Non-Binary Top Surgery

When thinking about top surgery for non-binary folks, it is important to remember that there are many ways in which gender surgery already moves beyond the binary. This page is going to touch on how our top surgeries fit in with our understandings of non-binary gender, breast and male chest aesthetics, non-binary chest aesthetics, chest fullness, and breast reduction options. 

Surgeries Beyond the Binary

If you are a a non-binary, genderqueer, or gender-expansive person, and you’re wondering if you can have top surgery, the answer is yes. We do not require our patients to use certain pronouns or identify as a certain gender in order to have top surgery, nor do we ask that our patients live as a certain gender for any period of time before their procedure. We also do not require that folks go on hormones before having top surgery. Read more about testosterone and top surgery here.

In order to get the most out of this page, please read our introduction page on top surgery for non-binary people.

Top surgery can be for anyone who experiences gender dysphoria or discomfort associated with their chest, not only binary-identifying trans masculine folks. We have worked with non-binary and gender expansive people to help reduce or eliminate gender dysphoria and discomfort, regardless of their pronoun or hormone use.

Breast and Male Chest Aesthetics

Before getting into the aesthetics of a non-binary chest, it is important to discuss the aesthetics of chests that looks more like a binary male or female chest. 

When thinking about breast aesthetics,  there are a lot of factors that affect people’s opinions about ideal aesthetics. Aside from body shapes and sizes differing widely, social and cultural norms regarding aesthetic preferences differ across time and geography. There is beauty in all body shapes, and the images on this page will show a more youthful aesthetic on a slimmer body in order to highlight the contrast between AFAB and AMAB chest aesthetics. Here are some common factors of breast aesthetics as they sometimes appear on the body:

• There is uniform curvature of the breast and the nipple is located centrally to the breast mound, creating a teardrop shape
• There is symmetry of the curvature of breasts 
• There are often varying degrees of inner and outer breast fullness 
• Strong convexity in the lower breast, meaning that the lower breast hangs away from the body which adds to the teardrop shape 
• Areolas are larger and closer together, around 40-42mm in diameter, but can vary depending on the size of the breast

The following is a list of components that are often associated with binary male chest aesthetics. While the person in Image 2 has considerable muscularity and low body fat, we know that bodies come in a variety of shapes and sizes. Image 2 is used to highlight male chest aesthetics:

• Areolas are smaller and wider-set (around 22mm in diameter, the size of a nickel)
• Areolas appear lower on the chest 
• There is uniform subcutaneous tissue thickness in the trunk
• The lower pectoralis major is boxy or trapezoidal in shape

Non-binary Chest Aesthetics

Now knowing what aesthetic qualities affect the appearance of a chest with breasts versus a chest without, there are a few approaches we can take when thinking about non-binary chest aesthetics. One approach is to create a chest that still appears male, but not distinctly adult or muscular. This means that some patients are looking for a chest that is flatter and does not have any adult characteristics. Image 3 is of a non-binary top surgery result that uses this approach.

Non-binary patients often ask about the different variables we can control in terms of the way a chest can look, rather than sticking with a traditionally male aesthetic. This is more of a gender-expansive approach, allowing us to incorporate aesthetic components of both binary female chests and binary male chests in order to craft something more neutral or non-gendered. We can use this approach to tailor the surgical result to what someone feels will bring them gender euphoria. We are happy to have consultations with folks to help them get a better understanding of all of the different approaches we can take with this type of surgery. 

When thinking about non-binary chest aesthetics, these are some variables to consider:

• Some people prefer no areolas.
• If areolas are present, some people prefer they have a diameter of 25-30mm (larger than traditionally male areolas) and that they appear higher and narrower on the chest.
• Some people prefer to not have a completely flat chest- they prefer breasts that might be a reduced size, but still look like breasts (see Image 7, 8, and 9 below).
• People often have preferences about breast overhang, referring to the hanging of skin/tissue over the fold of the breast. Meaning, is there still a convex teardrop shape to the breast where it is most full?
• Some people prefer that the incision is near the muscle border, and others prefer it to be somewhere else entirely. 

Please view the following pages to learn more about incision types and for nipple and areola options. 

Chest Fullness

As mentioned above, a component of non-binary top surgery and chest aesthetics is the amount of chest fullness left behind. This refers to the amount of tissue left in the chest after surgery. Often, in a binary-appearing top surgery, very little tissue is left behind. With the use of hormones and a regular fitness routine, this allows for muscle mass to build in the chest, as seen in Image 4.

However, in a non-binary top surgery, the amount of chest fullness left behind varies from patient to patient depending on their levels of dysphoria or discomfort and their gender expression goals. Respectively, Image 5 and Image 6 show a mild and moderate amount of chest fullness left after surgery. 

With the mildly full results in Image 5, we see a small amount of tissue with very minimal overhang. With the moderately full results in Image 6, we see slightly more overhang as a result of more tissue left behind.

Again, to a certain degree, the amount of chest fullness is up for discussion based on your individual goals and desires with regard to dysphoria, discomfort, and gender expression. 

What is a Breast Reduction?

Reducing the breast size, also called a breast reduction, is another available option for non-binary and gender expansive top surgery. There are people of all genders who choose to get a breast reduction for a variety of reasons, including but not limited to dysphoria or discomfort with breast size and/or aesthetics. This is a different surgical technique than what is described above.

For the purposes of definitions, a breast reduction will result in a smaller breast that maintains the teardrop shape with some amount of overhang, as seen in Image 7.

Breast reductions can be radical, as seen in Image 8 and Image 9. In order to know what type of breast reduction is right for you, please arrange a consultation with Dr. Mosser. 

In Summary

• Top surgery is a viable option for non-binary, gender-expansive, and genderqueer people to eliminate or reduce feelings of gender dysphoria or discomfort. 
• There are certain key elements to male chest and breast aesthetics, which help us determine the aesthetics for a non-binary chest.
• Chest fullness is a variable we can help control depending on your feelings of dysphoria or discomfort and your gender expression goals.
• Breast reductions can help reduce dysphoria or discomfort for non-binary and gender expansive people as well as cisgender people, again correlated with gender presentation goals and other factors.

To learn more about nipple and areola options and incision types, please view those pages. Read our newspaper to learn more about top surgery beyond the binary.