Surgery to create a more masculine chest shape
Masculinizing "top" surgery refers to plastic surgery techniques used to reshape the chest in people who were assigned female at birth and desire a more masculine chest contour. This commonly performed gender-affirming surgery is also known as female-to-male or transmasculine top surgery or gender mastectomy.
The goals of masculinizing top surgery are to:
- Remove existing breast tissue and any excess skin
- Reconstruct remaining tissues to create a flatter contour to the chest
- Reduce and reposition the nipple and areola, if desired
Masculinizing top surgery can be performed using a variety of techniques. Your anatomy determines which technique is best for you.
Double incision with free nipple grafting
The most common technique for masculinizing top surgery is a double-incision mastectomy with free nipple grafting. With this technique, an incision is made at the top and bottom of each breast and the breast tissue is removed. The incisions are then closed in a straight line across the chest.
If free nipple grafting is desired, the nipples and areolas are surgically removed, resized and reshaped to more masculine dimensions, and grafted back onto the chest in a more masculine position. Nipple grafts do not have nerves attached and, so, do not have sensation.
An option to surgical reconstruction of the nipple-areolar complex is 3D tattooing after the person has healed from surgery.
Periareolar (keyhole) incision
The periareolar technique involves a small incision around the lower half of the areola, through which the breast tissue is removed. There is less scarring than with a double incision approach and, while not guaranteed, some nipple sensation may be retained. Also, while the nipple-areolar complex is not completely reconstructed, the nipple can be reduced if it is very prominent. Nipple position, however, cannot be significantly changed.
The periareolar surgical approach will not work for everyone. Good candidates have a small amount of breast tissue without excess skin and good skin elasticity.
Inverted T incision
The inverted T technique is ideal for people who have medium to large breasts and want a smaller chest but wish to retain some breast fullness.
For this technique, excess skin is removed, and the nipple-areolar complex is reshaped and repositioned on a pillar of breast tissue (pedicle) that provides a blood supply to the nipple and areola. Some nipple sensation may be preserved but cannot be guaranteed, as a significant amount of breast tissue is removed and nerves to the nipple travel in the breast tissue.
An option to surgical reconstruction of the nipple-areolar complex is 3D tattooing once the person has healed from surgery.
Gender-affirming surgery at Main Line Health
Masculinizing top surgery is available at Main Line Health through the Gender Care Program. If you are interested in top surgery, a consultation will be scheduled with our plastic and reconstructive surgeon. During this consultation, your goals will be discussed and an examination of your chest will be performed. Based on your goals and your anatomy, a surgical technique will be recommended.
Before requesting a consultation, we recommend that you review the eligibility criteria for masculinizing top surgery.