Exploring Top Surgery Options for Trans Men and Nonbinary Individuals: A Comprehensive Guide

Top surgery is a significant milestone for many transgender and nonbinary individuals seeking to align their physical appearance with their gender identity. This surgical procedure aims to create a more traditionally masculine chest by removing breast tissue and reshaping the chest. For those considering top surgery, understanding the different surgical options, their risks and benefits, and the available support in their region is essential for making an informed decision.

In this blog post, we will provide an overview of the six common top surgery procedures, discussing each technique’s unique features, as well as their potential risks and benefits. Additionally, we will delve into the support available in British Columbia, Alberta, and Ontario, including insurance coverage, eligibility criteria, and local resources. This comprehensive guide aims to equip transgender and nonbinary readers with the information they need to make the best choice for their top surgery journey, in between psychotherapy sessions and other supportive care.

Six Common Top Surgery Procedures

A. Double Incision with Nipple Grafts

1. Description of procedure: This technique involves making two horizontal incisions across the chest, removing breast tissue, and repositioning the nipples using free nipple grafts. Excess skin is removed, and the incisions are closed, creating a flatter, more masculine chest.
2. Pros and cons: Pros:
   • Suitable for individuals with larger chests or excess skin
   • Provides a flat, contoured result Cons:
   • More visible scarring
   • Potential loss of nipple sensation

B. Peri-areolar (Keyhole) Surgery

1. Description of procedure: This method involves making a semi-circular incision around the lower half of the areola. Breast tissue is removed through the incision, and the remaining skin is tightened. Nipples and areolas are typically not repositioned.
2. Pros and cons: Pros:
   • Minimal scarring
   • Preserves nipple sensation Cons:
   • Suitable only for individuals with smaller chests and good skin elasticity
   • Potential for contour irregularities

C. Inverted-T/T-Anchor Surgery

1. Description of procedure: Also known as the “T-anchor” technique, this procedure combines the double incision and peri-areolar methods. Two horizontal incisions are made, and breast tissue is removed. A vertical incision is made below the nipple, allowing for resizing and repositioning without grafting.
2. Pros and cons: Pros:
   • Suitable for various chest sizes
   • Better nipple sensation preservation compared to double incision Cons:
   • More visible scarring than peri-areolar surgery
   • Potential for contour irregularities

D. Buttonhole Surgery

1. Description of procedure: Similar to the double incision method, this technique involves two horizontal incisions and removal of breast tissue. However, instead of using free nipple grafts, the nipples are left attached to the underlying tissue and brought out through a small hole in the newly positioned skin.
2. Pros and cons: Pros:
   • Better nipple sensation preservation compared to double incision
   • Suitable for various chest sizes Cons:
   • More visible scarring than peri-areolar surgery
   • Potential for contour irregularities

E. Minimal Scar Surgery

1. Description of procedure: This technique involves making small incisions along the chest’s natural contours, through which breast tissue is removed using liposuction. Nipples and areolas are typically not resized or repositioned.
2. Pros and cons: Pros:
   • Minimal scarring
   • Faster recovery time Cons:
   • Suitable only for individuals with smaller chests and good skin elasticity
   • Less dramatic chest contouring

F. Fishmouth Surgery

1. Description of procedure: This method involves making an incision around the entire areola and extending it outward, resembling a fish’s mouth. Breast tissue is removed, and excess skin is tightened. The incision is closed, with the nipples and areolas resized and repositioned as needed.
2. Pros and cons: Pros:
   • Suitable for a range of chest sizes
   • Allows for resizing and repositioning of nipples and areolas Cons:
   • More visible scarring than peri-areolar or minimal scar surgery
   • Potential for contour irregularities

II. Risks and Benefits of Top Surgery

A. General risks associated with surgery:

• Infection: As with any surgery, there is a risk of infection at the incision sites or within the treated area.
• Bleeding: Excessive bleeding can occur during or after surgery, which may require additional intervention.
• Adverse reactions to anesthesia: Some individuals may experience negative reactions to anesthesia, ranging from mild side effects to severe complications.
• Blood clots: The formation of blood clots can pose serious risks and may require further medical attention.
• Scarring: All surgical procedures carry the risk of scarring, though the extent and visibility of scarring may vary depending on the specific top surgery technique.

B. Potential complications specific to top surgery:

• Loss of nipple sensation: Some top surgery techniques may result in reduced or complete loss of sensation in the nipples.
• Asymmetry or contour irregularities: Top surgery may result in uneven chest appearance or irregular contours, which might require additional procedures to correct.
• Nipple necrosis: In rare cases, nipple grafts may not heal properly, leading to the loss of the nipple tissue.
• Seroma or hematoma: The accumulation of fluid or blood in the surgical area can occur, potentially requiring further medical intervention.

C. Benefits of top surgery for transgender and nonbinary individuals:

• Improved self-esteem and body image: Top surgery can significantly improve an individual’s self-esteem and body image by aligning their physical appearance with their gender identity.
• Increased comfort and confidence: Many transgender and nonbinary individuals experience discomfort and dysphoria related to their chest; top surgery can alleviate these feelings and increase their confidence in daily life.
• Expanded clothing options: A flatter, more masculine chest allows for more clothing options and the ability to wear clothes that reflect one’s identity.
• Social affirmation: Top surgery can help individuals feel more accepted and affirmed in their gender identity within social and professional settings.

III. Insurance Coverage and Support in BC, Alberta, and Ontario

A. British Columbia

1. Overview of available support: Trans Care BC, a program by the Provincial Health Services Authority, provides support and resources for transgender and nonbinary individuals seeking top surgery. This includes assistance in navigating the surgical process, coordinating care, and accessing support services.
2. Insurance coverage and eligibility criteria: Top surgery is covered under the British Columbia Medical Services Plan (MSP) for eligible residents. To qualify, individuals must have a diagnosis of gender dysphoria and obtain a recommendation from a qualified mental health professional. Additionally, they must be on hormone therapy for at least one year, unless contraindicated, and demonstrate the ability to provide informed consent.

B. Alberta

1. Overview of available support through the Alberta gender surgery program: Alberta Health Services provides support and resources for individuals seeking gender-affirming surgeries, including top surgery. Through the Alberta gender surgery program, patients can access information, referrals, and coordination of care.
2. Pre-approval process and eligibility criteria: Top surgery is covered by the Alberta Health Care Insurance Plan (AHCIP) for eligible residents. To qualify, individuals must have a diagnosis of gender dysphoria, undergo a mental health assessment by a qualified professional, and obtain a referral from a physician or family doctor. Surgeons or primary care providers (PCPs) must validate the patient’s eligibility using the Request for Breast Surgery form and submit it to Alberta Health for pre-approval.

C. Ontario

1. Overview of available support: The Ontario government provides support and resources for transgender and nonbinary individuals seeking gender-confirming surgeries, including top surgery. This includes information on how to access surgery, the referral process, and support services available within the province.
2. Insurance coverage and eligibility criteria: Top surgery is covered by the Ontario Health Insurance Plan (OHIP) for eligible residents. To qualify, individuals must have a diagnosis of gender dysphoria, be under the care of a qualified healthcare provider, and obtain a referral from a physician or nurse practitioner. Additionally, they must meet any further eligibility criteria set forth by the healthcare provider and the surgical facility.

IV. Additional Resources and Support

A. Local support groups and organizations:

• Reach out to LGBTQ+ community centers in your area, as they often have support groups and resources tailored to transgender and nonbinary individuals.
• PFLAG chapters are available in many cities and towns, providing resources, support, and connections to local transgender communities.
• Local mental health organizations may also offer support groups or therapy options specifically for transgender and nonbinary individuals.

B. Online communities and resources:

• Facebook groups and online forums such as Reddit’s r/ftm and r/nonbinary provide spaces for individuals to share experiences, ask questions, and connect with others going through similar journeys.
• Websites like Gender Spectrum, National Center for Transgender Equality, and Trans Lifeline offer a wealth of information, resources, and support for transgender and nonbinary individuals.
• YouTube channels and blogs by transgender and nonbinary individuals can provide personal insight, experiences, and advice related to top surgery and other aspects of transition.

C. Tips for navigating the surgery process and recovery:

• Research and choose a qualified, experienced surgeon who specializes in top surgery and has a strong understanding of the unique needs of transgender and nonbinary patients.
• Prepare a list of questions to ask your surgeon during consultations to ensure you fully understand the procedure, risks, and expected results.
• Develop a support system, including friends, family, or support group members, to help you through the surgical process and recovery period.
• Plan for postoperative care, including arranging time off work or school, having someone to assist you at home, and gathering necessary supplies like comfortable clothing, ice packs, and pain medications.
• Follow your surgeon’s post-operative instructions carefully to minimize the risk of complications and promote optimal healing.
• Be patient with your recovery process, as it can take time for swelling to subside and the final results of your top surgery to become apparent.

Conclusion

Understanding the various top surgery options, their risks and benefits, and the support available in British Columbia, Alberta, and Ontario is essential for transgender and nonbinary individuals considering this life-changing procedure. By being well-informed, you can make the best decision for your unique needs and circumstances, ultimately improving your self-esteem, body image, and overall quality of life.

We encourage you to seek further information and support through the resources provided in this blog post, as well as by consulting with your healthcare providers and mental health professionals. Surrounding yourself with a strong support network and accessing accurate, up-to-date information will empower you to navigate your top surgery journey with confidence and success.