Top surgery · Masculinizing mastectomy
Gender-affirming top surgery: Compare practices from our network
Top surgery removes breast tissue and shapes the skin and nipples to create a flatter chest that reflects your gender identity. It is permanent, so it starts with a careful plan.
Our network
Gender-affirming top surgery providers from Adoreal's partner network.
Linköping · Sweden
Plastikakademin
Mastectomy for trans and non-binary people using double-incision, periareolar or keyhole techniques, with documented assessor contact.
Linköping · Sweden
Plastikakademin
Mastectomy for trans and non-binary people using double-incision, periareolar or keyhole techniques, with documented assessor contact.
Ready to see who performs gender-affirming top surgery near you?
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How to choose a top surgery surgeon
Board certification is the starting point. The details below are worth weighing carefully when you're choosing the surgeon who's right for your goals.
Here's what to look for before you decide:
A good surgeon matches the technique to your chest, and tells you why.
Double incision, periareolar and keyhole techniques suit different amounts of tissue and skin, nipple positions and areola sizes. A surgeon worth trusting explains which one your chest needs, even when it isn't the one with the smallest scar.
Nipples and sensation deserve a clear conversation.
With a free nipple graft, the nipples can be resized and repositioned, but full sensation may not return. With a keyhole approach, they stay attached but can't easily be moved or made smaller. Ask what each option would mean for you.
Respect and clarity about the pathway matter.
A good practice tells you up front what documentation it needs from your gender assessment or care team, uses your name and pronouns, and answers questions without making you justify who you are.
Transparency about your plan and expectations is non-negotiable.
Your surgeon should be comfortable documenting the technique, where the scars will sit, the plan for your nipples, whether liposuction is included, and what recovery looks like week by week, and sharing that with you in writing.
Before your consultation, prepare this question
“Which technique would you use for my chest, and what does it mean for my scars and nipple sensation?”
A surgeon who answers directly, rather than deflecting, is one who puts your outcome above the booking.
Find a Gender-Affirming Top Surgery ProviderAbout the treatment
About gender-affirming top surgery
Top surgery, also called chest masculinization surgery or masculinizing mastectomy, removes breast tissue from both sides of the chest and shapes the skin, tissue and nipples to create a flatter chest. It is part of gender-affirming care for many trans men and non-binary people who experience gender dysphoria related to their chest.
How much surgery is needed depends on your chest. Often both breast tissue and excess skin are removed. Liposuction can be added to refine the contour, and the nipples are either kept attached or resized and repositioned as grafts, depending on the technique.
Top surgery is usually done as a single operation, and most people go home the same day.
What is top surgery?
Top surgery, or chest masculinization surgery, removes breast tissue from both sides of the chest and shapes the skin, tissue and nipples to create a flatter chest. It is part of gender-affirming care for many trans men and non-binary people.
It is usually a single operation, and it is permanent.
Who it's for
Practices and surgical guidelines generally look for the following before planning surgery:
- Gender dysphoria related to your chest
- A documented assessment, or contact with a professional you have discussed it with
- Being 18 or over and able to give legal consent
- Physical and mental health conditions that are being managed
- Realistic expectations about scars, sensation and permanence
Techniques
The right technique depends on the amount of tissue and skin, nipple position, areola size and how much nipple sensation matters to you:
- Double incision with free nipple grafts: for larger chests and excess skin; two longer scars, with nipples resized and repositioned.
- Keyhole: for small chests with no excess skin; a small scar at the edge of the areola, with nipples left attached.
- Periareolar: an incision around the areola, for smaller chests.
Liposuction can be added to refine the contour.
The treatment, step by step
Consultation. Your surgeon reviews your goals, history and documentation, and examines your chest.
Marking. Your chest is marked before surgery, usually while you are sitting up.
Anesthesia. Usually general anesthesia; surgery typically takes two to four hours.
Surgery. Breast tissue, and excess skin where needed, are removed and the nipples are shaped or grafted.
Closing. Incisions are closed and a compression garment is applied; a drain may be placed.
Recovery and aftercare
Most people go home the same day. Swelling and bruising fade gradually.
- Wear the compression garment as instructed
- Avoid strenuous activity for four to six weeks
- Attend follow-ups, usually starting within one to two weeks
Most return to work after about two weeks. Swelling settles over several months, and scars mature over around 18 months.
Risks and side effects
Every operation carries risks. Possible complications of top surgery include:
- Infection or bleeding
- A collection of blood (hematoma) or fluid that may need draining
- Slow healing or small open wounds in the first weeks
- Changes in, or loss of, nipple sensation
- Partial or complete loss of a nipple graft
- Scarring, which varies from person to person
- Uneven contour or nipples that may need further surgery
- Risks related to anesthesia
Common questions
Gender-affirming top surgery questions, answered.
If your question isn't here, ask us directly. A real person answers, and we won't push you toward anything.
Talk to us →What's the difference between double incision and keyhole?
Double incision suits larger chests and excess skin: it leaves two longer scars along the lower edge of the chest muscle, and the nipples are resized and repositioned as grafts. Keyhole suits small chests with no excess skin: it leaves a small scar at the edge of the areola, and the nipples stay attached but can't easily be moved or made smaller.
Do I need an assessment or referral first?
Yes. Practices ask for documentation before surgery. Some require a completed assessment through public gender care; others ask for documented contact with an assessor or other professional you have discussed your gender dysphoria with. Ask the practice exactly what it needs.
Is there an age limit?
You need to be old enough to give legal consent. In Sweden and the UK, gender-affirming surgery is usually for people aged 18 or over.
Will I keep nipple sensation?
It depends on the technique. Sensation in the chest is usually reduced, and full nipple sensation may not return after free nipple grafts. Some feeling often comes back over time. Some surgeons offer techniques that aim to preserve more sensation, so ask whether they suit you.
Is top surgery reversible?
No. Breast tissue, and the ability to breastfeed, are permanently removed. Volume could in theory be recreated later with implants or reconstruction, but not your own breast tissue.
Will I need more than one operation?
Most people need only one. Sometimes a smaller revision is needed, for example for uneven nipples or contour, or after later weight or hormonal changes. Ask how the practice handles revisions.
Is liposuction part of it?
Sometimes. Liposuction can be added to smooth the contour of the chest, depending on how fat is distributed and the result you want.
When can I go back to work?
Most people go home the same day and return to work after about two weeks, depending on the job. Strenuous activity and heavy exercise are usually avoided for four to six weeks.
Do I still need breast checks afterwards?
It's worth keeping an eye on your chest. The breast tissue is removed, but the risk of breast cancer is not zero, so checking yourself regularly is still recommended.
Can I have top surgery through public healthcare?
In Sweden and the UK, removing the breasts can be part of public gender-affirming care after an assessment, though waiting times can be long. Private practices can also operate once the documentation they require is in place.
