Understanding AFAB Top Surgery: A Comprehensive Guide
What is Top Surgery?
Top surgery is a gender-affirming procedure designed to create a masculine or more androgynous chest. For many transgender men and some nonbinary people, this surgery plays a critical role in aligning physical appearance with gender identity. The medical term most often used is “subcutaneous mastectomy,” which means the removal of breast tissue under the skin, with or without reshaping or repositioning of the nipples.
The significance of top surgery extends far beyond aesthetics. For many, it is a life-saving procedure that alleviates gender dysphoria, reduces mental health struggles, and enables individuals to live more comfortably in their bodies. A person may feel freer to wear clothing they like, swim without dysphoria, engage in sports, or simply wake up each morning without the daily discomfort of binding.
It is important to stress that not all trans or nonbinary people desire or need top surgery. Transition is deeply personal. Some individuals find affirmation through social transition, hormones, or none of the above. Every journey is valid.
Section for Allies: How to Support Someone Considering or Recovering from Top Surgery
Why Top Surgery Matters
Research has shown that access to gender-affirming care—including surgeries like top surgery—leads to a significant decrease in depression, suicidal ideation, and anxiety among transgender individuals. The presence of affirming medical care is not just about comfort; it is about survival and improved quality of life.
Who May Choose Top Surgery
Trans men (FTM): Many transgender men pursue top surgery as a core step in their transition.
Nonbinary people: Some nonbinary individuals also seek chest surgery. Their goals may vary: some want a flat chest, others want a reduced chest without total removal.
Others across the gender-diverse spectrum AFAB: There is no single narrative. What matters is that each person chooses what feels right for them.
Respectful Engagement
Do not ask invasive questions. Asking someone “When are you getting surgery?” or “What’s under your shirt right now?” is inappropriate.
Respect privacy. If someone shares their surgical plans, it is a sign of trust. Treat that information carefully.
Avoid trivializing comments, follow the person’s lead. Comparing top surgery to cosmetic breast augmentation or cracking jokes about “getting rid of boobs” undermines its seriousness. Each person is different, but let the individual decide what works best for them.
Offer tangible support. During recovery, people may need rides, help cooking, or someone to check in. Small acts of care make a big difference.
The Role of Allies
Being an ally means creating safe environments where trans people can make health decisions without fear of stigma. It means advocating for accessible, affordable healthcare, and speaking up when misinformation or disrespect arises.
Section for Trans Folks: What You Need to Know
The Process in Idaho and Surrounding Areas
In Idaho, access to gender-affirming surgical care is limited. Many people travel out of state for consultations and surgery. The steps typically include:
Initial Research
-Learn which surgeons perform top surgery. Trans Affirm maintains a Resource Hub that lists providers in Idaho’s neighboring states such as Utah, Oregon, Washington, and Colorado.
-Each surgeon may have slightly different requirements. Review their websites and talk to their staff.
Mental Health Letters
-Many surgeons or insurance companies require one or two letters from licensed mental health professionals. These letters confirm the diagnosis of gender dysphoria and document that the patient is informed and prepared.
-Some surgeons now follow the informed consent model and require fewer letters, but insurance often still demands them.
Insurance vs. Self-Pay
-Idaho Medicaid does not cover gender-affirming surgeries, which leaves many people without state-funded options.
-Some private insurance plans may cover top surgery, but pre-authorization is common. Be prepared for denials and appeals.
-Self-pay costs range widely ($7,000–$12,000+ depending on the surgeon and technique).
Consultation Appointment
-A consultation allows the surgeon to evaluate chest size, skin elasticity, and overall health.
-This is your chance to ask questions about procedure type, healing, scarring, nipple sensation, and risks.
Scheduling Surgery
-Once letters, insurance approvals, or payments are settled, surgery can be scheduled. Wait times vary from weeks to over a year depending on the surgeon.
Types of Top Surgery
Double Incision with Free Nipple Grafts
-Best for medium to large chests.
-Involves horizontal incisions across the chest and removal of excess skin and tissue.
-Nipples are resized and repositioned as grafts.
-Results in visible scars under the pectoral line.
Peri-Areolar (Keyhole)
-Suitable for small chests with good skin elasticity.
-Minimal incisions around the areola.
-Less scarring, but limited in how much tissue can be removed.
Buttonhole or Inverted-T
-Used for individuals with medium-sized chests or those who prefer to preserve more nipple sensation.
-Allows reshaping while maintaining nipple connection in some cases.
Other Variations
-Some nonbinary people seek chest reductions rather than full removal.
-Techniques may be adapted for body goals that are not strictly “flat” but affirming in other ways.
Healing and Recovery
First Week
-Drains may be in place to prevent fluid buildup.
-Pain and discomfort are normal but manageable with medication.
-A compression binder or vest will usually be required.
-Mobility will be limited—lifting arms overhead or lifting objects should be avoided.
Weeks 2–4
-Gradual return to daily activities.
-Stitches and drains are removed (if not dissolvable).
-Swelling begins to decrease.
Months 2–6
-Scars continue to heal. Scar care (ointments, silicone sheets, massage) can help minimize appearance.
-Numbness or changes in nipple sensation may persist, sometimes permanently.
Long-Term
-Final results become clearer after 6–12 months.
-Scars fade but rarely disappear completely.
-For many, the mental health benefits far outweigh the physical challenges of recovery.
Things to Consider
Support Network: Having a trusted person to help with meals, rides, and household tasks during recovery is highly recommended.
Work and School: Plan for at least 2–4 weeks off, depending on your job and healing speed. The best advice is to not rush it, as you may stretch your scars or hurt yourself. This timeline may change depending on your provider.
Mental Health: Healing can be both physically and emotionally demanding. Post-surgery depression or anxiety can occur. Stay connected to community or professional support.
Important Reminder
Not all trans people need or want top surgery. Choosing—or not choosing—surgery does not make someone more or less valid in their gender. Transition is diverse. What matters most is what feels affirming for you.
For surgeon referrals, state-by-state resources, and peer recommendations, visit Trans Affirm’s Resource Hub
Closing
Top surgery is one of the most common and affirming procedures for transgender men and nonbinary individuals, but it is not the only path. For those who pursue it, top surgery can be transformative. For allies, respectful support and advocacy are crucial. For trans individuals considering surgery, know that you are not alone—there are resources, options, and a community ready to stand with you every step of the way.
See this page for our medical disclaimer policy.
https://www.transaffirm.org/s/Medical-Disclaimer.docx
