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Top surgery: Difference between revisions
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Some transgender and/or nonbinary people want to have 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 as happens naturally for women, 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, non-surgical and surgical. 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. | Some transgender and/or nonbinary people want to have 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 as happens naturally for women, 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, non-surgical and surgical. 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:<ref>https://www.genderconfirmation.com/available-techniques/</ref> | There are several things one has to take into account when looking for breast augmentation surgery options:<ref>https://www.genderconfirmation.com/available-techniques/ [https://web.archive.org/web/20221207103322/https://www.genderconfirmation.com/available-techniques/ Archived] on 17 July 2023</ref> | ||
* '''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. | * '''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. | * '''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. | ||
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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. | 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.<ref>http://topsurgerymidwest.com/ftm-top-surgery/</ref> | 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.<ref>http://topsurgerymidwest.com/ftm-top-surgery/ [https://web.archive.org/web/20220520065238/http://topsurgerymidwest.com/ftm-top-surgery/ Archived] on 17 July 2023</ref> | ||
* '''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. | * '''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. | * '''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. | ||
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* '''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. | * '''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. | ||
After having a mastectomy/masculine chest reconstruction, the person is still able to get pregnant. If they do get pregnant, the person can experience swelling in the chest area and may possibly start lactating. These changes may be upsetting but they almost always go away after the pregnancy is over.<ref>{{cite web|last=Froom|first=Moss|url=https://www.instagram.com/p/CNAX9_-AcTr/|title=Chest Swelling In Pregnancy Is To Be Expected Even After Top Surgery|date=29 March 2021}}</ref> | After having a mastectomy/masculine chest reconstruction, the person is still able to get pregnant. If they do get pregnant, the person can experience swelling in the chest area and may possibly start lactating. These changes may be upsetting but they almost always go away after the pregnancy is over.<ref>{{cite web|last=Froom|first=Moss|url=https://www.instagram.com/p/CNAX9_-AcTr/|title=Chest Swelling In Pregnancy Is To Be Expected Even After Top Surgery|date=29 March 2021|archive-url=False|archive-date=17 July 2023}}</ref> | ||
=== Preventing breasts from developing === | === Preventing breasts from developing === | ||
Some transgender and/or nonbinary people who have not yet developed any breasts already know that they do not want to have any. If they can prevent their breasts from developing in the first place, then they will not have to get surgery to remove them. If someone knows that developing breasts would be a significant source of distress ([[gender dysphoria]]), then preventing breast development can be better for their longterm mental health. | Some transgender and/or nonbinary people who have not yet developed any breasts already know that they do not want to have any. If they can prevent their breasts from developing in the first place, then they will not have to get surgery to remove them. If someone knows that developing breasts would be a significant source of distress ([[gender dysphoria]]), then preventing breast development can be better for their longterm mental health. | ||
* [[wikipedia:Breast ironing|Breast ironing]] is a non-surgical procedure that attempts to destroy the breast bud, so that breasts cannot develop. This is mostly practiced in Cameroon and can lead to scarring, breast cancer, infection, severe fever, cysts, asymmetrical breast development, and the inability to breastfeed.<ref name="Obaji">{{Cite web |title='No girl is safe': The mothers ironing their daughters' breasts |last=Obaji Jr. |first=Philip Obaji |work=aljazeera.com |date=3 February 2020 |access-date=22 February 2021 |url= https://www.aljazeera.com/features/2020/2/3/no-girl-is-safe-the-mothers-ironing-their-daughters-breasts}}</ref><ref name="AHO">{{Cite web |title=Breast Ironing Fact Sheet |author= |work=Africa Health Organisation |date= |access-date=22 February 2021 |url= https://aho.org/fact-sheets/breast-ironing-fact-sheet/}}</ref><ref name="ohchr">{{Cite web |title=Breast Ironing : A harmful traditional practice in Cameroon |author= |work=ohchr.org |date=August 2011 |access-date=22 February 2021 |url= https://www.ohchr.org/Documents/HRBodies/CEDAW/HarmfulPractices/GenderEmpowermentandDevelopment.pdf}}</ref> | * [[wikipedia:Breast ironing|Breast ironing]] is a non-surgical procedure that attempts to destroy the breast bud, so that breasts cannot develop. This is mostly practiced in Cameroon and can lead to scarring, breast cancer, infection, severe fever, cysts, asymmetrical breast development, and the inability to breastfeed.<ref name="Obaji">{{Cite web |title='No girl is safe': The mothers ironing their daughters' breasts |last=Obaji Jr. |first=Philip Obaji |work=aljazeera.com |date=3 February 2020 |access-date=22 February 2021 |url= https://www.aljazeera.com/features/2020/2/3/no-girl-is-safe-the-mothers-ironing-their-daughters-breasts|archive-url=https://web.archive.org/web/20230531004744/https://www.aljazeera.com/features/2020/2/3/no-girl-is-safe-the-mothers-ironing-their-daughters-breasts |archive-date=17 July 2023 }}</ref><ref name="AHO">{{Cite web |title=Breast Ironing Fact Sheet |author= |work=Africa Health Organisation |date= |access-date=22 February 2021 |url= https://aho.org/fact-sheets/breast-ironing-fact-sheet/|archive-url=https://web.archive.org/web/20230601024152/https://aho.org/fact-sheets/breast-ironing-fact-sheet/|archive-date=17 July 2023}}</ref><ref name="ohchr">{{Cite web |title=Breast Ironing : A harmful traditional practice in Cameroon |author= |work=ohchr.org |date=August 2011 |access-date=22 February 2021 |url= https://www.ohchr.org/Documents/HRBodies/CEDAW/HarmfulPractices/GenderEmpowermentandDevelopment.pdf|archive-url=https://web.archive.org/web/20230326031810/http://www.ohchr.org/Documents/HRBodies/CEDAW/HarmfulPractices/GenderEmpowermentandDevelopment.pdf |archive-date=17 July 2023 }}</ref> | ||
* For children and teens, [[puberty blockers]] can postpone or temporarily stop the development of breasts for as long as they are on that therapy. | * For children and teens, [[puberty blockers]] can postpone or temporarily stop the development of breasts for as long as they are on that therapy. | ||
* For people who are on the female-to-male spectrum, or whose bodies do not naturally produce much testosterone: taking [[testosterone]] or otherwise being on a masculinizing [[hormone therapy]] can prevent or temporarily stop the development of breasts, for as long as they are on that therapy. | * For people who are on the female-to-male spectrum, or whose bodies do not naturally produce much testosterone: taking [[testosterone]] or otherwise being on a masculinizing [[hormone therapy]] can prevent or temporarily stop the development of breasts, for as long as they are on that therapy. | ||
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One rare complication of breast surgery is that some or all of the areola or nipple skin can die during recovery. This leaves a blank, scarred, or pitted area of skin. This can happen to one or both nipples. A person can help prevent nipple loss by choosing a proficient surgeon, choosing a surgical method that keeps the nipple attached during the entire surgical process, and quitting smoking. Nipple loss is more common in mastectomy and masculine chest reconstruction, in which the nipple has been removed, divided, reshaped, and grafted back on during surgery. In masculine chest reconstruction, the nipple is also divided and reshaped, in order to make the nipples smaller and placed higher on the chest. Nipple loss can also happen to people who have had surgery to treat breast cancer, in which case it is not always possible to save the nipple. | One rare complication of breast surgery is that some or all of the areola or nipple skin can die during recovery. This leaves a blank, scarred, or pitted area of skin. This can happen to one or both nipples. A person can help prevent nipple loss by choosing a proficient surgeon, choosing a surgical method that keeps the nipple attached during the entire surgical process, and quitting smoking. Nipple loss is more common in mastectomy and masculine chest reconstruction, in which the nipple has been removed, divided, reshaped, and grafted back on during surgery. In masculine chest reconstruction, the nipple is also divided and reshaped, in order to make the nipples smaller and placed higher on the chest. Nipple loss can also happen to people who have had surgery to treat breast cancer, in which case it is not always possible to save the nipple. | ||
For people who have lost one or both nipples, some non-surgical options to restore them include [[nipple tattooing]], which recreates the color, but not the three-dimensional shape.<ref>{{cite book | last1 = Arndt | first1 = Kenneth A. | last2 = Hsu | first2 = Jeffrey T. S. | title = Manual of Dermatologic Therapeutics | edition = illustrated | publisher = Lippincott Williams & Wilkins | year = 2007 | page = 116 | url = https://books.google.com/books?id=CP27h0r-FjwC&dq | isbn = 978-0781760584}}</ref> Although nipple tattooing is considered a medical tattoo, patients get aesthetically better and more realistic results by going to a professional tattoo artist than by having a doctor do the tattoo. Some artists offer nipple tattoos for free for breast cancer survivors.<ref>{{cite web |first=Caitlin |last= Kiernan |date=3 June 2014 |title=Tattoo Therapy After Breast Cancer |website=The New York Times |page=D6 |url=http://well.blogs.nytimes.com/2014/06/02/a-tattoo-that-completes-a-new-breast/}}</ref><ref>{{cite web |title=The Nipple Artist (video) |author=Kassie Bracken |url=https://www.nytimes.com/video/health/100000002915699/the-nipple-artist.html |author2=Taige Jensen |date=2 June 2014 |website=The New York Times}}</ref><ref>{{cite web |url=https://www.bbc.co.uk/news/uk-england-dorset-38814066 |title=Breast tattoo service for cancer patients|website=BBC News |date=31 January 2017 |author= |accessdate= 31 January 2017}}</ref> Another non-surgical option is a [[nipple prosthesis]], a realistic fake nipple temporarily glued to the skin.<ref>{{cite journal|last=Janes|first=S|title=Custom-made nipple prosthesis: a long-term satisfaction survey|journal=J Cancer Res Ther|date=Apr–Jun 2005|volume=1|issue=2|pages=111–3|pmid=17998638|doi=10.4103/0973-1482.16712|doi-access=free}}</ref> Many prosthetic nipples are sold for women who survived breast cancer. There are also ones such as [https://gendercat.com/products/gendermender-prosthetic-nipples-for-men-and-women-in-over-100-skin-tones GenderMender prosthetic nipples for men, women, and nonbinary people], which are available in over 200 custom skin tones, and in smaller sizes that can look more appropriate on a masculine chest. [[Nipple reconstruction]] surgery recreates the three-dimensional shape of the nipple. Sometimes it uses a piece of skin from another part of the body to help create a raised shape.<ref name="Uscher">{{Cite web |title=Nipple Reconstruction Surgery and Nipple Tattoos |last=Uscher |first=Jen |work=Breastcancer.org |date=18 January 2021 |access-date=28 August 2021 |url= https://www.breastcancer.org/treatment/surgery/reconstruction/types/nipple}}</ref> Any of these treatments for nipple loss can help cover scars that might have come from breast surgery. | For people who have lost one or both nipples, some non-surgical options to restore them include [[nipple tattooing]], which recreates the color, but not the three-dimensional shape.<ref>{{cite book | last1 = Arndt | first1 = Kenneth A. | last2 = Hsu | first2 = Jeffrey T. S. | title = Manual of Dermatologic Therapeutics | edition = illustrated | publisher = Lippincott Williams & Wilkins | year = 2007 | page = 116 | url = https://books.google.com/books?id=CP27h0r-FjwC&dq | isbn = 978-0781760584}}</ref> Although nipple tattooing is considered a medical tattoo, patients get aesthetically better and more realistic results by going to a professional tattoo artist than by having a doctor do the tattoo. Some artists offer nipple tattoos for free for breast cancer survivors.<ref>{{cite web |first=Caitlin |last= Kiernan |date=3 June 2014 |title=Tattoo Therapy After Breast Cancer |website=The New York Times |page=D6 |url=http://well.blogs.nytimes.com/2014/06/02/a-tattoo-that-completes-a-new-breast/|archive-url=https://web.archive.org/web/20221017085301/https://well.blogs.nytimes.com/2014/06/02/a-tattoo-that-completes-a-new-breast/ |archive-date=17 July 2023 }}</ref><ref>{{cite web |title=The Nipple Artist (video) |author=Kassie Bracken |url=https://www.nytimes.com/video/health/100000002915699/the-nipple-artist.html |author2=Taige Jensen |date=2 June 2014 |website=The New York Times|archive-url=https://web.archive.org/web/20230323234752/https://www.nytimes.com/video/health/100000002915699/the-nipple-artist.html |archive-date=17 July 2023 }}</ref><ref>{{cite web |url=https://www.bbc.co.uk/news/uk-england-dorset-38814066 |title=Breast tattoo service for cancer patients|website=BBC News |date=31 January 2017 |author= |accessdate= 31 January 2017|archive-url=https://web.archive.org/web/20221103114830/https://www.bbc.co.uk/news/uk-england-dorset-38814066|archive-date=17 July 2023}}</ref> Another non-surgical option is a [[nipple prosthesis]], a realistic fake nipple temporarily glued to the skin.<ref>{{cite journal|last=Janes|first=S|title=Custom-made nipple prosthesis: a long-term satisfaction survey|journal=J Cancer Res Ther|date=Apr–Jun 2005|volume=1|issue=2|pages=111–3|pmid=17998638|doi=10.4103/0973-1482.16712|doi-access=free}}</ref> Many prosthetic nipples are sold for women who survived breast cancer. There are also ones such as [https://gendercat.com/products/gendermender-prosthetic-nipples-for-men-and-women-in-over-100-skin-tones GenderMender prosthetic nipples for men, women, and nonbinary people], which are available in over 200 custom skin tones, and in smaller sizes that can look more appropriate on a masculine chest. [[Nipple reconstruction]] surgery recreates the three-dimensional shape of the nipple. Sometimes it uses a piece of skin from another part of the body to help create a raised shape.<ref name="Uscher">{{Cite web |title=Nipple Reconstruction Surgery and Nipple Tattoos |last=Uscher |first=Jen |work=Breastcancer.org |date=18 January 2021 |access-date=28 August 2021 |url= https://www.breastcancer.org/treatment/surgery/reconstruction/types/nipple|archive-url=https://web.archive.org/web/20230531065348/https://www.breastcancer.org/treatment/surgery/reconstruction/types/nipple |archive-date=17 July 2023 }}</ref> Any of these treatments for nipple loss can help cover scars that might have come from breast surgery. | ||
== Nipple free == | == Nipple free == | ||
Some transgender and/or nonbinary people do not want to have nipples. They can choose to have their nipples removed, possibly as part of a breast reduction, mastectomy, or masculine chest reconstruction. This can create a smooth chest with no nipples.<ref name="White2012">{{Cite web |title=Neither Man Nor Woman: Meet the Agender |last=White |first=Rachel R. |work=The Cut |date=20 August 2012 |access-date=28 August 2021 |url= https://www.thecut.com/2012/08/neither-man-nor-woman-meet-the-agender.html}}</ref><ref name="OBrien-Lavender">{{Cite web |title=Ex-transgender man now wants to live as sexless ALIEN and has had nipples removed |last1=O'Brien |first1=Danielle |last2=Lavender |first2=Jane |work=The Mirror |date=2 March 2019 |access-date=28 August 2021 |url= https://www.mirror.co.uk/news/us-news/ex-transgender-man-now-wants-14071689}}</ref> Other people who got a mastectomy or masculine chest reconstruction did not value nipple sensation, but wanted to look like they have nipples, so they chose to have their nipples removed during that mastectomy or masculine chest reconstruction, with the plan that later they would get [[nipple tattooing]], to create the appearance of nipples. If a mastectomy or masculine chest reconstruction is nipple free, then this can involve fewer incisions and scars, which can make recovery a little bit easier. For people who are at a higher risk of losing a nipple after surgery if it is grafted back on, such as smokers, going nipple free gets rid of the risk of the possibility of worse scarring if the patient happens to lose a nipple after surgery. | Some transgender and/or nonbinary people do not want to have nipples. They can choose to have their nipples removed, possibly as part of a breast reduction, mastectomy, or masculine chest reconstruction. This can create a smooth chest with no nipples.<ref name="White2012">{{Cite web |title=Neither Man Nor Woman: Meet the Agender |last=White |first=Rachel R. |work=The Cut |date=20 August 2012 |access-date=28 August 2021 |url= https://www.thecut.com/2012/08/neither-man-nor-woman-meet-the-agender.html|archive-url=https://web.archive.org/web/20230502234924/https://www.thecut.com/2012/08/neither-man-nor-woman-meet-the-agender.html |archive-date=17 July 2023 }}</ref><ref name="OBrien-Lavender">{{Cite web |title=Ex-transgender man now wants to live as sexless ALIEN and has had nipples removed |last1=O'Brien |first1=Danielle |last2=Lavender |first2=Jane |work=The Mirror |date=2 March 2019 |access-date=28 August 2021 |url= https://www.mirror.co.uk/news/us-news/ex-transgender-man-now-wants-14071689|archive-url=https://web.archive.org/web/20230602081714/https://www.mirror.co.uk/news/us-news/ex-transgender-man-now-wants-14071689 |archive-date=17 July 2023 }}</ref> Other people who got a mastectomy or masculine chest reconstruction did not value nipple sensation, but wanted to look like they have nipples, so they chose to have their nipples removed during that mastectomy or masculine chest reconstruction, with the plan that later they would get [[nipple tattooing]], to create the appearance of nipples. If a mastectomy or masculine chest reconstruction is nipple free, then this can involve fewer incisions and scars, which can make recovery a little bit easier. For people who are at a higher risk of losing a nipple after surgery if it is grafted back on, such as smokers, going nipple free gets rid of the risk of the possibility of worse scarring if the patient happens to lose a nipple after surgery. | ||
One point of confusion involved in this is that surgeons-- and patients who describe their experiences with having surgery, such as on sites like TransBucket-- use the phrase "no nipple grafts" to mean two different things. They can use "no nipple grafts" to mean someone who chose to have their nipples removed and not grafted back on. Or they can use "no nipple grafts" to mean a mastectomy or masculine chest reconstruction in which the nipples were kept, and stayed attached to the body the whole time, instead of being removed and grafted back on. | One point of confusion involved in this is that surgeons-- and patients who describe their experiences with having surgery, such as on sites like TransBucket-- use the phrase "no nipple grafts" to mean two different things. They can use "no nipple grafts" to mean someone who chose to have their nipples removed and not grafted back on. Or they can use "no nipple grafts" to mean a mastectomy or masculine chest reconstruction in which the nipples were kept, and stayed attached to the body the whole time, instead of being removed and grafted back on. | ||