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Masculinising Top Surgery

What is masculinising top surgery?

Content warning: the content below uses some anatomy/biological terms where it is important to be precise

Masculinising Chest Surgery, also known as Top Surgery or Gender Affirming Mastectomy, removes the breast tissue (mastectomy) while reshaping the chest to align it with the patient’s gender identity. It is important to be aware that this surgery is not reversible, therefore you need to consider all the options available before you make this important decision.

The procedure involves various techniques designed to create a male chest contour:

Double Incision Mastectomy with or without free nipple graft
Keyhole Mastectomy
Peri-Areolar Mastectomy
Breast Reduction
Liposuction

The choice of top surgery technique is based on several factors, including the patient’s breast size, skin elasticity, overall anatomy, and personal goals. During the consultation, all these aspects are assessed and all the suitable options are discussed. The aim is to recommend a technique that achieves a chest contour congruent with pateint’s identity.

Double Incision Mastectomy with or without free nipple graft

Double incision mastectomy with or without nipple graft is a surgical procedure designed to create a flatter, more masculine chest contour. During this surgery, breast tissue is removed through two horizontal incisions made across the chest. Excess skin is also removed, and the chest is reshaped to achieve a natural and more masculine result.

If nipple grafts are included, the nipples are removed, resized, and repositioned to align with male chest proportions. The grafting process reduces nipple size and ensures placement that complements the new chest contour. It’s important to note that the surgery may result in reduced or complete loss of sensation.

This procedure is irreversible and is recommended for individuals with larger chests or reduced skin elasticity, as it allows for optimal reshaping and contouring. Double Incision Mastectomy can be coupled with liposuction in the same surgery.

Keyhole Mastectomy

Keyhole mastectomy is a surgical procedure designed for individuals with smaller chests and good skin elasticity. This technique involves minimal scarring as breast tissue is removed through a small incision, typically placed along the edge of the areola.

The procedure reshapes the chest without the need for large incisions or significant skin removal. Because no skin is removed, this technique relies on the skin’s ability to contract naturally over time.

Keyhole mastectomy does not involve resizing or repositioning the nipples, so nipple sensation and appearance are often preserved. However, it may not be suitable for individuals with larger chests or those requiring significant skin removal or nipple reduction to achieve their desired results.

Periareolar Mastectomy

Periareolar mastectomy is a surgical technique used to remove breast tissue through a circular incision made around the edge of the areola (dark-colored skin surrounding the nipples). This approach allows for minimal scarring.

The procedure removes excess breast tissue and may involve some skin tightening to achieve a flatter contour. Nipple sensation is often preserved, though some loss of sensation is possible depending on individual factors.

Periareolar mastectomy is suitable for individuals with moderate breast tissue and good skin elasticity. It offers a balance between achieving a flatter chest and maintaining a more natural-looking result with minimal scarring.

Liposuction

Liposuction is often used in combination with other techniques, such as double incision or periareolar mastectomy, to achieve the desired masculine chest contour.

During the procedure, small incisions are made, and a suction technique removes the fatty tissue, helping to define the chest area. Depending on individual needs, liposuction can be tailored alongside glandular removal or skin tightening to ensure the best possible outcome.

Pre-Surgery Appointments

You will receive a questionnaire about your medical history to complete once we receive the referral from GDNRSS, while you wait for your first appointment. If necessary, a member of our team may contact you for additional information.

Your first consultation will be face-to-face with the surgical team, providing an opportunity to examine you and discuss the procedure. You will have the chance to ask any questions regarding top surgery, understand the risks and benefits, and discuss your suitability for the surgery.

If the surgeon feels you are fit to proceed, a member of our administration team will contact you to arrange a date for surgery. Additionally, you will be scheduled for a preoperative assessment appointment to prepare you for the procedure. If the surgeon believes further investigation or management from other specialists is needed before proceeding with surgery, they will discuss this with you during your consultation.The surgery will be performed as a day case under general anaesthesia at Chelsea and Westminster Hospital or at Fitzrovia Hospital.

Some more information about video consultations at the hospital can be found here: Video consultations — Chelsea and Westminster Hospital NHS Foundation Trust (chelwest.nhs.uk)

First face to face appointment with your Consultant Surgeon

You will have an appointment with your consultant surgeon and this is an opportunity for you to ask any questions and discuss the surgery and what it entails and understand the outcomes of this surgery. The appointment will cover:

Desired procedure detail, how long it will take, and what you should expect from this surgery.
A review of previous surgeries.
Initial Verbal informed consent discussion regarding the procedure, risks and outcomes.
Physical examination with the option of medical photography to be done on the day.

In addition to your verbal consent conversation, you will receive a digital consent form which formally documents the discussion that you will have had with your consultant. The consent form will be sent to your email or mobile phone using our digital consent system known as Concentric. This form confirms you are informed about the surgery including knowledge about the associated risks and complications of the procedure. You will need to sign this prior to your surgery.

This form confirms you are informed about the surgery including knowledge about the associated risks and complications of the procedure. You will need to sign this prior to your surgery.

Consent to the planned procedure will be confirmed with you again on the day of your surgery and any discussions or questions raised can be documented on your Concentric profile by the clinician.

If you have any difficulties with remotely consenting, please contact our Patient Pathway Co-ordinators. Their telephone contact details can be found on the last page of this information leaflet.

Pre-operative Assessment (usually six weeks before your operation)

You will attend a face-to-face appointment with a pre-operative nurse, who will talk through your previous and current medical history, arrange any tests such as blood tests that you need before surgery and give you information about preparing for your anaesthetic.

One Week before Surgery

It is required that you stop drinking alcohol one week before and for three weeks after surgery. This is because alcohol increases chances of bleeding. If you need support with this, let your Clinical Nurse Specialist know.
NO aspirin or any blood thinning medication.
NO nonsteroidal anti-inflammatory drugs- such as Ibuprofen, Diclofenac, or Naproxen.
NO herbal supplements e.g. St John’s Wort.
NO fish oil.
Wash and change bed sheets, as this will be more difficult to do when you get back from the hospital.
You don’t need to stop hormonal treatment prior to surgery
If you have had diarrhoea or vomiting 72 hours or less, before your operation, please contact the team as soon as possible, as your procedure will need to be rescheduled.
It is also important that you inform us if you are feeling unwell, have had a temperature, cough or flu like symptoms on or on the days leading up to your planned operation. It may be safer to postpone your operation until you are well.
Please remove any nail varnish before you come in for your operation as it can interfere with monitoring.

Day of Surgery

Fasting Instructions

Morning Surgery: You can eat until midnight the night before the surgery you may drink sips of clear fluids (which includes only water, black tea, or black coffee until time of surgery)
Afternoon Surgery: You must finish eating breakfast by 7am on the day of the surgery.

You may drink sips of clear fluids (which includes only water, black tea, or black coffee until time of surgery)

Why is Fasting Important?

Fasting (not eating, sips of clear fluids are allowed) is important to avoid complications with your anaesthetic during your operation.

What to expect on the day:

It is important you arrive on time. You may be waiting for a few hours for your surgery.

We advise you to wear comfortable clothes on the day e.g. wear a sweater with a front zipper to reduce the risk of adding stress to your chest when pulling a garment over your head.

On the day of surgery – shower before you leave home, don’t bring jewellery or cosmetics or a watch, and wear your glasses instead of contact lenses.

you may bring your phone with you but ensure that you have a charging cable for it.

Giuseppe Di Taranto (Service Lead for Top Surgery)
Victoria Rose
Dominic Yue
Saahil Mehta

Risks and complications

If you are accepted for surgery, your consent form will explain the potential risks and complications of your surgery. Details of this will also be discussed in your surgical consultations.