Medical procedures often share underlying techniques while serving distinct purposes. This is particularly true when considering “top surgery” and “mastectomy,” two terms that describe the removal of breast tissue. Many people wonder about the connection between these procedures, given their shared surgical component. While both involve altering the chest through tissue removal, their primary goals, patient populations, and aesthetic considerations typically differ.
What is a Mastectomy
A mastectomy is a surgical procedure involving the removal of part or all of the breast. It is primarily performed as a treatment for breast cancer, addressing conditions such as ductal carcinoma in situ or various stages of invasive breast cancer.
Beyond cancer treatment, mastectomies are also undertaken as a preventive measure for individuals identified to be at a high risk of developing breast cancer. This prophylactic removal is an option for those with strong family histories or specific genetic mutations, such as BRCA1 or BRCA2. Different types of mastectomies, such as simple or total mastectomy, remove the entire breast tissue, including the nipple and areola, while others may be more localized.
What is Top Surgery
Top surgery, in the context of gender-affirming care, is a procedure designed to create a chest contour that aligns with an individual’s gender identity. For many transgender and gender-diverse individuals, this involves removing breast tissue to achieve a flatter, more masculine, or gender-neutral appearance. This surgical step can be a significant part of addressing gender dysphoria, a discomfort arising from a mismatch between one’s gender identity and physical characteristics.
The primary purpose of top surgery is not disease treatment but rather to help patients achieve a greater sense of congruence between their physical form and internal identity. It focuses on chest masculinization or flattening, playing a direct role in improving psychological well-being and self-perception. This procedure is customized to the patient’s goals, contributing to their overall affirmation journey.
The Medical Relationship
From a medical and surgical standpoint, top surgery is considered a form of mastectomy. Both procedures involve the surgical removal of glandular breast tissue, along with varying amounts of fat and skin. The underlying anatomical intervention is similar, which is why medical coding systems classify top surgery under the broader mastectomy category.
For instance, a common Current Procedural Terminology (CPT) code used for top surgery is 19303. This code denotes a “mastectomy, simple, complete,” and is used because the procedure entails the complete removal of breast tissue, including the nipple and areola. Medical billing and insurance processes often use these established codes, highlighting the shared surgical definition despite different clinical indications.
Key Differences in Approach
Despite the medical classification, top surgery and mastectomy have distinct approaches driven by their differing objectives. The main purpose of a mastectomy is typically to remove diseased or at-risk tissue, prioritizing the eradication of cancer or significant risk reduction. In contrast, top surgery’s goal is gender affirmation and aesthetic contouring, focusing on creating a specific chest shape that aligns with a patient’s identity.
Aesthetic goals in top surgery include creating a natural-looking, masculine, or gender-neutral chest, which often involves careful consideration of nipple size, shape, and placement. Surgeons frequently employ techniques such as free nipple grafts or nipple sensation preservation to achieve desired cosmetic outcomes. This contrasts with mastectomies for cancer, where the primary concern is complete tissue removal, and aesthetic reconstruction may be a subsequent, separate procedure. Furthermore, the patient population for top surgery is primarily transgender and gender-diverse individuals seeking physical alignment with their gender identity, whereas mastectomy for cancer or risk reduction is typically performed on individuals diagnosed with or at risk for breast cancer.
Why Different Terms Are Used
The use of distinct terms like “top surgery” versus “mastectomy” reflects social, linguistic, and patient-centered considerations. “Top surgery” is widely preferred within the transgender community and among affirming medical professionals because it is considered less pathologizing than “mastectomy.” It avoids medicalizing gender identity by associating the procedure solely with disease.
This terminology also helps distinguish the procedure’s purpose from cancer treatment, emphasizing its role in gender affirmation rather than illness. Using “top surgery” respects patient autonomy and aligns with language that is affirming of a person’s gender identity, accurately describing the desired outcome of altering the “top” part of the body.