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“Non-Binary Surgery”: Gender-Affirming Surgery Options for Non-Binary Patients.

Medically reviewed by Jennifer Richman on September 19, 2024.

What is non-binary surgery?

Non-binary surgery encompasses a variety of gender-affirming procedures that seek to help non-binary patients feel greater gender alignment with their chest, genitals, face and/or body frame. When we talk about non-binary surgery, we are often referring to top surgery, bottom surgery, body contouring and facial surgery techniques that our surgeons offer to meet the needs and goals expressed by our non-binary patient communities. 

This article is meant to be a home for frequent questions and concerns that we get from non-binary patients about surgery. Here, you will find information to help you navigate choosing which procedure is right for you given your specific goals, needs and concerns. If you have specific questions or are ready to make a unique, surgical plan, you can request a free consultation with one of our board-certified surgeons.

What does it mean to identify as non-binary? Do non-binary people need to surgically transition?

Non-binary is an umbrella term for identities that transcend the binary of male and female. In the English language, it emerged in the 2000s to describe people who do not identify exclusively as a male or female. For example, some non-binary people identify as non-binary, transfeminine, transmasculine, agender, genderfluid, genderqueer, etc. Some non-binary folks identify as trans, while others do not consider themselves to be trans..

Not all non-binary folks need or desire to undergo surgery as a part of their gender-affirmation journey. While some non-binary patients aspire towards achieving a more androgynous appearance through surgery, there is no one right or valid way to look or present as non-binary. That means any gender-affirming procedure could be a good fit for a non-binary individual, regardless of whether it could be considered feminizing or masculinizing. 

Similarly, some non-binary people chose to undergo gender-affirming hormone therapy (GAHT) at full doses, by microdosing testosterone or microdosing estrogen. Again, not all non-binary people pursue gender-affirming medical care to treat gender dysphoria and/or experience gender euphoria.

Overview of Non-Binary Surgery

Considering the unique needs and interests of non-binary patients is relatively new in the field of gender-affirming care. The Gender Confirmation Center (GCC) is proud to be on the frontlines of designing and offering surgical techniques with and for the non-binary communities we serve. Again, there is no one way to look non-binary. The purpose of surgery is not to give our patients a “non-binary appearance,” but rather to help them experience greater gender congruence with their bodies on their own terms. 

In this section, you will find in-depth information for gender-affirming procedures, such as top and bottom surgery, that are commonly solicited by non-binary patients. You can consult for free with one of our board-certified surgeons to create a unique surgical plan that would help you experience greater gender euphoria.

Non-Binary Top Surgery

Top surgery refers to a number of procedures involving the sculpting and reshaping of the chest and/or nipples. These include the following:

1. Chest Reconstruction Top Surgery: Oftentimes, top surgery refers to something we call chest reconstruction surgery. This involves removing tissue to give the chest a flat(ter) appearance. For more information, visit our guide on top surgery techniques.
2. Breast/Chest Reduction: Many non-binary patients wish to reduce the amount of breast/chest tissue they have, while maintaining some volume in their chests. Having minimal leftover tissue allows for what patients have called a fluid chest presentation: allowing patients to shift between a more conventionally feminine or masculine presentation without the need for a binder or breast inserts. Common chest reduction techniques such as Inverted T or buttonhole incisions increase the likelihood of nipple sensation being maintained. For more information on this category of procedures, you can consult this page.
3. Nipple Options: Most chest reconstructions and reductions for top surgery procedures involve some changes to the nipples and areolas. While some patients may want their nipples resized and repositioned on their chest, others elect for no nipples. After surgery, patients can even undergo medical tattooing to recolor their nipples and/or reshape their areolas. Ultimately, nipples have no gender, and we encourage patients to make the choice that is most affirming for them.
4. Breast Augmentation: Many non-binary patients opt for breast augmentation to achieve gender euphoria. These procedures are intended to change or increase the size, composition and shape of breast tissue. For more details on augmentation refer to our breast augmentation techniques.

Non-Binary Bottom Surgery

There are a multitude of bottom surgery options available for non-binary patients, depending on the desired result. These are divided into procedures that are often considered “feminizing,” with the purpose of creating a vulva and/or vagina, and “masculinizing” with the purpose of reconstructing a phallus through a metoidioplasty or phalloplasty. 

Some patients are interested in “nullification” procedures or a nullectomy, which can involve taking out genital tissue and just leaving an exit for the urethra. This procedure can involve shortening of the urethra and removal of natal genital tissue via penectomy, orchiectomy, scrotectomy, hysterectomy, vaginectomy, and/or removal of the vulva. Despite the surrounding stigma, gender nullification offers affirmation to many non-binary and agender individuals who feel dysphoria having what they describe as binary genitalia. 

Non-Binary Body Contouring

Gender affirming body contouring refers to a collection of procedures intended to reshape the body to better align with an individual’s desired gender presentation. While many patients may choose to undergo body masculinization or feminization, there are many other forms of body contouring that address specific areas of the body. Liposuction removes fat from areas of the body and can be a tool to reduce the volume or curvature of body parts that may cause persistent dysphoria in patients (e.g., hip dysphoria). 

Other procedures involve transfer of fat or fat grafting to enhance certain areas of the body, such as a Brazilian Butt Lift (BBL or buttocks enhancement). Hip dip fat transfer involves transferring fat from an area of the body to the hips in order to add more volume to the hips and achieve a curvier body shape.

Non-Binary Facial Surgery

Gender-affirming facial surgery can be a powerful tool for non-binary individuals seeking to soften or augment their facial features. Procedures like brow bone contouring, rhinoplasty, and jawline reshaping can help achieve greater gender congruence with their appearance. For more information, click here.

How do I decide what procedures are best for me?

With such a variety of techniques available for top surgery, it can be difficult to know what option is best for you. We will discuss some key considerations to think about in making a choice.

1. First, it is important to assess which procedures you qualify for.
   • At the GCC, we understand that Body Mass Index (BMI) is not an indicator of one’s health. However, outside of top surgery, we have BMI limitations for certain procedures for reasons related to patient safety.
   • For chest reconstruction and reduction top surgery, another consideration is the amount of tissue the patient is looking to remove. For example, in order to achieve the most consistent results, keyhole and periareolar techniques are recommended for patients with minimal chest tissue. To figure out which incision type you qualify for, you can try out Mosser Method, which involves measuring the angle of your chest tissue. Your surgeon can provide more information in a free consultation.
2. Second, we recommend that you come prepared to your consultation thinking about what you want in terms of aesthetics, sensation and function.
   • Aesthetics: For example, top surgeries vary widely in nipple placement, scar appearance and overall shape of the chest.
   • Sensation: Similarly, different forms of top surgery impact nipple sensation. Those with nipple grafts may only feel pressure post-op, whereas those who undergo different forms of nerve preservation may maintain more sensitivity.
   • Function: Patients who are considering bottom surgery will need to consider what sexual and/or urinary functions they would like to have. For example, is the goal of your bottom surgery to be able to more easily urinate while standing or to have receptive, vaginal sex?

Choosing a Surgeon

Selecting a surgeon is an important step in accessing gender-affirming surgery. We encourage patients to consider the following when selecting a provider:

1. Experience and expertise in non-binary surgeries: Non-binary gender affirming surgery can differ in important ways from other forms of gender affirming care. It is important for surgeons to be aware of how non-binary patients differ in how they wish to achieve euphoria through surgery. Dr. Mosser, Dr. Facque, and the other board-certified surgeons at the GCC have been recognized as leaders in the field of gender-affirming top surgery for non-binary patients, including delivering a talk on achieving a non-binary look through top surgery.
2. Board certification and hospital privileges: Making sure your surgeon is board-certified and has hospital privileges, meaning that they can easily transfer patients to a hospital if a concern arises, is essential to ensure your safety.
3. Positive reviews and testimonials from previous patients: We encourage patients to look into reviews and testimonials from patients who have undergone similar procedures to them. Another helpful tool is viewing before and after images to gain a better understanding of the potential results of specific procedures.
4. Open communication and understanding of your individual needs and goals: Patients should feel comfortable communicating their goals to their surgeon regarding their body’s appearance, sensitivity and function. Speaking to your surgeon in a consultation will give you a good understanding of their willingness and ability to meet your needs and see if your expectations of surgery are realistic. While many practices charge for consultations, they are free of cost at the GCC.

Recovery and Aftercare

Recovering from surgery can be physically and mentally challenging, but maintaining proper aftercare is vital to healing and long term satisfaction. Prior to surgery, patients usually want to know how they should prepare for recovery. The following information can help you when planning for a gender-affirming procedure:

Return to Pre-Operative Activities

Recovery times vary depending on the procedure and an individual’s overall health. A consistent rule for patients is to wait about 6 weeks to engage in heavy lifting post-surgery. The table below gives general guidelines for when you will be able to return to work (as long as it does not involve heavy lifting) and light physical activity (such as household chores):

Recovery from bottom surgery is more complex than the procedures above. Many procedures, such as phalloplasty and vaginoplasty are performed in different stages. These stages can have their own recovery timelines. For example, a hysterectomy may be performed 8 weeks before a metoidioplasty. Generally, you can expect to restart light activity in 2-4 weeks, but to gain a better understanding of your unique timeline, we encourage viewing our pages on metoidioplasty, phalloplasty and vaginoplasty.

Promoting Mental Wellbeing

While the results of gender-affirming surgery are life changing and promote mental wellbeing, surgery and recovery can be mentally taxing. This can include reaching out to loved ones, caretakers and therapists. For many, planning low-stress and minimally taxing activities during recovery can facilitate mental wellbeing post surgery.

Risks and Considerations

While undergoing gender-affirming surgery is life changing for most non-binary and transgender patients, it is important to be aware of potential risks involved. This section is not intended to dissuade non-binary individuals from seeking out procedures, but to equip patients with all the knowledge necessary to make an informed decision. These risks include:

1. Surgical risks: Bleeding, infection, scarring and other complications are rare for patients in good health that follow recovery instructions. Patients can greatly reduce these risks by stopping nicotine consumption and smoking altogether or at the very least 3 weeks before and after surgery. Alcohol consumption should be
2. Temporary emotional and psychological impact: It is very normal to experience temporary, post-operative depression after surgery as your body has just undergone a taxing procedure and big change. It is important to take this into consideration, and ensure that you have a support network and coping mechanisms. Patients who wish to undergo microsurgery like nerve innervation cannot consume nicotine due to its effects on blood vessels and nerve tissue.
3. Future Revisions or Additional Procedures: On rare occasions, patients may opt for a revision surgery. If a complication comes up during the first week of recovery that requires surgical intervention, a patient will be admitted for an emergency revision. Generally speaking, if a patient secured insurance coverage for their procedure, it is very likely that their insurance will cover a revision. At the GCC, any revision surgery that is requested during the first year post-op will incur no additional costs to the patient.
4. Financial Considerations and Insurance Coverage: At the GCC, our insurance advocacy team has a 90% success rate in securing coverage for interested patients. You can learn more about insurance coverage as well as prices and financing resources in the hyperlinks.

Frequently Asked Questions

• Will insurance cover non-binary surgeries?

• The GCC’s insurance advocacy team has a 90% success rate in securing insurance coverage for interested patients. That said, insurance coverage for non-binary surgeries varies significantly depending on your specific insurance provider, plan and ability to provide necessary supporting documents. It is essential to reach out to your insurance company to understand their policies, requirements and limitations on gender-affirming surgery.

• How do I find a qualified surgeon for non-binary surgeries?

• We recommend that patients look for surgeons who specialize in serving non-binary patients. Look for surgeons who have a proven track record of not only performing gender-affirming procedures successfully, but also competency with non-binary patients. It is also valuable to seek recommendations from support groups, online communities, or individuals who have undergone similar surgeries.

• Can I breast/chestfeed after top surgery?

• Patients who undergo breast reduction may be able to chestfeed, but may have to supplement with formula. There are some anecdotal cases of patients being able to chestfeed after undergoing aggressive breast reduction and buttonhole/inverted T, but for most forms of chest reconstruction this is not possible. For those who receive nipple grafts, the nipples are not connected to milk ducts. Chestfeeding for transfeminine individuals has been anecdotally reported. Patients who undergo breast augmentation can produce milk, but may need to be supplied. If breast/chestfeeding is a priority for you, you can speak with one of our board-certified surgeons in a free consultation.

• Can I preserve the vaginal opening if I undergo metoidioplasty and phalloplasty ?

• At GCC, we use the labia minora tissue to create the phallus in metoidioplasty and phalloplasty. As a result, it is not possible to retain the vaginal opening. There are procedures that do not use the labia minora to create a phallus and preserve the vaginal opening, though these are not performed at GCC.

• Can I smoke or drink before or after surgery?

• Patients must adhere to a strict no smoking and no nicotine consumption for 3 weeks before and after surgery to reduce nipple graft reduction, anesthesia interference and delayed wound healing. While nicotine is the major culprit, smoking marijuana can interfere with healing and anesthetic. We suggest that patients switch to edibles or CBD and communicate openly with their surgeon to minimize risk. We also advise patients to not drink alcohol one week before and after surgery, and to never drink while taking prescription pain medication.