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Top surgery is gender-affirming chest surgery. Here you will find an overview of the techniques, who they are for and what to know before making a decision.
What is top surgery?
Top surgery is gender-affirming chest surgery. For trans men and transmasculine or non-binary people it means chest masculinization (FTM top surgery): breast tissue and, if needed, excess skin are removed and the nipples are resized and repositioned. For trans women it usually means breast augmentation. The technique is always chosen together with your surgeon.
In more detail, "top surgery" refers to chest procedures that help a person have a body that better reflects their gender identity. For transmasculine people it means chest masculinization (often called FTM top surgery or subcutaneous mastectomy): breast tissue and, where necessary, excess skin are removed, and the nipple-areola complex is resized and repositioned to create a flatter, more masculine contour.
For trans women, top surgery usually means breast augmentation with implants or, in some cases, combined techniques.
Who is it for?
- Trans men and transmasculine people who want a flat, masculine-looking chest.
- Non-binary people who want a flat chest or a reduction, sometimes with goals that differ from the "standard" result (for example no nipples or a more neutral contour).
- Trans women who want fuller breasts, usually after a period of feminizing hormone therapy.
All procedures are for adults only. Under the WPATH Standards of Care (SOC8), the key points are the capacity to give informed consent, marked and sustained gender incongruence, and other health conditions being reasonably well controlled. Hormone therapy is not a prerequisite for chest masculinization. Read more in our guide to top surgery requirements.
Techniques compared
| Technique | Incisions | Typically suited to |
|---|---|---|
| Double incision | two horizontal incisions below the pecs, free nipple grafts | medium to large chests, less elastic skin |
| Periareolar | circular incision around the areola | small to medium chests with good skin elasticity |
| Keyhole | small incision along the lower edge of the areola | very small chests with very elastic skin |
| Buttonhole / inverted T | horizontal incisions, nipple kept on a pedicle | people who want to preserve more nipple sensation, if anatomy allows |
| Non-binary top surgery | varies with the goal | flat chest without nipples, reduction, neutral contours |
| Breast augmentation for trans women | breast fold, areola or armpit | trans women who want fuller breasts |
| Revision | depends on the issue | scars, residual tissue or asymmetry after a first surgery |
The technique is always chosen together with the surgeon, based on chest size, skin elasticity, nipple position and personal goals. To get oriented before your consultation, read choosing a technique.
Where to have top surgery: destinations
Top surgery is available in many countries, with big differences in waiting times, cost, logistics and language. In Italy there are both public routes and private clinics – see our overview of top surgery in Italy. If you are looking further afield, read about top surgery in Thailand. To compare all countries side by side, explore our top surgery destinations in Europe and worldwide.
Why some people choose Istanbul
Istanbul has become a popular destination for plastic surgery. Many people choose it for short waiting times, prices that are often lower than private clinics in Western Europe and easy access via direct flights. As a rough guide, chest masculinization packages in Turkey often range from about 3,500 to 6,500 EUR, but the price depends on technique, surgeon and what is included – a written quote is always needed. See top surgery in Turkey and top surgery cost for details.
Important to know
- Like any surgery, top surgery carries risks: hematoma, seroma, infection, partial or complete nipple graft loss, changes in sensation, contour irregularities, raised scars and the possible need for a revision.
- Stopping smoking and nicotine for several weeks before and after surgery lowers the risk of wound-healing problems.
- The final result takes many months: swelling and scars keep improving for about a year. Read our guide to top surgery recovery.
- Realistic expectations and good communication with your surgeon are the foundation of a satisfying result.
For every step, from preparation to scar care, see our complete top surgery guide. If you would like an opinion on your own situation, request a free top surgery consultation – no obligation.
Sources and further reading
- Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 – WPATH – International Journal of Transgender Health (2022)
- Masculinizing surgery – Mayo Clinic
- Schedule Gender-Affirming Surgery (Mastectomy – requirements) – Cleveland Clinic
- Top Surgery (Chest Feminization or Chest Masculinization) – Johns Hopkins Medicine
- Feminizing surgery – Mayo Clinic
Last checked: 10/2026
Frequently asked questions
For medium to large chests the most common technique is double incision with free nipple grafts. For small chests with elastic skin, periareolar or keyhole may be options. The final choice is made by the surgeon after an examination.
No. Under the WPATH SOC8 standards, hormone therapy is not a prerequisite for chest masculinization. For breast augmentation in trans women, a period of feminizing hormone therapy, often around 12 months, is generally suggested.
Yes. There are approaches designed for non-binary goals, such as a flat chest without nipples or a reduction. Learn more on our non-binary top surgery page.
As a rough guide, chest masculinization packages in Turkey often range from about 3,500 to 6,500 EUR. The price depends on technique, surgeon and what is included; only the written quote is binding. See our top surgery cost guide.
The chest looks flat right after surgery, but swelling and scars keep changing for about 12 months or longer. Only then is the final result assessed, along with whether a revision might be useful.
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