Top Surgery: Masculinising Chest Surgery, Techniques and Results

Top surgery (masculinising mastectomy) removes breast tissue and contours a masculine chest; it is the most commonly sought gender-affirming surgery for trans men. The technique used depends largely on chest size and skin, and it determines the scar pattern¹. Many trans men have top surgery as their only gender-affirming surgery, which is an equally valid path. It is accessed through an assessed pathway under the WPATH Standards of Care, Version 8 (SOC-8), 2022².

I am a trans woman, so I write this from the shared parts of the journey I know first-hand, the assessment and the recovery mindset, and from listening to trans men describe what top surgery meant to them. This guide is reviewed by a consultant gender-affirmation surgeon for clinical accuracy. For where this sits among the wider options, see our overview of gender-affirming surgery and of masculinising surgery for trans men.

What is top surgery?

It is a masculinising mastectomy: the breast tissue is removed and the chest is contoured to a masculine shape. It is the most commonly sought gender-affirming surgery for trans men, and for many people it is the change that matters most to daily comfort and confidence.

Because it addresses the chest rather than genitals, it is a separate decision from genital surgery, and many people pursue it on its own.

Techniques and scars

The technique is chosen mainly according to chest size and skin elasticity, and it determines the scar pattern. In broad terms, larger chests often need a technique with more extensive scars to remove and contour the tissue, while smaller chests may suit a technique with less scarring.

There is no single best technique; the right one depends on your chest and your goals. Your surgeon explains the likely scar pattern for the technique that fits you, and good scar care helps the result mature over the months that follow. The honest point I take from trans men I have spoken to is that the scar pattern is part of the planning, not an afterthought, and worth discussing fully at consultation.

Recovery after top surgery

Recovery is comparatively quick: it is often a day case or 1 night in hospital, with heavy activity avoided for about 4 to 6 weeks and drains often in place for 1 to 2 weeks. A support garment is usually worn as your surgeon directs while the chest heals¹.

This is shorter than the genital procedures; for comparison, phalloplasty is staged and commonly takes 12 to 18 months across operations. Your surgeon gives you a specific timeline and restrictions for your case.

Complications

Complications after top surgery are generally low, with recognised possibilities including haematoma, infection, scarring, and changes in nipple sensation. These are explained at consultation, with how likely each is for you, as part of informed consent.

Quoting risks honestly and specifically, rather than as a single headline figure, is part of good care. Your surgeon discusses the particular considerations for your technique and chest.

How top surgery fits the pathway

Top surgery is one masculinising option among many and is accessed through the same assessed pathway as other gender-affirming surgery. Under the WPATH Standards of Care, Version 8 (SOC-8), 2022, care is based on informed consent, capacity, and individualised assessment². On the NHS, care is accessed via a Gender Dysphoria Clinic, where a first appointment commonly takes several years¹.

Regret after gender-affirming surgery is about 1 in 100 across a large pooled meta-analysis, low but not zero³. Nothing here is personal medical advice; decisions are made with your own clinical team, who can assess you individually. To understand the assessment and referrals, see the pathway to gender-affirming surgery.