The term “Top Surgery” is widely used to describe gender-affirming procedures that modify the chest. While this colloquial phrase is easily understood, medical professionals use precise clinical terminology to differentiate between surgical goals and techniques. These specific medical names are necessary for accurate communication, procedural documentation, and navigating health insurance and medical coding. This article clarifies the formal nomenclature, details the procedural differences, and outlines the preparation and recovery process.
The Official Medical Terminology
The medical terminology for “Top Surgery” depends on the intended outcome: chest masculinization or chest feminization.
For those seeking a flatter, masculine chest contour, the operation is formally termed a gender-affirming mastectomy or a subcutaneous mastectomy. Mastectomy refers to the removal of breast tissue. Subcutaneous indicates that the procedure removes glandular tissue while preserving the overlying skin and nipple-areola complex for aesthetic reshaping.
Other official terms include chest wall reconstruction or chest masculinization. These procedures emphasize creating a male-typical chest appearance through tissue removal and contouring. They are typically linked to a diagnostic code for gender dysphoria (e.g., ICD-10 code F64.0). For insurance billing, the procedure is often coded as a breast mastectomy, sometimes with modifiers to indicate the gender-affirming context.
For patients seeking a fuller, feminine chest, the procedure is officially called augmentation mammoplasty or breast augmentation. This surgery involves inserting silicone or saline implants to increase the size and reshape the chest tissue. These feminizing procedures are also considered gender-affirming surgery and are linked to the same diagnostic codes for gender dysphoria.
Detailed Surgical Techniques
Gender-affirming mastectomy procedures are individualized, with the surgeon selecting the technique based on the patient’s existing chest size and skin elasticity.
The Double Incision Mastectomy (DI) with Free Nipple Grafts is the most frequently performed method, especially for those with a medium to large chest size or significant skin laxity. This technique involves two horizontal incisions, typically placed along the pectoral muscle, through which glandular tissue and excess skin are removed. The nipple and areola are completely detached, resized, and repositioned as a free nipple graft (FNG), which allows for maximum contouring and the flattest possible result.
For those with a very small chest and excellent skin elasticity, the Keyhole or Periareolar Mastectomy is a less invasive option. This technique utilizes a small, circular incision made around the edge of the areola. Breast tissue is removed through this opening, resulting in a scar confined primarily to the areola’s border. Because the nipple-areola complex (NAC) remains connected to the underlying tissue, the chance of preserving sensation is higher than with an FNG.
The Inverted-T or T-Anchor technique is an alternative for patients with medium to large chests who wish to maximize the chance of retaining nipple sensation. This method involves an incision around the areola, a vertical incision extending downward, and a horizontal incision in the chest crease, forming an anchor-shaped scar pattern. The surgeon removes tissue while keeping the NAC attached to a small stalk of tissue, called a pedicle, which maintains blood and nerve supply. The trade-off for potential sensation preservation is that the final chest contour may not be as flat as the result achieved with the Double Incision technique.
Preparing for and Recovering from Surgery
Preparation for gender-affirming top surgery involves meeting physical health benchmarks and psychological readiness guidelines. Adherence to the World Professional Association for Transgender Health (WPATH) Standards of Care is often required by insurance providers and surgeons. This includes a diagnosis of persistent gender dysphoria and a letter of surgical readiness from a qualified mental health professional. Patients must cease smoking entirely for at least four weeks before and after the procedure, as nicotine impedes wound healing and increases complication risk.
The operation generally lasts two to three hours and is performed under general anesthesia, usually on an outpatient basis. Immediately after the procedure, the chest is wrapped in a compression garment to reduce swelling and promote proper skin adherence. Post-operative pain is managed using regional nerve blocks administered during surgery, combined with a short course of prescription pain medication for breakthrough discomfort.
Surgical drains, small tubes placed under the skin to remove excess fluid, are a common component of recovery. These drains are typically removed at the first post-operative appointment, usually within four to seven days after surgery. Patients are encouraged to take short walks soon after the procedure to promote circulation. Strenuous activity, heavy lifting, and raising the elbows above the shoulder must be avoided for four to six weeks. Most individuals can return to a non-physical job within two weeks, though the full recovery period lasts several months.