Understanding Chest Dysphoria in Transmasculine People: A Guide for Curious Cisgender Allies

Written and medically reviewed by Dr. Scott Mosser on January 27, 2025.

As a surgeon in the field of gender care, I hold the conviction that we serve our patients––in consultations, on the day of surgery or in post-operative check-ups. These are not times for patients to educate us as providers. Certainly, we must practice active listening to understand our patients’ unique goals, needs and concerns. As providers and allies, we need to find the time and space to learn about and sensitize ourselves to the experiences of the individuals we support. This article is meant to serve this effort. Here, I shed some light on what brings individuals to pursue chest reconstruction top surgery, sometimes called a transgender mastectomy.

Introduction

Over the years that I have performed chest reduction top surgery, many genuinely curious individuals have asked me to help them understand the motivations behind seeking a transgender mastectomy. Some see the visible scars inherent in these procedures and know there are trade-offs, such as potential decreased sensation or the inability to breastfeed. This often compels them to inquire more deeply about the experience of having breasts and strongly wanting them gone.

One particularly helpful tool to bridge the gap of understanding is a mental exercise: imagine yourself as a masculine-featured man—think hairy arms and body, deep voice—and then imagine waking up one morning with huge, pendulous, hairy breasts. In this scenario, it becomes easier to understand the unwelcome nature of breasts as an anatomic feature. While this model does not perfectly map to every transmasculine person’s experience, it conveys the visceral discomfort and the clear desire to address it.

When one identifies with the strong sense that excess chest tissue “should not be there,” it becomes easier to understand why having breasts can be intrusive. This persistent discomfort makes up a large part of the dysphoria that transmasculine people experience before chest reduction surgery. By gender dysphoria, I am referring to a persistent, invasive discomfort that arises from the conflict between the gender someone identifies with and the gender they were assigned at birth.

How Patients Experience Chest-Related Gender Dysphoria: Sensory Overload, Discomfort, Unwanted Daily Life Intrusion

Chest Movement

One of the most commonly discussed issues I hear from patients is the discomfort caused by chest movement: the jiggle, sway, and bounce of tissue with every step or jump. For many transmasculine and non-binary individuals, chest movement can serve as a constant reminder of a body part that feels alien and unwelcome. Even lying down at night offers little reprieve, as the shifting of chest tissue can disturb sleep and reinforce feelings of incongruence in gender diverse individuals.

Sensory Issues and Hypersensitivity

Often times, the discomfort that chest movement brings manifest itself into sensory issues: feelings of overwhelm and overstimulation. For example, for some, the hypersensitivity of nipples can make even the lightest brush of clothing unbearable. Everyday interactions like accidentally bumping into a counter become moments of acute discomfort, often described as invasive and non-consensual. For neurodiverse individuals with hypersensitivity, this sensory overload can be even more overwhelming, amplifying the sense of incongruence and unease.

The Benefits and Challenges of Binding

Binders are compression garments that bring individuals a relief from gender dysphoria by flattening the chest, allowing them to have an appearance that aligns more with their gender. While often necessary to reduce chest visibility and movement, binders also introduce their own set of difficulties. They can feel tight, restrictive, and claustrophobic, causing physical discomfort and even pain. Skin irritation from prolonged use and the inability to completely flatten the chest further contribute to the struggle. Despite these challenges, binding is often endured because the alternative feels even more unbearable.

It is essential to follow safe binding practices to maintain skin elasticity, avoid skin irritation and difficulty breathing. A good fitting binder should allow an individual to comfortably take a deep breath and enable a full range of movement. We strongly encourage our patients to avoid binding with ace bandages, duct tape and other materials not designed for chest compression. It is not recommended to or wear a binder for over 6-8 hours.

Personal Hygiene Challenges

For individuals with larger breasts, heat and physical activities can cause sweat to accumulate beneath chest tissue, creating added discomfort and sometimes leading to skin irritation or fungal infections. Not to mention, persistent moisture from perspiration serves as another reminder of the unwanted tissue.  For those wearing binders to compress their chest, managing sweat becomes even harder. Although binders can flatten the chest, they are not a long-term solution for many gender diverse individuals as they continue to serve as a reminder for a part of the body they would like gone. The compression of a binder or even sports bra can cause more sweating, leaving individuals feeling damp and frustrated.

Physical Activity Limitations

Activities like running, jumping, or participating in sports can be challenging due to the weight and movement of chest tissue. Many describe the sensation of carrying their chest as akin to lugging around “bags of water”—heavy, cumbersome, and inescapable. This burden often limits their ability to fully engage in physical activities, further detracting from their quality of life. Playing sports can be a source of healthy social connection with peers and gender-affirmation for youth and adults alike.

Clothing Challenges

Finding clothing that fits comfortably and minimizes chest visibility can feel like an uphill battle for some. Visible movement or bulges under clothing often provoke intense dysphoria in many of the patients I have spoken with. Many opt for purchasing oversized clothing to hide the volume of their chest. Though shopping in the men’s clothing section can exacerbate feelings of self-consciousness, it can also help individuals find clothes that affirm their gender, and in turn, feel more comfortable in their bodies.

Psychological Toll of Seeing Your Chest

The psychological toll of chest dysphoria cannot be overstated. Some patients have shared with me that when they see pictures and videos of themselves––for example, with their breasts moving while they exercise––they feel a deep sense of alienation from their bodies. The visual reminder often provokes a dissociation or disidentification expressed as a distress that the chest tissue is “not supposed to be there.” Many will go as far as avoiding mirrors or photographs to escape this distress. This dissonance can be an obstacle to self-acceptance and peace.

Weight Fluctuations and Body Changes

Weight fluctuations and body changes add yet another layer of complexity. For some, weight gain or restoration after weight loss increases chest volume, which can intensify dysphoria. Loose skin following weight changes or pregnancy can compound the sense of physical incongruence, making it even harder to feel at home in one’s body.

Voids in Understanding from Healthcare Providers

The lack of understanding from healthcare providers often leaves transmasculine and non-binary individuals feeling isolated in their experience with gender dysphoria. Many providers fail to grasp the sensory and psychological dimensions of chest dysphoria, offering advice that overlooks the lived realities of those they aim to support. This gap underscores the importance of education and empathy in addressing these deeply personal challenges.

It is crucial to remember that for gender diverse individuals with chest dysphoria, the presence of unwanted chest tissue is not a superficial concern. It is an intrusive, bandwidth-occupying issue that permeates every aspect of life, has a deep impact on their mental health and ability to function in the world.

Why Transgender Mastectomy Can Offer Life-Changing Relief

Transgender mastectomy provides profound relief for those who endure chest dysphoria. By removing the chest tissue, this procedure eliminates physical discomfort caused by movement, sweat, and overhang. It can also reduce or eliminate sensory intrusions like nipple sensitivity, and can enable individuals to engage in physical activities and wear clothing without anxiety or dysphoria. Perhaps most importantly, it aligns the body with the individual’s gender identity, fostering a sense of bodily autonomy and peace.

For many transmasculine people, the trade-offs of scarring or reduced nipple sensation are minor compared to the relief and freedom this surgery offers. Not to mention, for individuals that undergo top surgery techniques that leave visible scarring, these marks on their chest can be a source of pride for a gift they gave to themselves: a journey to improve their quality of life. Top surgery is not merely a medical procedure but a reclaiming of the body as a safe and congruent space.

Which Type of Top Surgery is Best for Patients with Chest Movement Dysphoria?

Volume: Generally speaking, patients interested in eliminating their chest movement dysphoria seek out a top surgery technique that gives them as flat of a chest as possible. For this reason, we do not recommend techniques such as the buttonhole and inverted T anchor procedures since they generally leave behind some volume in the chest that is often still enough to result in a “bounce” or chest tissue movement sensation.

Nipple Sensation: For some, having very sensitive nipples is an important part of their intimate life. That might make sensation preservation a major priority for their top surgery. For others, having sensitive nipples can be an obstacle in their day-to-day and intimate lives. Having sensitive nipples can feel overstimulating, invasive and even trigger gender dysphoria for some trans masculine and non-binary folks.  Reducing the volume of the chest can be enough for some patients to feel at-peace with and enjoy having heightened nipple sensitivity. For others, loosing or reducing sensation in the nipples is the most desirable choice.

If maintaining heightened sensitivity in the nipples is a priority for your loved one or patient, the following techniques can give them a flat chest while leaving leaving a great probability of preserving sensitivity:

• Double incision with nerve innervation
• Nipple sparing double incision
• Keyhole incision
• Periareolar incision

Conclusion

Chest dysphoria is a deeply intrusive experience that is persistent across time and impacts nearly every aspect of life for many transmasculine and non-binary individuals. The weight of this discomfort—both physical and psychological—is difficult to quantify but impossible to ignore.

While tactics like binding can provide short-term relief, transgender mastectomy or gender-affirming top surgery is a medically necessary solution to this concern for many. It is a life-changing procedure that provides relief from this persistent burden, allowing individuals to move through the world with greater comfort, confidence, and alignment with themselves.

By understanding the many facets of chest dysphoria, we can foster empathy and support for transmasculine individuals. This understanding bridges the gap between curiosity and compassion, creating a world where the choices and needs of transgender people are respected and affirmed.