Dr Lisa Friederich
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Top Surgery

Top surgery is gender-affirming chest surgery. For Transmen  and Non-Binary people this is most often a Mastectomy to remove existing breast tissue and redundant skin to create a flatter, masculine chest. This may be performed with or without preservation of the nipple-areolar complex. 

For some, the goal is not a flat chest but a significant reduction, sometimes called Non-Flat Top Surgery. 

Transwomen will generally require augmentation of volume with breast implants and/or fat grafting. Information about Breast Augmentation is contained within the Breast Surgery page.

The right approach is decided together at consultation. 

Like any surgery, it carries risks and a recovery period, and outcomes differ from person to person.

Top surgery is provided to candidates using the Informed Consent Model. 

Patients under the age of 18 will need psychiatric and parental support before proceeding to surgery.  This page is general information only and is not a substitute for medical advice. Results vary between individuals and no specific outcome is promised.

Within this area

Approaches to Top Surgery

There are a several different techniques to perform surgery, but the most common is the double incision mastectomy. The chosen technique will depend on assessment of the amount of skin – both Body and Breast– that needs to be resected, as well as Skin Quality.

Main approaches are outlined below in general terms; which is appropriate for you — including the result you want — is decided together at consultation.

01
Double incision with nipple grafts

Often suited to larger or fuller chests. Breast tissue and excess skin are removed through horizontal incisions, and the nipple-areola is resized and repositioned as a graft. It produces a flatter contour, with chest scars that settle over time but remain permanent.

02
Periareolar / keyhole (nipple-preserving)

May suit smaller chests with good skin elasticity. Tissue is removed through incisions around or below the areola while the nipple stays attached, leaving more limited scarring. Not everyone is a candidate, so suitability is assessed individually.

03
Chest reduction (non-flat top surgery)

For people who want a smaller, lighter chest rather than a flat one, a reduction can reshape the chest while preserving the nipples on their own blood supply. The approach and the likely result are planned with you.

Important to understand

Risks, recovery and expectations

01
All surgery carries risk

General risks of surgery and anaesthesia, as well as risks specific to the procedure being considered, are explained in detail and in writing before any decision is made.

02
Recovery takes time

Top surgery involves a recovery period that differs between individuals. You receive guidance on what to expect, activity restrictions and aftercare, with follow-up appointments to support healing.

03
Scarring is part of surgery

Top surgery involves incisions and permanent chest scars, and can change the position and sensation of the nipples. The likely extent and position of scarring is discussed in detail beforehand.

04
Results vary

Outcomes depend on individual factors and no specific result can be promised. In some cases, further or revision procedures may be needed. These possibilities are discussed openly.

Consultation

Considering top surgery?

The starting point is an individual consultation, where your goals, suitability, the available approaches, risks and recovery are discussed in full. Any assessment or referrals that may be needed are talked through with you. There is no obligation to proceed.

Request a consultation

Suite 2, 37 Bay Street, Glebe NSW 2037 · Sydney
1300 375 472  ·  info@drlisa.com.au