While the term top surgery usually refers to procedures that masculinize the chest, the surgery itself can be as varied and unique as the patients it serves. Everyone’s starting shape and everyone’s final shape goals are different, and so each surgery is customized and designed for its owner.
Top surgery involves removal of the entire or majority of the breast glands and overlying skin, giving the new chest a leaner, defined look. Sometimes this is to achieve a very muscular, masculine appearance. Sometimes this is to achieve neither a feminine nor a masculine look. Sometimes this means leaving a small amount of breast tissue, to be enhanced on the femme days, but flat enough to be masculine when desired.
What we take away matters just as much as what we leave behind. This surgery is not simply about removing as much tissue as possible: it’s about creating a new shape, one that looks and feels right for you.
What matters most is to figure out what will make you feel most at home in your own body. Dr. Shore will focus on the details and help guide you through the decision-making process, so that your new chest reflects who you are.
Top surgery procedures generally fall into two categories: double incision (DI) and keyhole (also known as periareolar). The choice of technique ultimately depends on whether extra skin needs to be removed, to avoid leaving loose, deflated skin.
Double incision is by far the most commonly performed technique, and is usually combined with free nipple graft reconstruction, allowing Dr. Shore to reposition, resize and reshape the nipple-areola complex in just the right way.
Keyhole, on the other hand, doesn’t remove any skin. Using small scars hidden around the areola, only the glandular tissue on the inside is removed. We then rely on the chest skin’s natural elasticity to shrink back and conform to the chest wall. (This technique may be more successful in preserving nipple sensation.)
Both surgeries have similar recovery timelines.
Six weeks is the time to full recovery after surgery (provided all healing and recovery goes as expected). Drains usually are removed at one week, the postoperative compression vest is removed at two weeks, scar care is started at two weeks, and activity is gradually resumed between two and six weeks.
Surgery is done as an outpatient, meaning you can go home the same day. You will need someone to drive you home (or Uber home with you), and stay with you for the first 24 hours.
You’re quite independent from day one. While there are some arm restrictions – pretend you are a T-Rex/sloth hybrid – you will be able to walk right after surgery and perform low-key activities right away. Walking is encouraged and very helpful for recovery. While it’s hard to put an active life on pause, the key (I’ve found) is to fill your days with fulfilling things that simply require less intense activity.
Most people have very little pain after surgery. Dr. Shore uses local anesthetics and blocks during the procedure (like when you get a cavity filled at the dentist) to lessen discomfort after surgery. Icing after surgery also helps.
