San Francisco
2299 Post St. Suite 207
San Francisco, CA 94115
(415) 530-5335
Los Angeles
1317 5th St #300
Santa Monica, CA 90401
(310) 751-5886
Gender-affirming chest mastectomy, or top surgery, removes a patient’s breast tissue to create a flatter, more masculine, or more gender-neutral chest contour. Depending on your surgical plan, your procedure may include tissue removal, skin reduction, nipple repositioning, nipple grafting, or pectoral (pec) implants.
At Align Surgical Associates in San Francisco and Los Angeles, top surgery planning is shaped by factors such as your current chest size, skin elasticity, and tissue distribution. Our role is to help you understand how these considerations affect your options and recommend a technique that supports your priorities.
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VIEW PHOTOSTop surgery is a masculinizing chest procedure that removes the breast tissue and resizes or repositions the nipples and areolas. While traditionally associated with masculinizing embodiment goals, this surgery can support nonbinary or gender-neutral expression as well.
Your plan starts with what matters most to you, such as function, sensation, privacy, recovery realities, and your day-to-day life.
We'll be transparent about what a technique can and can't reliably do for your anatomy and priorities, and we'll explain why we're recommending a particular approach.
We don't reduce care to a single concern or body area. We look at your goals, your comfort, and what's safest and most supportive for you overall.
We understand that many patients come in with complex past healthcare experiences and strive to create an environment where you always feel respected, welcomed, and seen at every step.
Gender-affirming surgery isn't a side offering at Align—it's our life's work.
Care and language change over time. We are dedicated to staying current, listening, and adapting.
Top surgery may be a meaningful option for transmasculine, nonbinary, and other gender-diverse patients seeking a flatter chest contour and a lasting alternative to binding.
Candidacy for certain techniques depends on factors such as chest size, skin elasticity, and whether preserving nipple sensation is important to you.
Top surgery can be performed using several different techniques, each with its own approach to tissue removal, scar placement, nipple management, and chest contour, including the possible addition of pec implants. During your consultation, we’ll guide you through your options so you can understand the trade-offs and what each technique may mean for your result.
Our board-certified surgeons often recommend double incision top surgery for patients with medium to large amounts of chest tissue or lower skin elasticity who need added contouring and skin reduction.
This technique uses two incisions across the lower chest to remove tissue, reshape the chest contour, and reposition the nipples as grafts. It usually offers the most control over the final chest shape, but it also creates the most visible scar pattern and may reduce nipple sensation.
Buttonhole top surgery is a variation of double incision top surgery that may preserve the nipples instead of using free nipple grafts.
We often recommend it for patients who need the contouring benefits of a double incision technique but who want to prioritize nipple sensation or avoid grafting. This option still involves visible chest scars, and candidacy is more selective.
Our surgeons may use inverted-T, or anchor incision, top surgery when more skin reduction is needed but nipple preservation remains part of the surgical goal. This technique combines horizontal and vertical incisions to allow more reshaping of the lower chest while keeping the nipple attached in select cases.
Inverted-T top surgery can offer a meaningful middle-ground option for some patients, though it creates a more involved scar pattern than limited-incision techniques.
We generally reserve the periareolar or keyhole technique for patients with a smaller chest and good skin elasticity. These approaches use more limited incisions around the areola, which can make scarring less noticeable.
Because they rely on the skin’s ability to retract, or “bounce back,” after tissue removal, they offer less control over skin reduction and contouring than more extensive techniques.
| Consideration | Double Incision | Buttonhole | Inverted-T/Anchor | Periareolar/Keyhole |
| Best suited for | Patients with more chest tissue or less skin elasticity | Patients with more chest tissue or less skin elasticity who want to preserve nipple sensation | Patients who need more skin reduction and may be interested in nipple preservation | Patients with a smaller chest and good skin elasticity |
| Scar pattern | Two horizontal scars across the lower chest | Two horizontal scars across the lower chest | Anchor-shaped scars with horizontal and vertical components | Limited scarring around the areola |
| Nipple approach | Free nipple grafts | Nipple preservation instead of free nipple grafts, when possible | Nipple preservation in select cases | Usually preserves the nipples |
| Nipple Sensation | Sensation may be reduced | May better preserve sensation | May preserve sensation in select cases | Often favored when preservation is a priority |
| Main trade-off | Most visible scars | More selective candidacy | More involved scar pattern | Less control over skin reduction and contouring |
Nipple sensation comes from small nerves that enter the nipple from the surrounding chest tissue. A top surgery technique that keeps these nerves intact has a better chance of preserving sensation, while one that removes the nipple and reattaches it as a graft cuts that nerve supply. In these cases, any sensation that returns depends on nearby nerves regrowing into the graft on their own, which often leads to partial or variable results between patients.
Nipple neurotization is an advanced technique that may be performed during top surgery to help restore sensation to the nipple-areolar complex. During this procedure, your surgeon uses microsurgical techniques to carefully connect the sensory nerves to the nerves supplying the nipple, allowing the nerve fibers to regenerate over time.
While sensation cannot be guaranteed, nipple neurotization may improve the likelihood and quality of sensory recovery compared with standard free nipple grafting. Candidacy for this technique depends on your anatomy, surgical goals, and the top surgery approach being performed. Your surgeon will help you determine whether nipple neurotization is a good fit for you during your consultation.
Some surgeons "offer" gender-affirming surgery among many other services. For Align, it's the center of our life's work. Our 6 board-certified surgeons have committed themselves wholly to gender-affirming care and research. This means we aren't just helping patients reach their embodiment goals; we are helping to make their care better—better understood, better supported, and performed in the best way possible. Meet the specialists behind the transformations.
Recovery after top surgery depends on the technique used and the extent of the procedure. Most patients should expect soreness, swelling, and activity restrictions, as well as the need to wear compression garments and, in some cases, care for drains.
We will walk you through the recovery timeline during your consultation, including what support you may need after surgery, when follow-up visits are likely to happen, and what to expect as swelling improves and your chest contour settles.
Gender-affirming care, including top surgery, is often covered by insurance. If you are using insurance, we will guide you through the authorization process and what to expect.
If you prefer to pay out of pocket, we will give you a personalized quote based on your surgical plan, including the technique used and the overall complexity of your procedure.
Travel planning can involve a lot of moving parts, especially when you're coordinating around surgery. If you're coming to Align from outside the Bay Area or Los Angeles, we have resources specifically for you.
As with any surgery, top surgery carries risks, such as bleeding, infection, scarring, asymmetry, healing concerns, contour irregularities, and changes in sensation. Depending on your treatment plan, your surgeon may also discuss nipple graft healing, partial graft loss, or other technique-related considerations.
The biggest trade-offs with top surgery often involve scarring visibility, nipple preservation, and how much contour control a given technique allows. Your chest size, skin elasticity, and tissue distribution can all affect which approaches are appropriate and what type of result can be achieved safely.
The right technique depends on factors such as chest size, skin elasticity, the amount of skin reduction or contouring needed, and whether preserving nipple sensation is important to you. During your consultation, we will recommend the approach that best fits your anatomy and priorities.
Not always. Some techniques use free nipple grafts, while others may preserve and reposition the nipples instead. The need for nipple grafts depends on the technique that is safest and most appropriate for your body.
Scarring depends on the technique used. Some approaches create two horizontal scars across the lower chest, while others add a vertical incision (inverted-T) or limit incisions to around the areolas. We will discuss scar visibility during your consultation and how it may affect your choice of surgery.
We recommend booking a consultation if you are considering top surgery and want expert guidance on which surgical approach is most likely to help you achieve your goals safely and realistically. A consultation can also help clarify what trade-offs to expect with scarring, nipple preservation, and contour.
When you’re ready, we’re here to help. Request an in-person or virtual consultation using the online form or call Align Surgical Associates to get started. We are proud to offer top surgery (chest mastectomy) for San Francisco and Los Angeles patients, as well as individuals traveling from outside California.
San Francisco Office: (415) 530-5335
Los Angeles Office: (310) 751-5886
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