.
Top surgery is generally safe when performed by a qualified plastic surgeon. While no surgery is without risk, with proper care and an experienced surgeon, the possibility of complications is minimal.
5 Types
Surgical techniques
4-6 Weeks
Recovery time
Safe
When qualified
Life-Changing
Results
- Reduces gender dysphoria — aligns physical appearance with gender identity
- Eliminates binding — no more discomfort, breathing restriction, or skin issues
- Improves quality of life — greater freedom in clothing, activities, and intimacy
- Boosts mental health — significant improvements in self-esteem and confidence
- Permanent results — one-time procedure with lasting effects
Related guides: For detailed information on specific topics, see our Top Surgery Cost Guide 2026 and Top Surgery Scars: Healing & Care Guide.
Who Can Have Top Surgery?
The World Professional Association for Transgender Health (WPATH) provides standards of care that most surgeons follow. Meeting these criteria helps ensure you're prepared—both medically and psychologically—for surgery.
- Persistent, well-documented gender dysphoria
- Capacity to make a fully informed decision and consent to treatment
- Age of majority in your country (or follow adolescent guidelines if younger)
- Any medical or mental health concerns must be reasonably well-controlled
Source: WPATH Standards of Care
Some surgical centers may have additional requirements:
- BMI requirements — to minimize surgical risks
- Mammogram — especially if you're over 40
- Referral letters — from mental health professionals
- Insurance authorization — if using insurance coverage
- No nicotine use — for several weeks before surgery
FTM Top Surgery Types
There are five main types of top surgery. The best option for you depends on your chest size, skin elasticity, and personal goals. All procedures are performed under general anesthesia.
1. Keyhole Top Surgery
Minimal Scarring
Ideal for: Small chests (A cup) with excellent skin elasticity
A small incision is made along the bottom of the areola, through which breast tissue is removed. The nipple remains intact—no resizing or repositioning needed. May be combined with liposuction for optimal contouring.
✅ Minimal scarring, quick recovery, nipple stays intact
⚠️ Only ~5% of patients qualify; requires very small chest
2. Donut Procedure (Peri-Areolar)
Preserves Sensation
Ideal for: Small to medium chests (A-B cup) with elastic skin
Two incisions are made—one around the areola and one slightly outside it, creating a "donut" shape. Breast tissue is removed, and skin is tightened using a "purse-string" technique.
✅ Minimal visible scarring, nipple sensation often preserved
⚠️ May result in some puffiness; limited to smaller chests
3. Batwing Procedure (Fishmouth)
Medium Chests
Ideal for: B-sized chests with less elasticity and some sagging
Two concentric incisions around the areola, plus triangular-shaped incisions on the sides to remove excess skin. Effective at achieving a flat chest contour when skin elasticity is limited.
✅ Good results for medium chests, effective skin removal
⚠️ More noticeable scars due to triangular incisions
4. Double Incision Top Surgery
Most Common
Ideal for: Medium to large chests (C cup and above)
Two horizontal incisions—one above and one below the nipple area. Breast tissue is removed and nipples are resized and repositioned as free grafts. The most versatile technique, allowing for significant chest contouring.
✅ Excellent results for larger chests, full contouring ability
⚠️ Visible horizontal scars, nipple sensation typically lost
5. Inverted-T / T-Anchor Surgery
Large Chests
Ideal for: Larger chests with significant excess skin and poor elasticity
Similar to double incision but with an additional vertical incision to remove more excess skin. Particularly useful when significant skin removal is needed for a smooth, flat result.
✅ Best for very large chests, thorough skin removal
⚠️ Most visible scarring (T-shaped pattern)
Scarring is a normal part of any surgery, but proper care can significantly minimize their appearance. See our complete Top Surgery Scars Guide.
Surgery Comparison Chart
Key differences between surgical techniques:
Keyhole: Very small chest, minimal scarring, sensation preserved, 2-3 weeks recovery
Donut: Small-medium chest, circular scar around areola, sensation often preserved, 3-4 weeks recovery
Batwing: Medium chest, moderate wing-shaped scars, sensation may be preserved, 4-5 weeks recovery
Double Incision: Medium-large chest, visible horizontal scars, sensation typically lost, 4-6 weeks recovery
Inverted-T: Large chest, T-shaped scars (most visible), sensation may be preserved, 5-6 weeks recovery
Preparing for Top Surgery
Proper preparation is essential for a smooth procedure and optimal results.
👨⚕️ Surgeon Consultation
Discuss goals, options, and concerns. Ask about technique, scars, and expected results.
📄 Documentation
Gather referral letters, insurance authorization, and health evaluations.
🚭 Lifestyle Changes
Stop nicotine, limit alcohol, discontinue certain medications as advised.
🏠 Home Preparation
Arrange help for first few days. Stock up on supplies and easy meals.
For detailed pricing, insurance tips, and hidden costs, see our Top Surgery Cost Guide 2026.
Recovery After Top Surgery
Recovery depends on surgical technique, overall health, and how well you follow post-op instructions.
Days 1-3
Most discomfort. Rest, pain management, wear compression garment.
Week 1-2
Drains removed. Light activity only. Follow-up appointment.
Week 3-4
Most restrictions lifted. Can return to desk work. Swelling decreases.
Week 6+
Resume normal activities including exercise. Scars continue to fade.
- Wear compression garment as directed
- Attend all follow-up appointments
- Don't rush back to exercise
- Watch for warning signs — fever, unusual discharge
Additional Masculinization Procedures
Several additional procedures can complement top surgery:
💪 Liposuction
Removes excess fat from chest, abdomen, flanks. Can be done during top surgery.
🔬 Phalloplasty
Surgical creation of a penis using tissue grafts.
✨ Metoidioplasty
Uses testosterone-enlarged clitoris to create a smaller, functional penis.
💉 Hormone Therapy
Testosterone therapy for masculinizing effects.
For bottom surgery costs, see our FTM Bottom Surgery Cost Guide.
Non-Surgical Alternatives
Surgery isn't the right choice for everyone. There are effective ways to feel more comfortable without surgery.
High-quality FTM prosthetics offer a non-surgical way to align your body with your gender identity—from packers to STP devices to pack-and-play prosthetics.
Binding
Chest compression garments for a flatter appearance.
Packing
Prosthetics worn in underwear for a masculine bulge.
STP Devices
Stand-to-pee products for restroom confidence.
Pack & Play
Prosthetics suitable for intimate activities.
Psychological & Social Considerations
Top surgery often enhances both physical and emotional well-being.
Reduced Dysphoria
Aligning physical appearance with internal identity.
Improved Self-Esteem
Greater confidence in your body.
Freedom from Binding
No more discomfort or breathing restrictions.
- Pre-surgical counseling — prepare emotionally
- Post-surgical support — adjustment assistance
- Community connections — others who've had surgery
- Support groups — online and in-person
🎯 Key Takeaways
5 Surgical Options
Technique depends on chest size and goals.
Safe & Effective
Life-changing results when qualified.
Your Timeline
Your transition is yours alone.
Frequently Asked Questions
Is top surgery safe?
Yes, when performed by a qualified plastic surgeon, top surgery is generally safe. With proper care and an experienced surgeon, risks are minimal.
How do I choose which surgery type?
Your surgeon will recommend based on chest size, skin elasticity, and goals. Smaller chests may qualify for keyhole; larger chests typically require double incision.
Will I lose nipple sensation?
Depends on technique. Keyhole and peri-areolar often preserve sensation. Double incision typically results in loss of sensation. Some may return over time.
Do I need testosterone first?
No, testosterone is not required. Some have top surgery before hormones, some after, some never take hormones. It's your choice.
How visible will my scars be?
Varies by technique. Keyhole produces minimal scars; double incision leaves visible horizontal scars. With proper care, scars fade over 12-18 months. See our Scars Guide.
Is top surgery covered by insurance?
Coverage varies by provider and location. Many insurers now cover it as medically necessary. See our Cost Guide for tips.
How much does top surgery cost?
US: $6,000–$16,000. UK: £6,000–£10,000+. Canada: $7,000–$15,000 CAD. See our Complete Cost Guide.
Top surgery is a deeply personal decision and a transformative step. By understanding your options and working with qualified professionals, you can achieve life-changing results. 🏳️⚧️
While You Consider Your Options
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