Mastectomy/Chest Reconstruction

Surgeries are an option for anyone who wants to align their body with their gender, including non-binary people. There’s no one way to be trans, and you can choose whatever journey feels authentic to you.

This might include hormone therapy and transition-related surgeries, or it might include surgeries without hormones. It might not include medical treatments at all. Not every trans, non-binary or gender diverse person has surgery – it’s a decision that’s yours to make.

What is chest reconstruction?

Chest reconstruction is often known as “top surgery”. It’s a surgery for people with breast tissue who’d like to change the shape of their chest. It can have one or two parts, depending on your surgeon, insurance coverage or personal preference. The first is a mastectomy, which removes breast tissue. The second is chest contouring, which usually shapes the chest in a way that’s perceived as “masculine”. 

Why do people get top surgery? 

There’s many reasons someone might get top surgery. The most common is that it can help ease feelings of dysphoria, which improves your wellbeing. It can give you more options for clothes to wear, since it removes the need for binding. Some people might also choose surgery to feel more comfortable in environments like the pool, gym or beach.

Alternative treatment options

If you’re not ready for surgery or are still exploring your options, there are other ways you can change the shape of your chest. The most common is binding or taping, which is when you use a special garment or tape to flatten your chest. There’s some safety tips to bear in mind though, and this guide from Trans Care BC has a helpful summary.

You can also change your chest appearance with clothing (looser clothes can help) or with diet and exercise. Weight loss can help reduce the size of your chest, but it’s worth talking to your healthcare provider before you start any diet or exercise plan. Some people can also have more noticeable results than others, so remember to be kind to yourself!

Surgical techniques

You have three main options when it comes to top surgery. The method you choose will come down to your surgeon, your current anatomy and your goals. In your pre-surgery consultation you’ll have a chance to discuss all of these options and find what works best for you.

Keyhole

• Possible for people with A cup size and lots of chest skin elasticity.

• The surgeon makes a small incision at the bottom of the areola and removes breast tissue with a liposuction needle.

• The nipple and areola usually aren’t moved or re-sized. 

• Leaves a small scar at the bottom of the areola.

Periareolar incision

• Possible for people with a small chest and moderate skin elasticity.

• The surgeon makes an incision around the entire outside of the areola, leaving it attached to the body.

• Breast tissue is removed with a scalpel or liposuction needle.

• The areola and chest skin may both be trimmed down and are then reattached.

• The nipple and areola may be repositioned.

• Leaves a scar around the areola.

• Not offered across Canada (only in Ontario).

Double incision/bilateral mastectomy

• Possible for people with C cup size and low skin elasticity, or people with D cup size and higher.

• The surgeon makes two horizontal incisions across the chest, below the areola.

• Breast tissue, fatty tissue and excess skin are removed with a scalpel. 

• Nipple and areola can be removed completely, trimmed, moved and re-attached (known as “free nipple graft”).

• Nipple and areola can also be left partially attached while it is trimmed and re-positioned. 

• Two drains might be left in the chest during the healing process to allow blood/fluid to escape.

• Leaves two long horizontal scars on the chest. Depending on anatomy, these can sometimes be disguised by chest hair or building chest muscles.

Side effects and risks

As with all surgery, top surgery comes with side effects and risks. These are:

• Inability to lactate or chestfeed.

• Breast cancer screening being less effective.

• Numbness or increased sensitivity in your nipples, areolas or chest (there’s a higher degree of sensation loss with double incision).

• Partial or full nipple graft failure (where the nipple tissue dies and falls off).

• Changes in symmetry and colour of nipples and areolas.

• Scarring (largest and most noticeable with double incision surgery).

• Skin irregularities, like bulges or puckering.

Some aesthetic problems can be addressed with revision surgery or other treatments, like tattooing or laser. Your surgeon should walk you through all of the potential complications with top surgery, and some will include revisions free of charge. You can ask them about this in your consultation appointment.

General surgery risks

There are some general risks that come with most surgeries. They are:

• Bleeding

• Blood clots in your legs or lungs

• Injury to surrounding organs, nerves or blood vessels

• Hematoma (a collection of blood) or seroma (a collection of fluid)

• Infection or abscess

• Wound opening or delayed healing

• Chronic pain

• Scarring

• Feeling dissatisfied with the outcome

• Feelings of regret about surgery

These risks can be higher with certain medications and health conditions, like immune or clotting disorders, or if you smoke. Tell your doctor about any medications and supplements you take, along with any health conditions you have (even if they don’t seem relevant!). 

Anesthetic risks

Top surgery usually requires going under general anesthetic. General anesthetic has the following risks (most of which are very rare):

• Nausea/vomiting

• Damaged teeth

• Aspiration pneumonia (pneumonia from inhaling liquid like saliva or vomit)

• Respiratory failure (i.e. stopping breathing)

• Heart attack

• Coma

• Death

Ready for surgery?

If you'd like to get chest reconstruction, your surgeon will require an assessment to confirm you're ready for surgery. If you'd like to apply for funding to cover your surgery then you also need to submit an application to the Ministry of Health in Ontario or Alberta Health in Alberta.

In Ontario, the clinician who does your assessment will submit this application. In Alberta, your surgeon will submit this application. They’ll do this after you’ve been referred to them - whether they accept your referral is at their discretion.

If you are in Ontario, Foria can provide your assessment and we can also submit and track your funding application for you. See our Surgical Referrals in Ontario article for more information.

Foria does not currently offer assessments in Alberta, but these services will be available soon. See our Surgical Referrals in Alberta article for more information.

This content has been reviewed by Foria’s Medical Director, Dr. Kate Greenaway and our community advisory team. Medical sources include Rainbow Health Ontario’s TRS Surgical Summary Sheets.

by Foria Clinical Team

Aug 22, 2023・ minute read

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