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Gender Affirming Top Surgery

The chest is a prominent gender identifying feature for a person. Mr Klein has been offering gender affirming procedures, (TOP surgery) for many years. TOP surgery includes both breast augmentation or chest masculinization. It is the most common procedure performed for trans women, trans men, and gender non-binary individuals.

Top surgery can be a physically and emotionally liberating procedure. However, as with any surgery there are risks and complications that must be considered. It is most important to candidly discuss your goals and expectations with Mr Klein at the time of your consultation. There is much to consider prior to TOP surgery and also your personal factors that need to be considered. There are both benefits and challenges with all types of reconstruction. We will strive to provide you with information that will allow you to make the best decision about your unique situation.

For chest masculinization, a commonly used technique is excision mastectomy with free nipple grafting. A peri areolar procedure (where there is an incision around the areola) is occasionally used. For chest feminizing procedures, a breast augmentation is usually performed with submuscular placement of an implant.

Many patients are often eager to get back to regular activities, but it’s important to give your body time to recover. After surgery, you may have drains on each side that should be removed in a few days. We recommend no heavy lifting or weight training for about six weeks. You may however return to walking or cycling much earlier. These procedures may impact nipple sensation. Over time, some feeling can come back, but the sensation probably won’t be erogenous. You will have different degrees of scarring depending on the type of procedure performed and your own biology. Generally, you can expect these scars to either be in the pectoral shadow, the fold beneath the breast, and/or around the areola. It takes time for scars to mature. The final results can take anywhere from six months to two years.

We recommend that individuals with a family history of breast cancer have genetic testing performed before any TOP surgery. The test will show if there is a genetic mutation linked to increased breast cancer or ovarian cancer risk, like a BRCA1 or BRCA2 mutation. These mutations carry a lifetime breast cancer risk that can be as high as 80 percent. Being BRCA positive doesn’t mean you aren’t eligible for TOP surgery, but we would refer you to a surgical oncologist for a consultation before moving forward.

We see patients frequently after surgery until full healing occurs and anytime there are issues or questions after that.

If you were born with breasts, make sure you’re getting regular screenings for breast cancer. If you’re taking hormones as part of your transition, you may need to be screened, too.

Transgender men who have not undergone mastectomy, or who have had a breast reduction as opposed to a mastectomy, should follow current screening guidelines for cisgender women (those with gender identity aligns with their sex assigned at birth). If you’ve had a reduction with breast tissue left behind, its recommended that you still get a mammogram at the recommended intervals

For transgender women who are taking estrogen, it’s recommended that a screening mammography be performed every two years once you are 50 or older or have been using hormones for 5-10 years. Increased circulating estrogen may increase the risks of estrogen receptor-positive breast cancer.

There may be other personal factors to take into consideration when considering breast augmentation or chest masculinization. We will discuss your specific situation and arrive at a personalized plan.