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Maintaining volume in chest reconstruction or through breast reduction

When it comes to top surgery, many non-binary patients express interest in maintaining a certain amount of chest fullness or chest/breast tissue after top surgery. The Gender Confirmation Center (GCC) offers a variety of breast reduction and chest reconstruction options that yield non-flat results. This article will address the difference between a breast reduction and a top surgery with a non-flat end goal. By having some tissue left behind after top surgery, some non-binary and gender fluid patients have expressed experiencing greater gender euphoria; this is because having minimal leftover tissue allows them, in their words, to more easily present feminine on some days and more masculine on others, without needing to wear a chest binder.

The photos and descriptions on this page are used to highlight breast aesthetics that are shared among many people who underwent a first, estrogen-dominant puberty. Because there is natural variation to body types and sizes, your particular body shape might not be represented in the images below. In the following informational video, Dr. Jacobs (he/him) describes the difference between a traditional buttonhole incision and a breast reduction top surgery technique. Generally speaking, this latter is sought by patients who are interested in maintaining a tear-drop form to their breasts, would like to keep a heightened level of sensitivity in their nipples and/or would like to retain the possibility to chestfeed post-op.

What is an aggressive breast reduction?

• Aggressive breast reductions are defined as procedures that yield a smaller breast with the classic teardrop shape (defined below) and some overhang of skin and tissue below the incision. Aggressive breast reductions reduce the amount of overhang and minimize the teardrop shape, usually leaving some overhang, and results in skin that is not as tight, i.e. there is most often some ‘bounce’ of the chest tissue during body movement after a breast reduction.
• Image A on the right shows the classic teardrop shape to a breast aesthetic that is usually maintained with a breast reduction. The teardrop/cone shaped aesthetic can be described as a gentle convexity towards the nipple and sloping into a more full and round shape towards the bottom of the breast.

• Image B on the left shows the degree of overhang that can be achieved with a breast reduction. Breast overhang is a component that can really impact someone’s experience of gender dysphoria or discomfort, and the procedure that is chosen should take this into consideration.
• Image C and D below show what results someone can expect from an aggressive breast reduction.

Chest fullness

Chest fullness can be achieved either with weight training to develop pectoral muscles, the placement of silicone pectoral implants or leaving behind a small amount of tissue so that there is some overhang. There are two different types of top surgery incisions that are likely to yield a result that is nonflat in appearance: the buttonhole and the Inverted T. The ammount of tissue left behind is never determined by the size of a patient’s body, but rather the patient’s individual goals.

Image E and F below depict a likely end result for someone who received the buttonhole incision type, and Image G and H show the end result of someone who received the Inverted T incision type.

In Summary

• Aggressive breast reductions are performed on patients who wish to maintain some elements of the teardrop shape and minimal breast overhang, and are okay with a bit of movement of the chest (i.e. “bounce”) after surgery.
• Top surgeries with a non-flat result are most commonly performed using a buttonhole or inverted T incision. Patients can also opt for silicone pectoral implants or weight training to increase the volume of their chest.
• You can speak with one of our board-certified surgeons in a free, virtual consultation with one of our surgeons to discuss the particularities of your needs and goals.