TOP Surgery, or Gender-Affirming Mastectomy, is a very common surgery that transgender patients undergo to remove their breasts. There are a few options for surgery that we will discuss with you. The first decision you have to make is what look you hope to achieve. Are you looking for a more "masculine" look, to be as flat as possible, or for a small breast mound? Some of this is dictated by your own body, which we will aim to have your surgical result fit your own body. The next decision you need to make is whether you would like to keep your nipples or not. Let us know your preferences, and we will work with you to achieve your goals. Most patients are very happy after TOP surgery, and we want you to be the same!

Double incision mastectomy is a technique which is very common. During this procedure, your nipples and breasts are removed. We contour your chest to fit your body and preferences, and the last part of the surgery, if you choose to keep your nipples, is to place the nipples back as free nipple grafts in the appropriate locations. After the surgery, you will have a bolster dressing on your free nipple graft that will stay on for 1 week, and you will also have a chest compression vest that you will wear at all times to reduce swelling. We typically avoid drains during the surgery by placing progressive tension sutures. There are some instances where drains are required, but the vast majority of patients do not require drains. You will be discharged the same day of your surgery if you are recovering well, and you will be seen in clinic 1 week after surgery.

Keyhole mastectomy is a technique we can use for a certain subset of patients who have small breasts and have a small frame. In this technique, you will have an incision around the areola that will allow us to remove breast tissue. In this technique, the nipples stay in their native position. The advantage to this procedure is that you will have a smaller scar. Due to the incision location, you will have a drain after this procedure that will stay for 1-2 weeks. You will be discharged the same day of surgery and encouraged to wear a chest compression vest postoperatively. You will be seen in the clinic 1-2 weeks later.

Buttonhole mastectomy is a technique we use for patients who desire a small breast mound. This technique is less commonly used. In this technique, your nipples remain attached to your body, but we are still able to reduce the size of the areola if needed. Drains are typically avoided in this technique, and you will wear a chest compression vest postoperatively. You will be discharged the same day as surgery, and you will be seen in clinic 1-2 weeks later.