FTM Top Surgery UK | Gender-Affirming Chest Surgery

Pre-op
Before your Top Surgery, you’ll need to complete a series of consultations to ensure that you are adequately informed and meet the relevant medical requirements. Following your initial call, you’ll attend a preliminary virtual consultation with our dedicated gender surgery Patient Adviser, Mamuna, to ensure that you are comfortable, well-prepared and happy to move forward. Kate and Chloe will then review information from your Gender Identity Clinic and make a decision on whether to proceed.

The next step is a relaxed first meeting with your surgeon via video consultation. It is helpful if you can show your chest to the surgeon during this consultation, but this can be avoided by simply answering some descriptive questions. There is a two-week cooling off period following this consultation, giving you sufficient time to make your final decision. You will receive a Patient Information Guide following your first consultation, which you can read and compile questions on before meeting your surgeon in person. A face-to-face surgeon consultation will be scheduled four weeks after your virtual meeting, after which a convenient date for your surgery can be selected.

The day of your surgery
Once the pre-surgery process is complete, your procedure can be scheduled for an available and convenient date up to six weeks after your initial consultation. The duration of your Top Surgery will depend on the number of surgeons overseeing the procedure, and can take anywhere from 90 minutes to three hours to complete. Upon your arrival at the hospital, the surgeon will visit your room to obtain your final consent and answer any last-minute questions about your procedure.

You will then meet with the Consultant Anaesthetist to agree on a plan for your pain control and ask any relevant questions.

Once the procedure is complete, dressings will be applied and your compression vest will be fitted. It’s important to arrange transport to and from the hospital on the day, as you should not operate a car for at least two weeks following Top Surgery. While 70% of patients return home on the day of their procedure, we recommend packing a basic overnight bag, in case you are required to stay.

Post-op
We are committed to ensuring that you remain as comfortable as possible during the post-operative recovery period. Due to the nature of Top Surgery, it’s important that you thoroughly understand all aftercare requirements and ask questions about anything you’re unsure of. A comprehensive post-operative care package will be discussed with your surgeon during consultation, and your local clinic will serve as your primary point of contact throughout the healing process. You will be provided with out-of-hours contact information during your consultation, which should be used in the event of any urgent post-op concerns.

Following your surgery, you may be provided with medicines to take home. Please take these medicines as prescribed, and continue taking any pain relief, HRT or birth control medication as normal. As antibiotics can impact the efficacy of the birth control pill, however, we do not recommend the concurrent use of both. You should also avoid using vitamins, herbal supplements, Omegas and aspirin for two weeks following your procedure, unless they have been prescribed to you by a doctor.

Yes. All Top Surgery procedures result in some level of permanent scarring. Periareolar or keyhole procedures result in less scarring due to the relatively small size of incisions required. Double Incision surgery leaves behind more noticeable scars, which appear in the natural creases that sit below the pectoral muscles. Patients should nonetheless expect some level of lasting surgical markings following any variation of Top Surgery.

Healing from Top Surgery is a delicate process that is unique to each individual patient. The full duration of your recovery period will depend on the surgical technique used and any post-operative complications that arise, but patients can expect to return to regular physical activity within 4-6 weeks.

Like any surgical procedure, Top Surgery carries the possibility of post-operative complications. You are likely to experience swelling, bruising and some discomfort for a few weeks post-op which can be managed with painkillers. In rare cases, patients may experience bleeding, infection, seroma, necrosis or loss of nipple sensitivity.

Yes. Top Surgery has shown to alleviate dysphoria and improve quality of life for individuals who seek this surgery. As traditional masculinizing surgery techniques may not align with the goals of some non-binary individuals, we offer personalised approaches to achieve the most gender-affirming results possible. These include unique nipple size and position adjustments, ‘nipple-free’ procedures without grafts, ‘non-flat’ contouring and traditional breast reductions.

No, Top Surgery is not reversible. It is a significant surgical procedure that involves the permanent removal of breast tissue and reshaping of the chest. Due to the permanent nature of the procedure, individuals considering Top Surgery should carefully evaluate their decision and discuss it thoroughly with a qualified specialist.

Patients of Top Surgery commonly experience some level of discomfort and pain in the weeks following their procedure. While thresholds for pain vary from person to person, you are likely to feel sharp, short-term discomfort which can be relieved with pain medication.

The minimum age for any Top Surgery consultation or procedure with Pall Mall Medical is 18. The maximum age for patients is 70.

It is best to discuss with our Patient Liason in the first instance. Some chest/breast reduction procedures for non-binary patients do not require a referral, whilst other surgery cannot proceed without a referral letter from a licensed UK Gender Specialist, as per WPATH and NHS service specifications.

Yes, although the process of accessing these procedures can be complex and time-consuming. Private care offers a significantly quicker pathway and an increased level of comfort for patients.

Gender-Affirming Top Surgery is not guaranteed to be covered by all health insurance plans, and some patients may be required to pay out-of-pocket expenses. Each insurance provider has unique policies around gender-affirming procedures, so it’s important to verify and assess your options before proceeding.

The likelihood of regaining full nipple sensation depends on the type of Top Surgery that is administered. Patients undergoing periareolar surgery retain sensation in more than 70% of cases, while about 30% of nipple graft double incision patients report a return of tactile sensation. If you have a larger chest and hope to preserve sensation in your nipples, the dermal flap surgical technique can be used.

Gender-Affirming Top Surgery is a major procedure which will require a minimum period of 4-6 weeks’ rest before returning to regular levels of activity. We recommend taking 2-3 weeks off desk jobs and 4-6 weeks off demanding physical activity in the period following your procedure.