Top surgery
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Top surgery is a phrase used in the transgender community to mean a variety of kinds of gender-validating surgeries that can be done on the chest or breasts. This is as opposed to bottom surgery, which is any kind of gender-validating done on the reproductive organs or genitals. As with any kind of transgender people, some nonbinary people seek top surgery, some prefer not to. Top surgery is an option that a person can take on their transition path only if they personally want or need it. There are three main kinds of top surgery: making the breasts larger (breast augmentation), making the breasts smaller (breast reduction), or removing the breasts (mastectomy). It is each nonbinary person's own choice to get one of these, or none of these.
This page is written to use anatomically correct and yet gender-neutral language everywhere possible. This includes calling the surgery patient the "patient" or "person," rather than "woman" or "man," and calling the patient by "they" pronouns.
Breast augmentation
See main article: breast augmentation.
Some nonbinary people want breasts. For people who are developing breasts without having to take any hormone therapy, breasts can continue to grow during puberty until about the mid-20s. For people who take estrogen hormone therapy, this causes the exact same kind of breast development, just not necessarily at the same age. If either of these processes has finished, and the person still wants to have larger breasts than what they have, then they have a variety of options. They can temporarily make their breasts look larger by wearing a more supportive bra, a push-up bra, or padded bra. They can wear breast prostheses, also called fake breasts. For people who want to permanently make their breasts larger, then they have the option to get breast augmentation surgery.
There are several things one has to take into account when looking for breast augmentation surgery options:[1]
- Type of implant: there are two types of implants: silicone implants and saline (i.e. saltwater) implants. While silicone feels and looks more natural, it also requires bigger incisions, which means bigger scars.
- Shape: the shape of the implant can be round or like a teardrop. Round implants are the most popular choice, because they are symmetrical and rotation is not a problem. However, teardrop implants can give a more natural look.
- Incision location: there are three ways to insert an implant: through a periareolar incision around your areola, an inframammary incision just below your chest muscle or a transaxillary incision through your armpit. With silicone implants, an inframammary incision is normally the best choice, as they are inserted fully inflated. With a saltwater implant there are more possible choices.
Mastectomy
See main article: mastectomy.
Some nonbinary people want or prefer to have a flat, masculine chest. For transgender children and teens, going on a prescription medicine called puberty blockers can postpone or pause puberty, which prevents or reduces the amount of breast growth they would have. The effects of puberty blockers are temporary, so breast growth will resume whenever the person stops taking that medicine. For people who have already had breast growth, going on hormone therapy such as testosterone may reduce breast size just a little bit, if at all, but it does not get rid of breasts. There are also nonbinary people who go on estrogen hormone therapy in order to get other body changes that they want, but who do not want breasts. Wearing a well-fitted sports bra or binder can reduce how large the breasts look, and temporarily make a flat, masculine chest shape. The only way to permanently get rid of breasts is through surgery. Surgery to take away the entire breast is called mastectomy. For transgender people, mastectomy is also called masculine chest reconstruction, to emphasize that they don't see it as a loss, but as fixing a problem.
Mastectomy for trans people is not as painful or traumatic as mastectomy to remove breast cancer or lumps, because the latter usually has to remove lymph nodes. For trans people, mastectomy is a short, single-stage procedure done under general anesthesia at a cosmetic surgery clinic or hospital. The patient goes home the same day. The recovery process depends on which method for mastectomy the patient had.
These are a few of the different methods for mastectomy. These options vary depending on what is possible or best for that patient's anatomy. They also vary from one surgeon to the next, since each has a specialty or a preferred method.[2]
- Double incision with free nipple grafts. In this surgery, both the breast tissue and the nipples are removed. Then, nipples are reconstructed in a typically male position. This usually causes loss of sensation in the nipples and the areolae.
- Inverted-T or T-Anchor: This surgery is similar to the previous one, but the nipple is not removed, which means that the person is much more likely to still have nipple sensation. The nipple stays attached to the body with a piece of skin, and moved higher up on the chest after the breast volume is taken away. This creates a scar on each breast shaped like an upside down capital letter T, with a long horizontal scar below the pectoral muscle, and a vertical scar going up from the middle of that to the nipple.
- Peri-areolar. In this surgery, the surgeon makes two incisions around the areolae in order to remove the breast tissue. Scarring is minimal, but it often requires further revision surgeries to reduce puckering from extra skin. Only people with medium to small chests are eligible.
- Keyhole. A semi-circular incision is made under the areola, and the breast tissue is removed through it. Otherwise it is similar to peri-areolar.
Breast reduction
Some nonbinary people have larger breasts than they want. If the temporary methods such as sports bras and binders do not meet their needs, then they may prefer to get surgery to reduce the size of their breasts. The variety of methods for breast reduction are very similar to those for mastectomy described above. Larger breasts or those that need to go down more sizes will be reduced by the T-anchor method. Breasts that only need to be a little smaller can be reduced by the peri-areolar or keyhole method.
