GENDER-AFFIRMING TOP SURGERY
Individualised surgical planning for chest masculinisation and contouring.
Gender-affirming top surgery refers to chest masculinisation procedures designed to create a flatter, more traditionally masculine chest contour. Techniques vary depending on chest size, skin elasticity and individual goals, and may involve glandular tissue removal, liposuction and chest contouring with or without nipple-areola repositioning. As a specialist breast surgeon, Dr Saam Tourani provides comprehensive assessment and personalised surgical planning to ensure safe, respectful and individualised care.
The Broader Journey of Gender Affirmation
Gender-affirming top surgery can play an important role in aligning physical appearance with gender identity. However, surgery represents one component of a broader process of gender affirmation. Appropriate preparation may include psychological assessment, discussion of hormone therapy, and coordinated care within an experienced multidisciplinary team. These elements contribute to safe decision-making and optimal surgical outcomes.
Assessment and Preparation for Top Surgery
Gender-affirming top surgery is a critical step in the journey toward gender alignment, but it is only the final step in a broader process. For both transmasculine (female-to-male) and transfeminine (male-to-female) individuals, preparation involves several important steps, including psychological counselling and medical support, particularly hormone therapy. These preparatory stages are essential for achieving the best surgical outcomes and ensuring the person is physically and emotionally ready for the procedure.
1. Psychological Assessment
As recommended by the World Professional Association for Transgender Health (WPATH), a psychological assessment is an important part of the process before undergoing gender-affirming top surgery. These assessments help to ensure that individuals are emotionally prepared for the surgery and that they fully understand the physical and emotional changes they will experience. A psychologist can help manage expectations, address any underlying mental health concerns, and provide support throughout the transition process.
2. Hormone Therapy Considerations
Hormone therapy is an essential part of the transition process and plays a significant role in achieving optimal surgical outcomes. For transmasculine individuals, testosterone therapy helps to induce physical changes such as chest flattening and skin thickening, which contribute to the final chest contour after surgery.
For transfeminine individuals, oestrogen therapy (sometimes in combination with anti-androgens) is often prescribed to promote the development of breast tissue, leading to the creation of a breast bud. This is particularly important for those seeking breast augmentation through top surgery, as it can help enhance the final results by ensuring the chest tissue is softer and more natural-looking post-surgery.
Working with an experienced endocrinologist is key to ensuring that hormone therapy is administered safely and effectively. Oestrogen for transfeminine individuals and testosterone for transmasculine individuals can significantly impact the surgical outcome, so it is essential to follow a tailored hormone regimen. If patients do not already have an endocrinologist, I work with a trusted team of medical professionals and can refer individuals to experts who specialize in transgender care. This integrated care model ensures that patients are fully supported throughout their journey.
3. Surgical Planning and Technique Selection
Before undergoing gender-affirming surgery, patients meet with me for at least two comprehensive consultations. This is a collaborative process where we discuss the patient’s goals, medical history, and any previous procedures they may have had. It’s important to ensure that patients have realistic expectations about what surgery can achieve. Likewise, It’s equally important for me to understand the patient’s goals, as there are various types of chest surgeries for transgender and nonbinary individuals, each designed to achieve a different result and body image.
Risks and Safety Considerations
All surgical procedures carry potential risks. Gender-affirming top surgery is generally safe when performed by an experienced surgeon, but patients should be aware of possible complications before proceeding.
Potential risks include:
Bleeding or haematoma formation
Infection
Delayed wound healing
Seroma (fluid collection)
Noticeable or hypertrophic scarring
Asymmetry or contour irregularities
Changes in nipple sensation
Partial or complete nipple graft loss (in procedures requiring grafting)
Careful surgical planning, appropriate preparation and close postoperative follow-up are essential to minimise these risks. During consultation, individual risk factors — including smoking status, medical history and skin quality — are discussed in detail to ensure informed decision-making.
A Holistic Approach to Transgender care
Gender-affirming top surgery is a life-changing procedure, but it is only one part of the larger process of aligning one's body with their true gender identity. The most successful outcomes are achieved when individuals receive the right preparation, which includes psychological counselling, appropriate hormone therapy, and surgical care. By addressing both the physical and emotional aspects of transition, we ensure that every patient can achieve the best possible results.
Frequently Asked Questions
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Hormone therapy is not mandatory for chest masculinisation surgery. Some individuals may already be on testosterone therapy, while others may not require it. Suitability is assessed individually during consultation.
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A letter of support consistent with WPATH standards is typically required prior to proceeding with surgery.
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Scar patterns depend on the surgical technique used. Double-incision procedures result in horizontal chest scars, while periareolar techniques produce more limited scarring. Scar maturation continues over several months.
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Most patients return to light daily activities within 1–2 weeks. Strenuous activity and upper-body exercise are generally restricted for approximately 4–6 weeks. Recovery guidance is tailored individually.
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Changes in nipple sensation can occur. In some cases, sensation may be reduced or altered permanently, particularly when free nipple grafting is required. This is discussed in detail prior to surgery.
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Eligibility for Medicare rebates and private hospital cover depends on individual circumstances and fund policies. These details are discussed during consultation.
Learn more about gender-affirming top surgery with specialist breast surgeon Dr Saam Tourani.