Masculinizing top surgery is a gender-affirming procedure designed to create a flatter, typically masculine chest contour. It is generally sought by transmasculine individuals, including trans men and non-binary people, whose gender identity does not align with their chest appearance. Medically, it is classified as a bilateral subcutaneous mastectomy, emphasizing the removal of breast tissue beneath the skin. The primary goal is aesthetic and psychological, aiming to alleviate gender dysphoria by harmonizing the body with one’s gender presentation.
This procedure differs from a mastectomy performed for cancer treatment in its focus on chest contouring and minimizing scarring. Surgeons concentrate on shaping the remaining tissue and skin to resemble the male pectoral muscle structure. Achieving a flat, masculine result requires careful planning tailored to the patient’s existing anatomy and desired outcome.
The Anatomical Focus: Glandular Tissue Removal
Yes, top surgery removes the mammary glands. The mammary glands, composed of glandular tissue responsible for milk production, are the primary target for removal during the procedure. Breast tissue consists of fat, connective tissue, and glandular tissue. To ensure a lasting, flat chest, the glandular tissue must be excised because it is the component most responsive to hormonal changes and potential regrowth.
The procedure is technically a subcutaneous mastectomy because the bulk of the underlying glandular tissue is removed while most of the overlying skin is preserved. Complete removal of all breast cells is not the surgical goal; approximately five percent of tissue is intentionally left behind. This residual tissue is necessary to ensure the chest wall does not appear “skeletonized” or concave, which would compromise the desired aesthetic contour.
Overview of Surgical Techniques
The method a surgeon uses depends on the patient’s chest size and skin elasticity. For individuals with moderate to large chest volume or significant excess skin, the Double Incision Mastectomy (DI) is the most common technique. This method involves two horizontal incisions, through which the surgeon removes the glandular tissue and excess skin, resulting in a flat chest contour. The nipple-areola complex is typically removed, resized, and then placed back onto the chest as a free nipple graft (FNG).
For patients with smaller chests and good skin elasticity, a Keyhole or Periareolar technique may be appropriate. These methods allow for the removal of the glandular tissue through a small incision made around the edge of the areola. The surgeon excises the glandular tissue through this minimal opening, often leaving the nipple and areola attached to the chest wall. Regardless of the technique chosen, the fundamental surgical objective remains the complete removal of the breast’s glandular components to achieve a masculine chest.
Functional Implications of Breast Tissue Removal
The surgical removal of the mammary glands has direct and irreversible functional consequences. Since the glandular tissue and associated milk ducts are excised, the potential for future lactation or chestfeeding is permanently eliminated. This results from removing the anatomical structures necessary for milk production.
Another significant functional implication involves changes in chest sensation. Many techniques, particularly the double incision method with FNG, involve severing the nerve supply to the nipple-areola complex. Patients frequently experience a loss of sensation, with the area becoming numb or only having tactile sensitivity. While some protective sensation may return over the months following surgery, the high degree of erotic sensation often experienced before surgery is rarely preserved.