Top Surgery or Gender Mastectomy
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Top surgery, or gender mastectomy, involves direct excision of breast tissue with or without liposuction to create a masculine chest in transgender or gender-expansive patients. A variety of incision patterns may be used, including peri-areolar, circumareolar and double incision with free nipple grafting. The specific technique used is dependent on a patient’s scar preference as well as breast size and anatomy. This procedure is done under general anesthesia and patients typically will go home the same day as an outpatient procedure.
Frequently Asked Questions
Who is a good candidate for gender mastectomy surgery?
The UW Health team follows the World Professional Association for Transgender Health (WPATH) standards of care and requires that patients are 18 years of age and have one letter of readiness for surgery by a mental health provider. Patients younger than 18 may be surgical candidates if the patient, legal guardians and mental health professional are in agreement that delaying surgery would induce patient harm.
What should I do in the time leading up to my gender mastectomy surgery?
Your doctor will give you instructions before your breast augmentation surgery, including guidelines on eating, drinking and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure.
Your surgeon may require you to have a mammogram before surgery, depending upon your age and family history.
You will also want to arrange for someone to drive you home after surgery and stay with you for a day or two because some activities may be uncomfortable.
What should I expect following a gender mastectomy procedure?
Immediately following gender mastectomy surgery, you may experience bruising, swelling, temporary soreness, sickness upon waking from anesthesia and changes in nipple sensation. You may be advised to wear a surgical chest binder to help alleviate swelling for several weeks after surgery. If you undergo free nipple grafting as part of your procedure, you will have special bolster dressings on your nipples for five days after surgery, which will be removed in clinic. You may be discharged home with surgical drains in your breasts, which will be removed when output decreases in the first one to two weeks after surgery.
You will be able to resume light activities one to two days after surgery. Usually, patients return to work within three to four weeks after surgery. Risks associated with gender mastectomy surgery include hematoma (limited bleeding under the skin), seroma (fluid collection), unfavorable scarring and chest asymmetry.