Top Surgery

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What are the top surgery options for trans women?

Trans women can have breast augmentation with implants (subglandular or subpectoral).

Can liposuction be used to flatten the chest?

Liposuction can be used in addition to a surgical procedure, and can achieve excellent results. However, it should not be used on its own if the goal is a flat chest.

What are some of the more unusual techniques used in top surgery?

Rarely used techniques include: Inverted T mammoplasties, fishmouth, or buttonhole incisions.

What are the main surgical techniques for top surgery?

The main surgical techniques are: 1. Keyhole: periareolar or concentric circumareolar incisions 2. Double incisions with dermal flap reconstruction 3. Double incision with free nipple grafts

What personal or family history is important to tell the surgeon about before top surgery?

If you or any of your family members have had any illnesses, make a list. Of particular relevance are things like previous breast lumps or biopsies, or family history of breast disease - find out details so you can share with your doctor at your consultation.

Does it matter what type of surgeon does my operation?

Top surgery is a special operation requiring special skills. In the same way as a brain surgeon wouldn’t make the best heart surgeon, different surgeons have different skills. Make sure your surgeon can show that they have carried out a good number of these procedures, that this is part of their regular workload, and that they have the required training and experience. What guidelines do they follow and have they audited their work? What training courses and professional development have they do...

Why should I optimise my BMI before top surgery?

Talking about a target BMI range with your surgeon can be good for both your general health and make general anaesthetic safer. If you intend to lose or gain a lot of weight in the future, it would be best to do that before your operation. Weight changes and body workouts that affect your muscular shape may affect the final look after top surgery, so make any weight adjustments and body-building before the operation.

I have a very big chest, does that matter?

No chest is too big. There are techniques for all chest sizes. There may be more need for nipple removal and replacement if you are bigger. Discuss this with your surgeon.

There is a strong family history of breast cancer - does that affect things?

Top surgery is very different to having preventative mastectomy. If you have an elevated risk of breast cancer, then we should discuss with a cancer specialist and think about genetic screening before the operation goes ahead.

Will I get dog ears?

The results of the surgery depend on a number of factors, including: - your skin quality - the size of your chest - the technique that is used - your body shape and size. Discuss this with your surgeon early to see what you can do to help get the result you want.

I have health risks, does that mean I shouldn’t have top surgery?

Safety is the most important thing, but you should always explore your options. If you have additional health risks, it might just mean that you have the technique that carries the lowest risk of needing a revision so as to minimise the chance of needing two operations.

I am older, does that make any difference to having top surgery?

If you are over 40, then we recommend you have a mammogram before the operation. Small or hidden breast cancer would be very important to know about as the approach to the operation would be very different. Older people may have other co-existing medical problems which might affect having general anaesthetic. Make a list ready to show your doctor.

Will I get the result I want from my top surgery?

It is really important to think about what is important to you. What are you hoping for? What outcome are you looking to achieve? Do you want to go topless, or just be able to wear a t-shirt, or just have a flatter chest? What do you want to be able to do that you can’t do now? Is it confidence for you or with your partner? In the gym or swimming pool or just at home? Have a think so you can explain this to your surgeon.

Why do some people need to have further top surgeries, or a revision?

If the end result is not symmetrical or if the ends of the scars have bulges or extra skin (dog-ears) then your surgeon may suggest some revision surgery to see if they can get a better result.

Will the sensation in my nipples be affected by top surgery?

This depends very much on the technique that is used for the operation, and whether the nipple needs to be completely removed and repositioned. If nipple sensation is very important to you (e.g. in your romantic life), then be sure to make this known. Your surgeon may use a different technique to reduce the risk of nipple sensation loss, but that may in turn increase the need for a revision. Talk it through.

Is it ok to bind before top surgery?

Binding can cause stretching of the skin and lead to poor skin quality. This can mean that wound healing and scarring can be affected. Try and keep binding to a minimum if you can and, if possible, stop 2-3 weeks before the operation.

I have quite bad acne on my chest, will that affect my top surgery?

Many transmasculine people find a worsening of acne when they start testosterone, and that can affect the skin on the chest. If your acne is bad, consider getting some medical help, and be careful that chest shaving doesn’t make it worse just before the operation. Acne can increase the risk of post-operative wound infections.

How long do you recommend being on hormone replacement therapy before a breast augmentation?

It can take around three years for breasts to fully develop from starting HRT. You may want to wait until your breasts have developed as much as can naturally before considering breast augmentation surgery. You will also need to have enough skin for the implant to sit under. If you have a very taut, 'masculine' chest with less available skin then it can be difficult to fit the implant under it. If you have more skin / soft tissue then it will be easier to fit implants. You can find more info...