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Top Surgery for Non-Binary Patients: Common Techniques

When thinking about top surgery for non-binary folks, it is important to remember that there are many ways in which gender-affirming 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, binary chest aesthetics, and non-binary chest aesthetics. We also cover varying options for chest fullness and breast reduction surgery. If you have questions about what non-binary gender identities are, we encourage you to explore our resources page.

Surgeries beyond the binary

If you’re wondering if you can get top surgery as a non-binary, genderqueer, or gender expansive person, the answer is yes. We do not require our patients to use certain pronouns or identify as a certain gender in order to get top surgery, nor do we ask that our patients “live as a certain gender” for any period of time before the procedure. We also do not require that folks undergo hormone replacement therapy (HRT) to be eligible for top surgery. If you would like to read more about testosterone HRT and top surgery, click here.

We believe that top surgery should be an option for anyone who experiences gender dysphoria or discomfort associated with their chest, regardless of gender identity. We have worked with non-binary and gender expansive people to help reduce or eliminate gender dysphoria and discomfort, regardless of pronoun or hormone use.

Chest aesthetic considerations

• 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 40mm but can depend 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, the size of a nickel).

• Areolas appear lower on the chest
• There is uniform subcutaneous tissue in the trunk
• The lower pectoralis major is boxy or trapezoidal in shape

Non-binary chest aesthetics

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. The following aesthetic variables come up frequently, but not always, with non-binary patients interested in top surgery:

• Some people prefer no areolas or nipples
• 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. For more information about nipple and areola placement and sizing options, click here.
• Some people prefer to not have a completely flat chest; they prefer breasts that might be a reduced size, but still overhang and/or a convex teardrop shape
• Some people prefer that the incision is near the muscle border, and others prefer it to be somewhere else entirely, such as across the areolas as is the case with the fishmouth incision.  

Incision options: shape and location

If a patient desires a more traditional chest reconstruction top surgery outcome, there are certain  shapes of incisions that could achieve this listed below:

• Very gently curved incision that runs as close to as possible along the lower border of the pectoralis major muscle
  
• Straight incision lines instead of curved lines
   
• Diagonal incision which runs upward along the outer border of the pectoralis major muscle up and toward the armpit. This is not a very common request at our practice, but is an option if desired.

Below are a few incisions requests we’ve received from patients who are interested in having less common types of incisions:

• Longer, higher, or lower than the position described above 
• Incision not located anywhere close to the lower pectoralis major muscle line because of the perception that that is a distinctly male appearance for a mark that is on the chest

It’s important to note that the fish mouth procedure results in an incision across the very center of the chest horizontally.

Areolar excision top surgery results in two horizontal scars about three times the length of the previous areola in the center of the chest. This procedure is ideal for patients who would also qualify for keyhole or periareolar incisions but do not want their nipples or areolas on their chest after surgery.

Sensation preservation through neurotization for top surgery

Some patients are eager to remove their nipples or have the heightened, erotic sensation in their nipples be reduced after top surgery because of feelings of dysphoria. For other patients, maintaining heightened levels of sensation in their nipples can be a priority for their top surgery results. The double incision (DI) top surgery procedure performed with a free nipple graft (FNG) often comes at the cost of reducing nipple sensitivity to a tactile level of sensation. However, the GCC now offers a neurotization or sensation preservation technique so that DI FNG patients can retain heightened sensitivity in their nipple areola complex post-op. For more information about nerve preservation or nerve grafting in top surgery, click here.