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IndonesianMedically Reviewed by DITSAYANIN THAWEETHANATSIT, M.D.
The decision to undergo “Top Surgery” is a significant step in the journey of Gender Affirmation for Transgender Men and Non-Binary individuals. At Rattinan Clinic, we understand deeply that this is not just about aesthetics, but about unlocking physical and mental discomfort, allowing you to live with confidence as your true self.
Top Surgery is a surgical procedure to reduce or remove breast tissue so that the chest shape aligns with the patient’s identified gender, specifically for those assigned female at birth but who identify as male (Transgender Men) or gender-diverse individuals (Non-Binary).
In medical terms, we call this procedure Masculinizing Chest Surgery or Mastectomy, which not only means the removal of breast tissue. The key is “Chest Wall Contouring” to achieve a flat, proportionate shape, and the repositioning of the Nipple-Areola Complex (NAC) to best align with a masculine physique. This allows you to wear clothing without relying on chest binders ever again.
How Is Top Surgery Different From Breast Reduction Surgery?
Top Surgery is often referred to as Gender-Affirming Mastectomy or Masculinizing Chest Surgery, focusing on creating a more masculine chest shape for those seeking to align their appearance with their gender identity. This may include repositioning the areola, reducing areola size, and adjusting chest muscle proportions appropriately.
Breast Reduction Surgery, or Reduction Mammoplasty, is a procedure that removes excess breast tissue, fat, and skin to make the breasts smaller, flatter, and suited to the desired body shape.
This surgery is not only for aesthetic purposes; it also helps resolve several significant health issues, such as reducing back, neck, and shoulder pain caused by excessive breast weight, improving posture, increasing ease of exercise and various activities, as well as building confidence and improving overall quality of life.
Who Is Top Surgery for?
To ensure that top surgery is truly the right decision, surgeons will evaluate readiness in 3 main areas prior to the procedure to ensure maximum safety according to medical standards, as follows:
- Gender Dysphoria: Experiencing persistent feelings of distress or discomfort with one’s primary sex characteristics.
- Physical Health: Being in good health with no high-risk underlying medical conditions; if present, these conditions must be controlled within normal limits.
- Mental Readiness: Having passed an evaluation and received certification from a psychiatrist based on the required criteria (1 or 2 specialists, depending on the case and the current regulations.
The Benefits of Top Surgery
Top Surgery is not only a physical change, but an elevation of quality of life in several dimensions, both physical and mental, as follows:
- Unlocking Confidence in One’s Identity (Gender Affirmation): Helps the external physique align with internal gender identity, reducing gender dysphoria and allowing one to feel like their complete self.
- Freedom from Chest Binding: Eliminates health issues caused by long-term use of binders or chest tape, such as back pain, difficulty breathing, rashes, or pressure bruises.
- Agility in Daily Life: Ability to perform various activities with confidence, whether exercising, swimming, or choosing from a wide variety of clothing styles without worrying about body shape.
- Long-Term Results: Once the mammary glands are surgically removed, the chest will remain permanently flat (subject to maintaining an appropriate body weight).
The Disadvantages of Top Surgery
Rattinan Clinic wants you to have complete and in-depth information for the best possible preparation.
- Will Nipple Sensation be Gone?
- In the Case of Small Incision/Endoscopic Surgery: The nerves supplying the nipple are usually not severed; so, sensation remains or is only temporarily reduced during the initial period.
- In the Case of Double Incision Surgery (Nipple Repositioning): Because the nipple must be removed and replanted (Free Nipple Graft), the original nerves are severed. This causes sexual sensation in the nipple to decrease or disappear, although the nipple may still retain some response to temperature.
- What Is the “Dog Ear” Condition (Excess Skin at the Armpit)?
This is commonly found in those with significant chest tissue on the sides. When the incision is sutured closed, tissue may occur at the ends of the incision, resembling a dog’s ear.
Rattinan’s Prevention Approach: Our surgeons utilize liposuction techniques alongside the surgery to refine the details along the sides of the torso and under the armpits. This reduces the chance of Dog Ear from the very first step.
Types of Top Surgery
Masculinizing Top Surgery can be performed using various techniques to meet the needs of diverse body types. The choice depends on several factors, including original chest anatomy, skin elasticity, nipple placement, and scar appearances.
The procedure is categorized into 3 main techniques:
- Small-incision Top Surgery
- Medium-incision Top Surgery
- Double incision Top Surgery
Small-Incision Top Surgery (Minimal Scar)
This is the surgical removal of breast tissue through incisions made strictly within the areola area. There are no long incisions extending beyond the borders of the areola. Once fully healed, the scars blend seamlessly into the natural edges of the areola, making them invisible.
The incisions are categorized as follows:
- Keyhole (Semicircular Shape): A small, curved incision is made along the lower edge of the areola. The surgeon then inserts instruments through this opening to excise and suction out the tissue.
- Periareolar (Circular Shape Around the Areola): A circular incision is made around the entire perimeter of the areola (like a donut) to remove a small amount of excess skin, then the skin is pulled in and sutured to the new areolar border.
Who Is Small-Incision Top Surgery for?
- Small Breast Size: Mostly not exceeding an A cup or a small B cup.
- Highly Elastic Skin: The skin must be firm; once the tissue inside is removed, the skin must be able to shrink back and flatten on its own (like an elastic pillowcase).
- Well-Positioned Nipples: The original nipples must not be placed too low, as this method cannot reposition the nipples.
Who Is Small-Incision Top Surgery Not Suitable for?
- Large Breasts (Cup C and up): There is too much excess tissue and skin to be pulled smooth through small incisions.
- Sagging Breasts with Loose Skin or Loss of Elasticity (e.g., from years of chest binding or aging): If a small-incision technique is forced, the remaining skin will look wrinkled like an empty coffee bag.
- Those Who Want to Reposition Their Nipples: If the original nipples are positioned too low or too far apart, this technique cannot help.
Benefits of Small-Incision Top Surgery
- Minimal Scarring: Scars are hidden seamlessly along the edge of the areola, making it ideal for those who prefer being shirtless.
- Preserved Sensation: There is a very high chance that the nipples will retain their original sensation (because the neurovascular pedicles are not cut).
- Fast Recovery: The small incision size results in less pain.
Limitations of Small-Incision Top Surgery
- Uneven Skin: If the skin is not elastic enough, it may wrinkle or sag after the procedure.
- Cannot Reposition Nipples: Must accept the original natural nipple placement.
- Possible Residual Tissue: Due to the narrow surgical opening, the surgeon may not have as clear a view of the interior as with larger incisions (though liposuction may help).
- Puckered Areola: In the Periareolar technique, if the skin is pulled too much, the incision around the areola may appear pleated or “cinched” during the initial stage.
Medium-Incision Top Surgery
This is a technique that serves as a middle ground between small-incision and double incision methods. It involves an incision around the areola combined with a short vertical or horizontal incision. This allows for more excess tissue and skin removal than small-incision methods without requiring long incisions that extend to the sides of the torso.
The incisions are categorized as:
Lollipop: An incision around the areola with a vertical cut extending down to the chest base.
Inverted-T: Adds a short horizontal incision at the base. The breast tissue is removed while preserving the “neurovascular pedicles and blood vessels” that supply the nipple, after which the skin is sutured tightly.
Who Is Medium-Incision Top Surgery for?
Those with medium-sized breasts (Cup B to C) or mild sagging who do not want to lose nipple sensation, as this technique typically utilizes a method that preserves the neurovascular pedicles.
Who Is Medium-Incision Top Surgery Not Suitable for?
Those with breasts that are too large or severely sagging, as it may not be possible to remove all excess skin, leading to wrinkles. It is also not suitable for those who want the most seamless scars (since this method leaves a visible scar in the center of the chest).
Benefits of Medium-Incision Top Surgery
Nipple sensation can be preserved at a higher rate than with double incision methods, while sagging skin can be managed more effectively than with small-incision methods.
Limitations of Medium-Incision Top Surgery
Visible scarring (in a lollipop or anchor shape) and a risk that the chest may still retain a slight volume (not as perfectly flat as the long-incision method) because some tissue must be left behind to supply the nipple.
Double Incision (DI) Top Surgery
This is the most popular standard technique. It involves 2 long horizontal incisions made under the chest base, allowing the surgeon to remove as much tissue and “excess skin” as needed to create a flat chest that best fits the muscular contour.
The surgeon makes long horizontal incisions beneath the chest muscle line to remove all excess tissue and skin. Typically, a Nipple Graft technique is then used. It is when the nipples and areolae are removed, resized, and “grafted” onto a new position that is anatomically appropriate for a male physique.
Who Is Double Incision Top Surgery for?
This technique is suitable for everyone of all sizes, especially those with large breasts (Cup C and up), significantly sagging skin, or those whose skin has lost its elasticity from long-term chest binding.
Who Is Double Incision Top Surgery Not Suitable for?
There are no physiological contraindications for Double Incision surgery, but it is “not recommended” for those who are concerned about long scarring or for individuals who wish to preserve 100% of their nipple sensation.
Benefits of Double Incision Top Surgery
Achieves the flattest chest result, allows for the most precise and aesthetically pleasing nipple placement and sizing, and perfectly resolves the issue of sagging or excess skin.
Limitations of Double Incision Top Surgery
Visible horizontal scarring and a near-total or permanent loss of nipple sensation, as the nerves are severed during the nipple repositioning process.
Comparing Top Surgery Techniques: What Are the Differences?
Surgery Technique Ideal Candidate (Size/Skin) Scar Appearances Nipple Sensation Primary Advantages Limitations / Risks Keyhole Very small (Cup A), high skin elasticity Tiny semi-circular incision at the lower edge of the areola Very high (neurovascular pedicles remain intact) Smallest scars, very fast recovery Minimal tissue removal; cannot reposition nipples Periareolar / Double O Small to medium (Cup A-B), good elasticity Circular incision around the entire areola edge High (neurovascular pedicles preserved) Scars blend with areola; can resize the areola Potential "purse-string" puckering if skin isn't elastic enough Omega / Extended Peri Medium (Cup B), slight sagging Around the areola with small lateral extensions Medium to high Removes more tissue than a standard circular incision Scars extending beyond the areola are more visible Inverted-T / Anchor Medium to large; desires nipple sensation Around areola + horizontal base + vertical connecting line High (uses Pedicle technique to save nerves) Flat chest result while maintaining nipple sensation Significant scarring (anchor-shaped) Double Incision(DI) Large / severely sagging (suitable for all sizes) 2 long horizontal incisions below the chest muscles Very Low (usually uses Nipple Grafts) Flattest result; perfect removal of all excess skin Long, prominent scars and permanent loss of nipple sensation Liposuction Very small breasts composed primarily of fat Tiny puncture marks (2-3 mm) Very high No long surgical incisions; almost no downtime Cannot remove firm glandular tissue; usually combined with other methods
Endoscopic Transaxillary Top Surgery Technique at Rattinan Clinic
The Endoscopic Transaxillary Breast Surgery technique is a small-incision (subcutaneous) procedure that utilizes endoscopic technology. It is suitable for small to medium breast sizes (Cup A-B). The surgeon makes a small incision hidden within the armpit and inserts an endoscope to excise the breast tissue. The key highlights are the absence of scars on the chest, reduced internal tissue trauma, and a better recovery compared to standard open surgery.
In some cases, patients with medium or larger breasts (Cup B-C) may not be eligible for small-incision surgery via the areola or the armpit. This is because certain areas of breast tissue, such as those along the side of the torso, cannot be reached or fully removed through small openings. Ultimately, a surgeon might need to enlarge the areolar incision or extend it laterally to remove fat and tissue from the sides, resulting in a longer scar.
However, this can be resolved by combining the Endoscopic Transaxillary technique with an areolar incision. This keeps the areolar scar very small since there is no need for an extended incision. This approach allows for chest contouring that is smooth, proportionate, and looks as natural as a masculine chest.
Why Choose Top Surgery at Rattinan Clinic
- AACI (American Accreditation Commission International) Standard: We are accredited as an Ambulatory Plastic Surgical Center, emphasizing outpatient safety equivalent to leading hospitals for 3 consecutive years with a 98% score.
- Anesthesia by Specialized Anesthesiologists: Every major surgical case is managed by a dedicated anesthesiologist on a 1:1 basis throughout the entire procedure.
- Chest Wall Contouring Technique: Our surgeons don’t just “remove”, they “design.” We use the art of sculpting and liposuction to ensure the chest takes on a natural, masculine shape.
What to Prepare Before Top Surgery
To ensure the surgery proceeds smoothly and safely according to international standards, patients should prepare as follows:
- Hormone Suspension (Testosterone)
- Those who have been on continuous testosterone therapy may have high hematocrit levels (blood concentration), which increases the risk of blood clots.
- Medical Advice: You should stop hormone therapy at least 2 weeks – 1 month before surgery and must undergo a Complete Blood Count (CBC) test to meet safety criteria.
- Medical Certificate (Psychiatrist Letter)
- A psychiatrist’s certificate is required to confirm a diagnosis of Gender Dysphoria, in accordance with Medical Council regulations and current laws. (Please re-verify the number of certificates required with staff, as hospital regulations are subject to updates.)
How Long Is Recovery After Top Surgery
The recovery period for top surgery varies depending on the specific technique used and each individual’s physical condition. Generally, surgeons recommend planning for at least 1–2 weeks of rest before returning to work (for office-based roles). Additionally, strenuous physical activity should be avoided for 1–2 months.
How to Care for Yourself After Top Surgery
Post-operative care accounts for up to 50% of the final aesthetic results. Here is a rough timeline you should know:
- Day 1-3 (Recovery Period): You may need surgical drains to reduce swelling and prevent hematoma. A chest compression garment must be worn at all times. Pain can be managed with medication.
- Day 5-7 (Drain Removal): The doctor will schedule a follow-up to remove the drains and sutures (in some cases). You can begin showering according to the doctor’s instructions.
- Week 2-4 (Resuming Daily Life): Swelling and bruising will gradually subside. You can return to work that does not require heavy lifting.
- Month 1-3 (Scar Care): This is the “Golden Period” for applying scar reduction gels to prevent keloids. Light exercise can be performed.
- Month 6 (Final Results): Chest muscles and skin will fully settle into shape. Scars will fade and look more natural.
How Much Does Top Surgery Cost?
If you are wondering about the cost of Top Surgery, the actual cost will depend on the surgical technique the doctor assesses as appropriate for your physical structure and original chest size; whether it is the small incision, O-incision, or double incision technique, as well as the complexity of each case.
At Rattinan Clinic, we prioritize safety according to AACI standards and price transparency with no hidden costs. You can check the price table and preliminary package details below.
Mastectomy Procedure | Starting Price (THB) |
Endoscopic Mastectomy | 330,000 |
Peri-areolar Mastectomy | 200,000 |
Double Incision Mastectomy (DI) | 280,000 |
Double Incision with Free Nipple Grafts (DI with FNG) | 330,000 |
Frequently Asked Questions about Top Surgery
During the procedure, the patient is under general anesthesia, so you will not feel any pain at all. After waking up, you may experience some tightness or a dull ache, similar to the soreness felt after an intense chest workout. This discomfort can be effectively managed with prescribed pain medication and typically improves significantly within 3–5 days.
No. Since the surgery removes almost all of the breast gland tissue, the chest cannot grow back or expand like female breasts again. However, if you experience significant weight gain, “fat” can still accumulate in the chest area, similar to how cisgender men may develop chest fat when gaining weight.
Actually, Top Surgery greatly reduces the risk of breast cancer because the majority of the breast tissue is removed. However, since a tiny amount of tissue is sometimes left to ensure a natural aesthetic contour, there remains a very small theoretical possibility of cancer. So, regular annual health check-ups are still recommended.
Our Expert Medical Contributors are licensed doctors and specialists who ensure every article is accurate, trustworthy, and easy to understand. Guided by our commitment to safety, care, and confidence, they provide expert insights to help patients make informed decisions. At Rattinan, we believe that knowledge is the first step to transformation.