Top surgery

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.

Some nonbinary people call themselves transsexual and seek bottom surgery, some prefer to avoid this word or not having surgery at all. A nonbinary person doesn't need to have or want bottom surgery in order for their gender identity to be valid. This is true for transgender people of all kinds. Bottom surgery is an option that a person can take on their transition path only if they personally want or need it.

Content warnings: This page is not safe for work. Much talk about chest, breasts, and surgery on them.

Top surgery and gender identity
For binary trans people who want to have surgery, top surgery usually means a fairly specific variety of procedures, depending on the individual's needs to treat their gender dysphoria or make their body like that of a cisgender dyadic person of their own gender. For transgender women, top surgery usually means augmenting the size of their breasts, which could have already been developed thanks to hormone therapy. For transgender men, it usually means removing the breast tissue from their chest so that it looks flat. As for nonbinary people, it generally depends on which direction they want to modify their appearance.

Resources about top surgery usually put different kinds of surgeries into groups based on whether they are in the female-to-male or male-to-female transition spectrums. In order to make this page's resources useful and helpful to nonbinary people, people born with intersex conditions, this page instead puts different kinds of surgeries into groups based on how the body is affected. 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 gender-neutral "they" pronouns.

Mastectomy
This section lists different types of surgery that result in the removal of breast tissue. It's worth noting that, generally, top surgery refers only to mastectomy.
 * Double incision with free nipple grafts: in this surgery, both the breast tissue and the nipples are removed through two incisions: one at the top and the other at the bottom of the breast. Then, nipples are reconstructed in a typically male position. This causes total loss of sensation in the nipples and the areolas.
 * Inverted-T or T-Anchor: this surgery is similar to the previous one, but the nipple is not removed, which means that sensation can be partially maintained. However, this procedure requires two additional vertical incisions, so the scars are more visible.
 * Peri-areolar: in this surgery, two incisions around the areolas are made in order to pull the breast tissue. Scarring is minimal, but it often requires further revisions and only people with medium to small chests are elegible.
 * Keyhole: this one is very similar to the peri-areolar surgery. A semi-circular incision is made under the areola and the breast tissue is removed through it. Scarring is minimal, but it often requires further revisions and only people with small chests are elegible.

Breast augmentation
There are several things one has to take into account when looking for breast augmentation surgery options:
 * 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.