Top surgery requirements: what you really need

Top surgery requirements according to the WPATH Standards of Care (SOC8)

What are the top surgery requirements? According to WPATH SOC8 you need to be an adult, have marked and sustained gender incongruence, be able to give informed consent, and have any other significant health conditions reasonably well controlled. Hormone therapy is not required, although some clinics ask for a letter from a health professional.

The Standards of Care, Version 8 (SOC8), published by the World Professional Association for Transgender Health in 2022, are the most widely used international reference for gender-affirming care. For adults seeking chest surgery, the recommendations can be summarised as follows:

• Marked and sustained gender incongruence, assessed by an experienced health professional.
• Decision-making capacity and the ability to give informed consent for the specific procedure.
• Age of majority in the country where treatment takes place.
• Other significant physical or mental health conditions reasonably well controlled.

A frequently misunderstood point: hormone therapy is not a requirement for masculinizing chest surgery. Many trans men, transmasculine and non-binary people have top surgery without taking testosterone, or before starting it. For breast augmentation in trans women, SOC8 does suggest a period of feminizing hormones (often around 12 months) beforehand – as a recommendation, not an absolute rule.

Age: why we only work with adults

TopSurgery.it and our partner clinics in Turkey treat only people aged 18 and over. This is a clear criterion, consistent with the legal framework and the recommendations for surgery in adults.

Informed consent: more than a signature

Informed consent is a process. Before surgery, the surgeon should explain the proposed technique, the alternatives, the risks (haematoma, seroma, infection, nipple graft loss, changes in sensation, contour irregularities, scarring, need for revision), the recovery and the limits of the result. You have the right to ask questions, take your time and receive the document in a language you understand – which is why our partner clinics provide interpreting in Italian, English and German. To arrive well prepared, you can read our overview of all top surgery procedures and our guide to top surgery techniques beforehand.

Health checks before surgery

Top surgery is performed under general anaesthesia, so a pre-operative assessment is needed. It usually includes:

• Blood tests: full blood count, clotting, blood sugar, kidney and liver function, sometimes infection screening.
• ECG and possibly a cardiology check, especially above a certain age or with risk factors.
• Anaesthetic assessment, covering medications, allergies and previous operations.
• Weight and BMI: a higher BMI does not automatically rule out surgery, but it can increase the risk of complications and influence the technique. Many surgeons use indicative limits that are discussed case by case.
• Smoking and nicotine: cigarettes, vapes and other nicotine products reduce blood flow to the tissues and increase the risk of healing problems and graft loss. You will usually be asked to stop several weeks before and after surgery.

Clinics may ask you to do some tests at home before travelling; others are repeated on site. How to organise tests, medication and quitting nicotine in the weeks beforehand is covered in our guide to preparing for top surgery.

Breast cancer risk assessment

SOC8 recommends assessing breast cancer risk before chest surgery. This means reviewing your family history (for example breast or ovarian cancer, known BRCA mutations) and, depending on age and risk factors, completing the recommended screening, such as an ultrasound or mammogram. A subcutaneous mastectomy always leaves a small amount of tissue behind, so it is worth discussing follow-up with your doctor after surgery as well.

Letters some clinics ask for

SOC8 does not require a fixed number of letters for adults. Some surgeons or clinics, however, ask for a report from a mental health professional or physician confirming the diagnosis of gender incongruence and capacity to consent. Public healthcare and insurance routes often have additional requirements – see our overview of public and insurance routes and check directly with the relevant service.

Practical requirements if you have surgery abroad

If you choose to have top surgery in another country, for example top surgery in Turkey, a few organisational points come on top of the medical requirements:

• A valid travel document and, where needed, a check of the entry rules for your nationality.
• Time: usually around 7–10 days on site, plus a few weeks of recovery at home.
• Fitness to travel: if you have conditions that increase the risk of thrombosis or problems during a flight, talk to your doctor beforehand.
• A point of contact at home: it helps to have a GP or clinic who can see you if needed after you return, in addition to the clinic's remote follow-up.
• A clear written quote stating what is included (tests, nights in hospital, hotel, transfers, compression vest, check-ups) and the conditions that apply if a revision is needed.

These points are not obstacles – they help turn an idea into a safe plan. To compare countries, waiting times and included services, see our top surgery destinations in Europe and worldwide and our guide to top surgery cost.

What to prepare for the consultation

• Chest photos from the front and side, in good light and without a binder.
• A list of medications, supplements and hormone therapy (if any), with doses.
• Known conditions, allergies, previous surgery, any bleeding disorders.
• Family history of breast or ovarian cancer.
• Smoking or nicotine use.
• Your priorities: flatness, scars, sensation, recovery time.

With this information your free top surgery consultation becomes much more useful and the surgeon can give you a realistic first opinion on the top surgery requirements in your case. More topics, from recovery to scars, are collected in our complete top surgery guide.