Everything you ever wanted to know about top surgery…

January 5, 2013 § 50 Comments

…but were too afraid to ask/tried to ask about but didn’t get an answer/were idly curious about.


EDIT: Answers up now

For all the personal accounts and youtube channels out there, I still found it hard, frequently impossible, to find answers to all of my questions regarding top surgery before I had it three and a half years ago. There’s more information out there now than there was then but, still, not always as much as you’d like. So…

I’m getting together a small panel of trans people I know who’ve been down different top surgery routes to answer questions about the process/procedures/results, and to provide any tips and hints they’ve picked up along the way.

Questions? Leave a comment below and we’ll do our best.


§ 50 Responses to Everything you ever wanted to know about top surgery…

  • jess says:

    Does anyone know much about options for people who identify as genderqueer and therefore might struggle with referrals?

    • Tate says:

      Hi jess – I’m tate! i identify as genderqueer and am not on T, and like other people below, I was able to get a therapist to write me a letter that said that chest surgery was the next step in my “transition” for gender affirmation. I am having surgery with Dr. Curtis Crane in March, who has taken over Dr. Brownstein’s office in SF.

      Here is a list of resources for non-male-identified folks interested in chest surgery: http://butchinthesouth.tumblr.com/topsurgeryresources

      It’s not the most up-to-date, but hopefully it will point you in the right direction. If I can help at all or answer any questions, feel free to get in touch!


  • Anji says:

    I don’t know if this is the sort of question you’re after, but I’m curious anyway. How, as a non-male person, does one get top surgery? I identify as genderqueer/nonbinary, and top surgery is something that I’m more than a little interested in, at some point in the future. I get the feeling though that because I’m “not really trans” (i.e. I am AFAB and do not identify strongly as male) I’d just get laughed at by my GP if I even mentioned it.

    • Sky says:

      At Dr. Garramone you do not have to identify as male nor do you have to be on any hormone treatment in order to receive surgery. All his office needs is a letter from a therapist of treat physician stating that, for your mental health (except substitute professional lingo lol), top surgery is needed in order to live a healthy life.

  • Molly Ren says:

    Getting top surgery when you’re fat and have huge breasts. Are huge scars inevitable? Will my nipples just have to go? Are they getting any better at keeping the nipples in place so you won’t lose all feeling in them?

    • Nic says:

      No, huge scars aren’t inevitable, but it’s really dependent on your shape as well as your size.
      It’s something you need to discuss with your surgeon as you may be able to opt for multi-step surgery i.e. several surgeries but less scarring. The disadvantage of this being lots of surgery, therefore more chance of things going wrong.

      By nipple, do you mean the areolar tissue surrounding the nipple, or the nipple itself (sticky out bit)?! If it’s just the nipple then that can be nipped so it’s shortened.
      The areolar tissue can be reduced, or got rid of altogether. I would suggest a reduction. And if the worse comes to the worse and the areolar graft didn’t “take” when it’s regrafted then there may be the option of having one tattooed instead.

      But, as you may have gathered, it’s a discussion between you and your surgeon. And I would suggest that you shop around to see which one matches your requirements the best. You can, to a point, shop around on the NHS as well…

  • maddox says:

    This is still by far the topic I get most (the majority of) questions on, even after 2 years of blogging about other stuff. Glad you are compiling this.

    • cnlester says:

      If you have any that you think it would be helpful for us to address then could you send them through? Bizarrely, whenever I’m not talking about top surgery it’s all people want to ask about – and now I’m taking questions people are slow to ask them 😉

    • cnlester says:

      Only generalised/anonymous questions obviously.

      • maddox says:

        Same here. I’m trying to compile a similar list. Maybe we can share ideas.

        The biggest question that comes to mind, that is the hardest to answer, is “how do I know if I should get top surgery / if I’m ready / if that’s what I really want?” Most of the times this comes from somebody non-male or still female identified. Since it’s usually preceded by moundfuls of personal anecdotal data and fuzzy identity stuff, it’s tricky to answer in a generalized sense.

        The other major ones are:
        – hormones (which are no longer necessary with WPATH SOC v7)
        – referral from mental health professional
        – informed consent surgeons for non-binary folks
        The latter two of which are especially difficult for non-binary people in the UK given the health system and their stricter requirements. Whatever you write on this will be my primary source for referring UK people.

        • cnlester says:

          Hmmm…fairly similar to the questions I get asked – particularly ‘how do you get top surgery if you’re not a trans man?’

          The information I was most desperate for pre: surgery was more to do with scar management, how much time off work, how much time before exercise etc. Do you tend to find that those are common concerns raised, or not so much? I’m amazed that I’ve never seen anything before on scar massage, to take one example.

          • dimovier says:

            Yeah, as someone who’s a little bit too obsessed with working out I also really want to find more experiences getting back into exercise post-op/whether the whole “6 weeks of no heavy lifting” thing can maybe be fudged a little bit/how to tell if you’re in good enough shape to head back to the gym. Also since I’ll still be in school and going straight back to classes (high school btw, not college) how much disorientation I might expect from anesthesia and the like even a few weeks after surgery. (Thankfully I will be a second term senior, which basically means I have a kindergartener’s level of academic responsibilities)

  • maddox says:

    Been giving this some thought… Would it be ok with you if I put the same call-out on my blog? I’m curious to see if we come with with different answers to the same questions, so they can complement each other. Especially regarding regional differences.

  • SJD says:

    Do you have to have a catheter when getting top surgery?

    • Nic says:

      Ummm… Do you mean a chest drain? Or a catheter, as in pee drain?!!! ;-D

      If it’s the pee drain – unless you’re unable to get to the loo, cannot use a pan, or are usually catheterised – can’t see any reason why you should have a pee drain.

      If it’s the former e.g. a chest drain – it depends on whether the surgeon thinks it’s necessary. I would be guided by them, as it may be for the best.
      I certainly had chest drains. OK so it’s temporarily inconvenient, but you run the risk of having a build up of fluid if you don’t have them. And if anyone has ever seen, or heard of anyone that’s had that then I grit your teeth and bear the chest drains!

    • rg says:

      When I got top surgery a few weeks ago, they put a catheter in after I went under. It was removed by the time I woke up in the recovery room. It stung a bit when I went to the loo for a day or two afterward but it was really no big deal. I assume they put it in to ward off potential problems if the surgery went over time or something.

  • CJ_Dudebro says:

    How does the Scottish system work for top surgery referral? Is it easier for non-binary folk to get top surgery funded there? (It’s different to England as NHS Scotland has gender reassignment protocol)
    A list of surgeons who perform the various top surgeries, and where one can find reviews, would be helpful too.

    • Nic says:

      Sorry – can’t help with the Scottish referral system – but having a quick scoot around the web, so not recommending as I don’t really know the organisations that well, you might like to try here …. http://www.scottishtrans.org/ and here http://transmenscotland.wordpress.com/
      Reckon one, or both, may be able to assist… ;-D

    • NM says:

      You go to a GIC (I’ll assume you know the differences from England on that) and within 6-12 months (usually) of living ‘full time’ as male then you can get a referral. The GIC write to the local surgeon (I believe there’s a couple in Glasgow/Strathcyle, one or two in Edinburgh/Lothian and one in Aberdean) and you go their their list.

      No approving funding crap usually- there was a while when Lothian were being difficult but seems all good now. If there are problems STA (linked to in the previous reply) can help and the GIC doctors generally already know about it.

      I’m non-binary and went for lying. It’s what I tell others to do too. It’s not different from England as far as I know. The GIC doctors decide if you can get surgery or not and to the best of my knowledge none of them are great about non-binary people. I would say that the Edinburgh doctor (Dr Myskow) is the best bet if you don’t want to lie since she has seemed more willing to engage with non-binary people (but then doesn’t seem to understand them the way they’d understand themselves) but I’m fairly sure she is retiring soon. I guess someone will replace her fairly quickly but no idea what they will be like or even who it will be.

  • Isaac says:

    Can you get top surgery and get nipples removed? Is this a ridiculous idea? Would people look at me crazily if I walked around on a beach with no nipples?

    • Nic says:

      By nipple do you mean the sticky out bit, (nipple), or the areolar tissue surrounding the sticky out bit?!?
      The nipple can be nipped to reduce it’s length, and the areolar tissue can be reduced in diameter. I’d recommend that you don’t have either removed completely as that would look a bit weird as men do have both and in all shapes and sizes! ;-D

    • maddox says:

      You absolutely can, there are a few people who have done this. It looks weird – as in, different – but it’s personal choice. You need to talk to your surgeon about what you want.

    • J.D. says:

      I want my nipples completely gone like a blank slate. Did you have surgery yet, Isaac? If so, did you toss the nips and are you happy with the result?

  • Mori says:

    -Do I have to take out all oral/facial piercings (some of which would close up and be a pain to re-pierce) or can I use a plastic retainer/jewelry with tape over it so it won’t catch?
    -If I got a therapist’s letter abroad would a U.S. surgeon accept it? Vice versa? Would I have to go through my country-of-residence’s standards of care?
    -Does anyone (not on T) have experience with losing important nipple sensation and making up for it somehow? What is the best technique for keeping erotic sensation in nipples? (T-anchor or peri?)

    • dimovier says:

      From what I’ve heard the “no piercings/metal” thing is in case they have to resuscitate you using a defibrillator and I guess metal would not be good to have in your face then. Don’t know about any other reasons that might preclude using a retainer to keep a piercing open. But there are some surgeons that actually do answer questions over email – Dr. Richard Bartlett is one for instance.
      As for the therapist letter thing – I think you just have to fulfill what’s required by the surgeon in question, since the Standards of Care aren’t always identical to what the surgeon’s policy is (see: age limits, and the fourteen-year-olds I’ve known of who’ve gotten top surgery even while the SOC discourages it.) It might be trickier when it comes to getting insurance to cover that stuff though, since insurance generally does require a letter (or two in some cases, and from someone with a doctoral degree, etcetc hoops upon hoops to jump through) and let’s be real, it’s a business, insurance might pull some ridiculous policies out of their ass when confronted with your claim even if they say they cover trans surgeries.
      And I don’t really have an answer for the third, sorry!

    • maddox says:

      T shouldn’t have any effect on nipple sensation, as far as I’ve researched. This will mostly depend on what type of surgery you get (t-anchor vs peri vs DI), the surgeon’s skill or record with nipples, and just plain luck at having your body respond.

  • I must say that you should research your surgeon. You should make sure you see photos of their work, make sure if you can to talk to people if possible who have had work done by them. Make sure you like their style and approach.
    When going for appointments ALWAYS write a massive list of all your questions, if it is a good surgeon they will listen and advise and talk to you.
    If they say they can ive you perfection, do not trust them they are talking bullshit, they can offer you as good and near to male looking as poossible but NOT perfection, as there is no such thing as a perfect chest be it any gender varient!!!

  • Nic says:

    Happy to answer questions as I identify as a transman, have been working within the community, offering advice and assistance for…. blimey – over 20 years!
    And, for funding reasons, am just about to formalise this by starting up as a social business.

    Anyway… IDing as genderqueer should not be a barrier to getting top surgery, if that’s what you want/need.
    And if your GP is too stupid to see that you need a referral to a Gender Identity Clinic (GIC) then change GP – if at all possible.

    It always takes persistence, but once you’ve started the process at the GIC you should be met with more sympathy.
    However, be warned – going via the NHS route is going to be slow, but you will, eventually get what you want…

  • Name says:

    I’m not yet on the state where i find top surgery something i need asap (i have those plans for future). But i’m just curious: is it possible to get breasts just removed, without any hormone stuff, without psychologist recognizing you as a transsexual, without making any sort of nipples or male-like breasts of it – just chop it off, make a nice flat scare and be done with it? I have something around F sized breasts and everything i dreamed of since late teens (i’m 26 atm) was to get those removed – they hurt, cause lots of discomfort, look terrible and don’t fit my agender/asexual personality at all. Just usual flat skin without any extra things, even if it’s scared, would do just fine for me and fit my aesthetic taste, and i don’t really care if whoever would find it weird (not like many could see me without cloth anyway and even if they did – well good for them). All i’m asking, is it possible/ever done in legal clinics?
    Sorry if my english isn’t that good – not my native language, hope i was able explain what i mean…

    • dimovier says:

      Find a surgeon who doesn’t require a psychiatrist’s letter first. Then ask those surgeons whether they would be willing to not do a nipple graft. (Don’t see why they’d really say no, I mean, you are paying them.) Speaking of payment, if you don’t get a diagnosis of anything, insurance won’t cover shit either – so save yr money like crazy bc top surgery can be wicked expensive.

      • Name says:

        Thanks for answering 🙂
        Well, i leave in Russia, no such thing as insurance for plastic surgery here anyway, so i don’t mind to pay – was just wondering if it’s possible for surgeons to agree for something non-standard if they’re not some kind of underground illegals. I’ve already asked on local forums, seems like they’re ok with most, but no one clearly answered the nipple part (usually “let’s talk about it, maybe we’ll find some compromise”).
        Anyway, thanks.

  • cjthesane says:

    Question! Dr. Garramone needs a letter from… Someone. Who? I don’t see a therapist, although my GP referred me to a psychiatrist-person back before she referred me to a GIC. I haven’t been to the GIC for an appointment yet either. So, is a letter from my GP okay or does it need to be someone else? (I find it all really confusing!)

    • Leigh says:

      What I needed for my surgery (with Medalie) was a clearance letter from my GP basically stating that I was healthy enough and a letter from my counselor asserting that I was cleared for surgery from a mental-health standpoint.

    • maddox says:

      Usually this means a letter from a mental health professional, and depending how closely they are following the WPATH standards they have to have a certain degree (master’s and above).

      I would ask the surgeon or their office specifically. Some surgeons who “required” letters implied they would loosen the requirement once I stated I didn’t have the letter and wouldn’t be able to get it.

      As an aside. I am just surprised Dr Garramone keeps requiring a letter, he’s done so many of these you’d think he’d loosen up on the requirements and go the informed consent route.

  • Leigh says:

    Does anybody have suggestions for flattening out nipples after surgery? Mine took well enough, but the right one is perpetually semi-hard and it makes me self conscious.

    Also, does anybody else experience like.. clogged nipple pores? Not quite zits, but like little white blackhead-esque plugs. Mostly on the areolas, but sometimes on the nipple itself. They don’t hurt, and I don’t know if it was a thing that I had before surgery (as I tried my damnedest to not ever look at my chest, ever, especially not close-up.) or if it’s new. I had surgery 10 months ago.

    Also, are there any particularly good things to do to help with keloid scarring? I’ve been just massaging it with normal lotion and it’s flattened out noticeably since surgery, but it’s still really pink and raised.

    • maddox says:

      For nipples mine took a year or so to flatten out. For keloid scars I really recommend Silicone Strips, and if it’s bad then cortisone injections. I have a few posts about this on my blog.

      • Elliott says:

        I have those areola “zits” too, but I’m pre-top. I’ve wondered if it would go away or change after surgery, but it’s probably just one of those body things.

    • eric says:

      About the white non zit thing on the areola. I had surgery 2 months ago and had one until I finally decided to see what it was. I couldn’t find anything on the internet about it. But I stumbled on this forum. Have u had it looked at yet? I took mine out and all it was was a lil bubble of soft white stuff. Didn’t hurt and didn’t bleed it didn’t stink either. Not quite sure what to think about it.

  • M. says:

    My chest size varies depending on the time of month (which I know is common), so if I had surgery during the time it’s smallest, would any tissue left behind still periodically get bigger according to my menstrual cycle if I don’t start T? (Hopefully that made sense). Also, when it’s smallest it’s an A, but before my period it looks big enough to require double incision (or maybe I’m just paranoid). How does a surgeon approach this?

  • Corin says:

    do you have to be referred to a GIC by a GP? I’m from the north- east of Scotland, and I don’t know how to go about seeing a therapist to get a referral.

  • Felix says:

    i had my first consultation with my surgeon yesterday and she said that since i dont really have any breast tissue left, mainly skin, there may be an indent between the line under my pectoral muscle and the placement of the scar. i wanted to know if its possible to ask surgeons whether they are able to position scars higher up so that they sit under the line of definition under the muscle and, if not, how have other people dealth with this kind of indentation (for example, are there any chest exercises that bulk out the lower pectoral muscle, which would fill out the indentation, if that makes sense). cheers.

  • kazerniel says:

    Can you tell me how long does it take after a DI surgery to regain the range of motion that’s enough for everyday activities? Eg. how long did it take until you could dress by yourself? Thank you!

  • […] are already some fantastic answers under the original post – and now, for the longest post this blog has ever […]

  • Ryan says:

    Hello, I have a few questions about top surgery..
    I am not FTM, but androgynous. However my breasts (36B) cause me great dysphoria. So I would like to get top surgery to get a flat chest.
    Though I am confused on a few things.
    Because my breasts are the size they are, could I get away with just a breast reduction to achieve the flat chest? Or would I have to do the whole top surgery?
    Would I have to get my nipples grafted? I mean I would be perfectly happy leaving them the way they are…I just want a flat chest.
    I scar easily, so can anyone give me any tips on how to reduce scaring or avoid it completely?
    Thank you!

  • Kim Murphy says:

    Can I get my nipples pierced 22 yrs after a breast reduction with out worry? I have no milk glands left done bearing children n have maintain my weight for 15 yrs. my nipples are not overly sensitive but slightly to touch n cold . I really want them done but am worried that I will cause some damage my breast are my best feature . Please help me with some answers. Thanks

    • cnlester says:

      I know quite a lot of people who’ve had nipple piercings after top surgery/breast reduction – I don’t think it should be a problem at all, but if in doubt, speak to a piercer. I get my piercings done at Extreme Needle in London – incredibly supportive, knowledgeable people – maybe ask them?

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