Gender Affirming Chest Surgery Sydney

Chest Contouring

Gender affirming chest surgery, usually called top surgery, removes breast tissue and repositions the skin and nipples to create a flatter chest contour. It is for transmasculine and non-binary people, and the aim is the chest you want rather than one standard shape.

Technique is driven by how much breast tissue there is, how elastic your skin is, and where your nipples sit relative to the lower border of the pectoral muscle. The two main routes are a double incision with free nipple grafts, or a periareolar or keyhole approach.

Dr Maryam Seyedabadi, Specialist Plastic Surgeon, MBBS FRACS, performs top surgery in Sydney and consults privately in Paddington.

Who it may suit

• You are transmasculine or non-binary and your chest is a source of dysphoria.
• Binding causes you pain, skin irritation, back discomfort or restricted breathing.
• You have a larger chest with loose skin and accept horizontal scars in exchange for a flat result.
• You have a smaller chest with elastic skin and nipples close to their final position, which may allow a periareolar or keyhole approach.
• You want a reduction in size while keeping some tissue or sensation, rather than a fully flat chest.
• You do not smoke, or will stop, since smoking has a strong effect on nipple graft survival.

What top surgery involves

Top surgery is done under general anaesthetic, as a day case or with one night in hospital, and takes roughly two to four hours depending on technique.

1. Marking: your chest is measured and marked standing, with skin elasticity, tissue volume and nipple position checked against the pectoral border.
2. Double incision with free nipple grafts: breast tissue and excess skin are removed through horizontal incisions, and the nipples are taken off, resized and replaced as grafts on the flattened chest.
3. Periareolar or keyhole: tissue is removed through an incision at the edge of the areola, with the nipple left attached to its blood supply. Periareolar tightens the surrounding skin, while keyhole suits a small chest with little skin to remove.
4. Contouring: liposuction at the sides of the chest and towards the armpit blends the result into the chest wall. Drains are sometimes used.
5. A compression garment is applied, with nipple graft dressings left undisturbed until your first review.

Recovery

Timeframes vary with technique and are a guide only.

• Home the same day or after one night, with any drains usually removed within a few days.
• A compression garment or binder is generally worn for about four to six weeks.
• Nipple grafts are kept dry and dressed. They often look dark and crusted before settling, and colour can take months to even out.
• Lifting and overhead movement are restricted for around four to six weeks. Desk work is often possible within one to two weeks.
• Scars stay firm and pink for months and usually soften over twelve to eighteen months.

Risks and considerations

Risks include bleeding, haematoma that may need a return to theatre, seroma, infection, delayed wound healing, wide, raised or keloid scars, asymmetry in scar or nipple position, contour irregularity, residual fullness at the sides, and skin or fat necrosis. Some breast tissue always remains, so any new lump should be checked.

With free nipple grafts, partial or complete graft loss can occur. A graft may lose pigment, thin, or fail and need reconstruction or tattooing later. Nipple sensation is reduced or absent after grafting and this is usually permanent, and sensation can also change after a periareolar approach. Revision surgery is common enough to plan for, most often for dog ears, contour or nipple position, and it is a separate operation with its own cost and recovery. General anaesthetic carries risks including blood clots.

Your consultation with Dr Maryam

Consultations are private, at 2c Heeley Street, Paddington, and Dr Maryam is a female surgeon. Assessment in line with recognised standards of care is part of the pathway and is worked through with you. Letters from a GP, endocrinologist or psychologist involved in your care are useful if you have them, and whether or not you have had gender affirming hormone therapy, its bearing on your result is discussed.

Where the procedure is classified as cosmetic surgery, a referral from a registered medical practitioner is required before consultation and a cooling off period of at least seven days applies, or at least three months with an additional assessment for patients under 18. Some gender affirming procedures may attract Medicare item numbers and others do not, so out of pocket costs vary. Surgery is performed at St Luke’s Hospital in Potts Point, East Sydney Private Hospital or Sydney Day Hospital. Call 1300 067 668.