Top surgery (chest masculinisation) in Thessaloniki and Athens, Greece

Top surgery is a gender-affirming operation that turns the breasts into a male chest. I remove the breast tissue and excess skin, use liposuction for a smooth contour, and make the nipple smaller and move it further to the side. In medical terms it is a subcutaneous mastectomy with chest contouring.

It is the most common gender-affirming operation for trans men and non-binary people. Many have worn a chest binder for years, which can cause skin irritation, shortness of breath and back pain.

The technique is similar to a breast reduction, with one essential difference: the aim is not a smaller breast but the complete removal of the breast tissue and the excess skin. If you have been on testosterone, the breast has usually shrunk and dropped, so the skin is always tightened as well.

A male chest is not simply a breast with the tissue taken out. The nipple and areola are smaller, often oval, and sit further to the side, and the chest has a gentle contour along the lower edge of the pectoral muscle. I plan the incisions and the new nipple position to these proportions. For breast enlargement in cisgender men, see the gynaecomastia (gynecomastia) page.

Top surgery suits adult trans men and non-binary people with marked, persistent gender incongruence who want a flat chest. I follow the WPATH Standards of Care, Version 8 (SOC8): you need an assessment by a qualified health professional experienced in gender identity. Testosterone or other hormone therapy is not a requirement.

Who is top surgery for?

• Trans men, with or without testosterone.
• Non-binary people who want a flat or less feminine chest.
• People who wear a binder and have problems with their skin, breathing or back.
• Adults in good general health, at a stable weight.
• People who have one assessment from a qualified health professional experienced in gender identity, in line with WPATH SOC8.

When is top surgery not advised?

• Under 18: I perform gender-affirming surgery on adults only.
• When serious health problems are not under control.
• When your weight has not settled, or you are planning major weight loss.
• When there is a suspicious finding in the breast, until imaging has been completed.
• If you smoke and cannot stop, when the technique needs a nipple graft.

Preparation starts with a consultation, where we agree on the result you want and the technique that will achieve it, followed by pre-operative tests. You will need your health professional’s assessment, blood tests, a fitness check for general anaesthesia and breast imaging. You stop smoking at least 4 weeks before and after surgery.

What happens at the consultation?

We start with the result you want: a completely flat chest or a softer contour, and how you would like me to address you. I examine the size of the chest, how much it has dropped, the elasticity and quality of the skin, the size and position of the nipple, and symmetry, because the technique depends on them. I explain where the scars will be, whether the nipple will keep its blood supply or be grafted, and what recovery will involve. If you are on hormone therapy, I liaise with your endocrinologist. You receive a written plan and quote.

Which tests are needed before top surgery?

You need the assessment from the qualified health professional who follows your care. Then come pre-operative blood tests, a check for general anaesthesia, and a breast ultrasound or mammogram depending on your age and history. Testosterone is usually not stopped; the decision is made with your endocrinologist. Smoking raises the risk of complications and of losing the nipple, so stop at least 4 weeks before and 4 weeks after surgery. If you take anticoagulants or antiplatelet medicines, tell me; they are only stopped in agreement with the doctor who prescribes them. The date of surgery is set once all the checks are complete.

Top surgery is done under general anaesthesia and takes about 2 to 3 hours. The technique depends on the size of the chest and the elasticity of the skin: a periareolar (keyhole) incision for a small chest, the nipple kept on a pedicle for a medium chest, and a double incision with nipple grafts for a large one.

I remove the breast tissue completely but leave a thin layer of fat, so the contour is smooth with no hollows. I use liposuction to refine the sides of the chest. When the nipple is moved, I place it further to the side, as on a male chest, and make it smaller.

Keyhole (periareolar) incision for a small chest

When the chest is small, the skin is elastic and there is no sagging, I remove the tissue through a small incision along the lower edge of the areola (keyhole) or around it. The scars are as small as possible and the nipple stays where it is, with its blood supply. It does not suit a chest with excess skin, because the skin will not shrink back and folds remain.

Double incision mastectomy with the nipple on a pedicle

For a large chest or marked sagging, I prefer a double incision mastectomy: one horizontal incision on each side, along the lower edge of the pectoral muscle, through which the breast tissue and most of the skin are removed. The nipple is moved to its new position on a thin pedicle of tissue, which keeps its blood supply and some of its sensation, and is made smaller to suit a male chest. The scar is long, but it follows the line of the muscle. I rarely use a free nipple graft, because the nipple loses its sensation and may lose colour.

Liposuction

Liposuction is part of every technique. It removes fat from the sides of the chest and the armpit, so the chest blends smoothly into the torso. See the liposuction page for more on the technique.

Incisions and stitches

The scars depend on the technique: around the areola with a keyhole incision, around the areola and downwards when the nipple is kept on a pedicle, and one horizontal scar on each side with a double incision. I place them along the lower edge of the pectoral muscle and do not extend them towards the breastbone or the armpit without need. The stitches are dissolvable and the dressing comes off after about a week.

Combining top surgery with other procedures

I often combine top surgery with liposuction of other areas of the torso. Facial or genital surgery is usually done at a separate time.

Hospital stay

Top surgery is done without an overnight stay. You leave with someone to accompany you, wearing the compression vest. You must not drive after a general anaesthetic.

The first few days bring tightness and mild pain, which painkillers control. Drains and the dressing come off at around day 7. Most people return to desk work in 1 to 2 weeks and to exercise after 6 weeks. You wear a compression vest for 4 to 6 weeks, and the final contour settles over 6 to 12 months.

Plan to stay in Greece for 7 to 10 days after top surgery. Your drains and dressing come off at the practice at around day 7, and the stitches dissolve on their own, so there is nothing to remove later. You are usually ready to fly after the day-7 check, once the drains are out.

Hospital stay: none; you return to your accommodation the same day. For the first days you will need someone with you, as you must not drive after a general anaesthetic and should avoid lifting your arms high.

Once you are home, follow-up is by video call at 10 days, 1 month, 6 months and 1 year. At the 1-month video call we decide when you can return to chest training.

What to arrange at home:

• Time off work: 1 to 2 weeks for desk work, longer for physical jobs.
• Help with daily tasks for the first days, since raising your arms will be uncomfortable.
• Your compression vest, worn day and night, for 4 to 6 weeks.
• No weights, chest exercises or swimming until you are cleared.
• Sun protection for your scars over the first year.
• Your written plan, to share with your own doctor.

The chest is flat straight after surgery, and the final contour develops over 6 to 12 months as swelling settles and the scars mature. The breast tissue that is removed does not grow back, although a small amount of remaining tissue or a large change in weight can affect the contour.

Studies show high satisfaction and better quality of life after top surgery. Some patients need a minor revision, such as removing excess skin at the ends of the incision or extra liposuction, particularly after a keyhole incision on a chest that was only borderline suitable, or after a double incision on a very large chest. Top surgery does not affect hormone therapy. Because a small amount of breast tissue may remain, discuss future breast screening with your doctor.

Top surgery carries risks linked to general anaesthesia and to the technique itself. Most are uncommon and can be treated. The most typical are a haematoma (hematoma), partial loss of a nipple graft, and excess skin at the ends of the incision. I explain the risks that apply to you at your consultation.

Smoking. Stop at least 4 weeks before and 4 weeks after surgery. Smoking increases healing problems and the risk of losing the nipple, especially when the nipple is grafted.

Blood thinners. Tell me if you take anticoagulants or antiplatelet medicines. They are always stopped in agreement with the doctor who prescribes them.

We do not publish prices. The cost of top surgery varies from person to person, depending on the size of the chest, the technique, how much liposuction is needed and the hospital stay. You receive a quote after your consultation, once I have examined you and we have agreed on the plan that suits you.

• The size of the chest and how much skin is removed.
• The technique: keyhole incision, nipple kept on a pedicle, or double incision with nipple grafts.
• How much liposuction is needed, for example towards the armpits or the torso.
• The length of the hospital stay.
• Combining top surgery with another procedure.