Questions about Top Surgery

Everything you ever wanted to know about top surgery…

…but were afraid to ask (or tried to ask about but didn’t get an answer).

For all the personal accounts and youtube channels out there, I still found it hard, frequently impossible, to find answers to all of my questions regarding top surgery before I had it three and a half years ago. There’s more information out there now than there was then but, still, not always as much as you’d like. So…

I’m getting together a small panel of trans people I know who’ve been down different top surgery routes to answer questions about the process/procedures/results, and to provide any tips and hints they’ve picked up along the way.

Borrowing this from CN Lester.

After nearly two years of blogging, top surgery is still the #1 topic I get questions on, it gets the most hits on my blog, and personally, it was a major catalyst in my transition and my life. Of special concern for me and my readers is top surgery for genderqueer, non-binary, neutrois, agender, non-male, female identified, or otherwise trans* persons.

What I’d like to do is gather questions that you, dear readers, had or are still aching to ask. I’ll answer each and every one. Then I’ll compile a list of other people doing the same on their blogs. It’s going to be awesome.

Post your question here as a comment, or email it to me.

In the meantime, check out my top surgery posts, or the transition resources page.

27 responses to “Questions about Top Surgery

  1. Just because I think this would have such varied responses, I’d be curious to know, beyond aesthetics, what would be the reasons for top surgery? (I totally understand the desire for the outside to match how you see yourself inside, so I’m trying to get a deeper understanding than that I guess.)

    • I get emails from readers all the time who have a wide variety of reasons for considering top surgery, especially when they are unsure as to whether it’s right for them. It’s not always about identity or aesthetics. So this is a totally valid question!

  2. have you ever heard of anyone getting a bilateral mastectomy without nipples? i dont want nipples for all sorts of reasons, but im not sure if a surgeon would do it the same way as he would with nipples. would the incisions be in the same place or not?

    • Yes, I’ve known people who do this. If you get a DI the scars and procedure is the same, there’s just no nipple graft stapled on at the end.

  3. After the healing process, what does the chest feel like? Does it feel more like your chest before puberty or does it feel more like when you would bind or is it much number? Are there certain positions that cause it to feel odd or unnaturally tight?

    • It depends how far along you are on the healing cycle. For the first few weeks to months, it feels a little numb, or rather, you aren’t as sensitive to touch in certain areas (think about the difference in sensitivity between touching your heel and touching the inside of your elbow.) There are positions that might be uncomfortable or tight. Eventually the sensation returns to normal as you heal.

      Personally, my chest just feels like a natural part of my body, I don’t even feel the scars.

  4. I don’t know if my experience is common but I’m unable to touch or let anyone touch my breasts due to dysphoria issues. I would like to know whether people are able to return to healthy sexual functionality post-operation. Also, approximately what percent of people regain nipple sensation after surgery, and does that vary depending on the surgery? Thanks for any help!

    • Experiencing extreme breast dysphoria is also common, and mirrors my own more closely. From what I’ve read, most people do return to healthy sexual functioning.

      As for nipple sensation, that depends on the technique – a nipple graft is literally skin stapled on top, so less-to-no chance of regaining sensation, whereas with the t-anchor you retain the original nipple and it remains attached to its blood supply.

  5. How significant were nipples to the overall healing process? Did they take longer to heal than the rest of the incisions? Based on your experience, do you think someone who opted not to keep their nipples would have a noticeably quicker/easier recovery? I’m not terribly attached to mine so I’m trying to decide whether keeping them is worth the effort just so I can have another potential piercing site.

    • I don’t think they affected my healing process at all. They took a while to return to normal (like, a few months).

      However, I did NOT have nipple grafts, and some people experience complications with these. It usually does not affect the entire healing process (as long as there is no infection or it doesn’t spread), you just have to deal with it on top of everything else. I think it’s worth the effort, especially if you go to a good surgeon with a low complication rate.

  6. I was wondering, would it be a harder process for me to have top surgery. I have large nipples and I want to do the t anchor procedure. Would that cause a problem as far as surgery. Also, I’m a police officer and I was wondering how I would go about speaking to someone about the transition. Like what I would have to go through with my job, do I have to tell them right away or after I start taking T. I’m afraid they may look down on it and fire me or something.

    • The surgeon resizes your nipples, so it doesn’t matter what size they are originally.

      I would do some more research before coming out at your job. For instance, does your state have employments protections for gender identity? Are they any other trans officers in your district, or does HR have experience with this? You might want to consult with a therapist or social worker who specializes in workplace transitions.

      • Thank you so much for responding micah. I actually spoke with the sheriff today and we have known each other for a while. He was very supportive and only wanted me to know that there may or may not be people inside the dept. that had negative comments. He also said that I should be ready because media may pick up the story because of people talking. He assured me that he was not afraid of the media coming at him, but he was concerned about me. I will be pursuing this and he said I only need to make sure that I receive counseling and let him know if he can help in any way.

  7. I’m planning to have chest surgery soon and still deciding on surgeons. I am very intrigued with the T-anchor technique since I would like to keep the sensation in my nipples if at all possible. So I have two questions for you. 1. Are there any other surgeons that you know of that perform the T-anchor technique besides Dr. Steinwald and 2. Can you give me an idea of how much the surgery cost so I can compare to regular DI surgery? In other words is it a lot more expensive and if so, how much? Thanks.

    • 1. I know of one other doctor who does t-anchor and I forgot her name!
      2. T-anchor is basically a “style” of DI, the cost is unrelated to the technique. Generally top surgery is in the $7-8K range, +/- $1K. Each surgeon sets their own prices, and Dr Steinwald is on the more expensive side.
      You can send me an email for more detailed info.

  8. I am scheduled for surgery in a few weeks. The doc will keep my nipples attached (no grafting back on). But says i will need to come back in in a few months post op for procedure to resize them. What can you tell me about this procedure?

    • This is actually common when the nipple is not grafted, (like in the keyhole technique too). They do it in a second session to ensure the nipple doesn’t lose too much blood and is therefore not lost.

      The doctor cuts a pie-like slice out of the nipple, then folds the rest over, so it is smaller. It is a neat little surgery.

      Good luck!

  9. Thank you so much for this blog!!! It has helped me discover my identity as a genderqueer person.

    I have some questions for you:
    What age does one have to be to get top surgery (minimum)?
    What sorts of legal/beaurocratic things would a genderqueer person have to do to be qualified for top surgery? (like therapist statement, being out for a certain amount of time, testosterone, etc.)
    How would one find out if their insurance partially or fully covers the cost of surgery?
    What’s the time frame for recovery?
    How much does the surgery hurt?
    how should one go about finding the right surgeon? (as in, what should one look for in a surgeon and how does one get the contact information?)
    How does one get top surgery without nipples?

    Sorry for the inordinate number of questions…<|:P

  10. I want top surgery without nipple retention. Does that cost less?

    Also, is there any concern about incontinence during surgery? I’ve only had a general once (wisdom teeth) which was short so no problem. Since top surgery takes longer do patients need to wear a ‘diaper’ (I could deal with that) or is a catheter more standard (no fucking way!!)?

    • Keeping or not your nipples has no effect on the cost.

      Generally you do not need a catheter for top surgery. It’s 2-4 hours and you are fairly mobile once you wake up.

  11. So I’m contemplating getting top surgery sometime in the future and one thing that’s i need to make the decision is pictures of people post surgery so I can see what it will look like. The problem is I can’t seem to find any post op pictures of anyone with my body type. I’m extremely thin and my chest is about a 32 B. I’m also not planning on taking T. All of the pictures I found were of trans men either average weight, chubby, or muscular and mostly on T. These don’t help me at all because my body type is just so different. Are there any websites or blogs I could look for that you think would help?

    • I’d keep browsing the sites that have pictures (and doctor’s websites too) until you find someone that looks like you.

      I was about a little bigger than you, a 34B (maybe C) and slim but not very thin (I’ve lost weight since). Also check out Meike and Eli, they might fit the bill.

  12. Pingback: Top Surgery: 4 years | Neutrois Nonsense·

  13. Hi there! (Wow we have the same name lol)
    So I’m a 15 year old non-binary who is publicly female. I want to get top surgery because my breasts make me feel really dysphoric and they’re really large (Over D maybe DD). Not to mention I’m fat so that adds to size.. My questions are, do I need to lose a certain amount of weight to get top surgery (or be in a specific range)? And do you have any tips on dealing with the tubes? I get really nervous and have anxiety attacks about surgery and my own bodily fluids so I was wondering if you knew anything that could help with that? Thanks!

    • Since you are 15, you’re going to need parental consent first. While it is recommended to lose weight before surgery, it is certainly not a requirement. And I’ll write more about the drains in a later post.

  14. When does the swelling at the drain sites go down? On week 2 after surgery and being a non patient person I found myself getting very frustrated after I take off my binding don’t need to see how much swelling is still at the drain sites. Does anyone have any advice to get the swelling down my drains are out I realize that should be patient but this is getting frustrating not only physically but mentally of seeing.

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