Top surgery is a name given to removal of female breast tissue for transgenders who wish to have a male chest, and do away with binders.
This is done through a minimal incision in the lower areola from 9 o’clock to 3 o’clock. Liposuction and removal of breast tissue can also be accomplished and this works well for patients with small breasts. The areola and nipple can also be reduced with a circumferential incision. There is minimal trauma to the breast stalk so neurological innervation is least likely to be disturbed.
For larger breasts a transverse incision at the level of the infra- mammary fold can be done. Liposuction is usually performed first to remove peripheral fatty breast tissue and loosen the tissue planes. In that the skin is window shaded downwards, a nipple areola graft is needed. This harvesting permits easy reduction typical of male anatomy, before suturing the graft into a pre-marked symmetrical usually somewhat more lateral position. A drain is necessary for each sided and is removed about the 3rd to 4th post-op day. A binder promotes wound healing and facilitates good apposition between skin and chest wall.
Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami