Top surgery

Here is a visual and schematic representation of chest masculinisation surgery.

Chest masculinisation surgery gives a lasting masculine chest by removing most of the breast tissue. Non-surgical options, such as compression garments or binding, change the appearance of the chest only temporarily. They do not permanently alter its anatomy, and they can cause lasting damage to the quality of the chest skin.

Before chest masculinisation surgery, Dr Manon Belhoste and the anaesthetist give instructions on fasting and medication, which must be followed. Stopping smoking and nicotine is required. All treatments and supplements must be declared, in particular anticoagulants, antiplatelet drugs, anti-inflammatories, hormone treatments, psychotropic medication, diabetes treatments and herbal remedies. No prescribed treatment should be stopped on its own, and how hormone treatment is managed around the procedure is decided case by case. Any personal or family history of breast or ovarian cancer and any known genetic mutation must be reported, as must any fever, cough, infection or skin problem. Arrangements for getting home and for the support you will need are made before the procedure.

After chest masculinisation surgery, pain, chest tightness, bruising and swelling are common in the first few days. Dr Manon Belhoste gives instructions on dressings, showering, scar care and sun exposure at discharge. Scars often remain red, firm and visible for the first few months, then gradually fade. Scars take 12 to 18 months to mature, sometimes longer.

Top surgery is a chest masculinisation mastectomy. It removes most of the breast tissue. Some glandular tissue may remain, unlike in a mastectomy for breast cancer. The tissue removed is sent to the laboratory for analysis.

Binding changes the appearance of the chest only while the garment is worn. The anatomy of the chest stays intact. Binding or taping is strongly discouraged if chest masculinisation surgery is planned, because it irreversibly alters the quality of the skin and can affect the future quality of the scar and the choice of surgical technique.

Whether sensation is kept depends on the surgical technique. With techniques whose incisions are in the areola, sensation is generally kept but may still be reduced. The chest, areola and nipple may be less sensitive. After a graft of the areola and nipple, erogenous sensation may be reduced or lost permanently.

The price of chest masculinisation surgery includes Dr Manon Belhoste's fees, follow-up consultations after the operation, anaesthesia and clinic fees.