What is Transgender Top Surgery?

Top surgery is a reconstructive surgery performed on the chest for those who wish to alter their chest size, shape, and overall appearance. This procedure can be done for individuals looking to achieve a more masculine or flat appearing chest, or for individuals seeking a more feminine sized and shaped chest. Prior to moving to Montana, Dr. Ridgway was one of the few surgeons at Dartmouth performing top surgery for transgender individuals and is proud to continue doing so today.

FTM (or Female to Male) Top Surgery is a gender affirming procedure for transgender men and non-binary individuals that creates a masculine chest. Top Surgery involves breast removal and male chest contouring, and may also include free nipple grafts, or nipple/areola resizing and repositioning. There are a variety of techniques in top surgery and depending on a person's anatomy, one technique may be recommended over another to ensure the best results.

Double incision top surgery with nipple grafts Double incision top surgery with nipple grafts, also known as a bilateral mastectomy with nipple grafts, is a procedure typically recommended for people with larger chests and bodies.

This specific procedure often results in decreased nipple sensation and more significant scarring.

This procedure is usually an outpatient surgery that takes between 3 and 4 hours for the surgeon to perform.

In this procedure, the nipples are removed, typically decreased in size, and positioned on the chest to match a more male or masculine appearance.

Periareolar top surgery

Periareolar top surgery, also known as peri or circumareolar, is a procedure typically recommended for people with smaller chest sizes (size A or B cup) prior to surgery.

This procedure is usually an outpatient surgery that takes between 3 and 5 hours to complete.

Most people are able to maintain most of or all of their nipple sensation after recovery — though the large majority of people experience decreased nipple sensation in the days immediately after surgery.

While periareolar top surgery provides you with less visible and less significant scarring, people require revisions to achieve a completely flat chest around 40-60 percent of the time.

Keyhole top surgery Keyhole top surgery is only recommended for people with very small chests and tight chest skin.

Very few people are good candidates for keyhole top surgery because no excess skin is removed.

In order for this technique to result in an aesthetically pleasing and flat result, you must meet the criteria of having a small chest and tight chest skin.

This procedure is typically an outpatient surgery that takes between 1.5 and 3 hours.

This procedure results in very little visible scarring and preserves nipple sensation, but doesn’t provide the opportunity for the nipple to be repositioned on the chest.

MTF (Male to Female)?

MTF and MTN top surgery is also known as breast augmentation or augmentation mammoplasty. MTF and MTN top surgery typically takes between 1 and 2 hours. You are put under general anesthesia for the duration of the surgery. The breast augmentation procedure your surgeon uses will vary based on your desired chest size, the type of implant used, and the incision location.

You’ll typically have a choice between saline implants (filled with saltwater) or silicone implants (filled with silicone gel).

Silicone implants have the reputation of being softer and more natural appearing while saline implants are often less costly and can be inserted through a smaller incision.

Incisions are most commonly located along the areola, under the armpit, or under the fold of skin where your chest meets your breast tissue.

Once under general anesthesia, the surgeon makes an incision in the previously determined location and the implant is placed in the pocket above or below the pectoral muscle. See our breast augmentation page for more information.




1-3 hours (depending on extent of procedure)




Usually Outpatient


Back at work in 1-2 weeks
Resume light exercise at 2 weeks
Resume strenuous activity at 6 weeks
8-12 weeks for swelling to resolve


Usually permanent if weight is maintained and any other hormonal/medication factors have been identified and controlled