DocQ: Top surgery with Dr Rhys Young

As we approach the top of 2023, let’s talk about top surgery.

It’s summertime, the sun’s out, and the beach is calling your name. For many transmasc or non-binary folk, this can be a big trigger for chest dysphoria.

While some people use tapes or binders to help manage their dysphoria, some people will choose gender-affirming top surgery.

In addition, some (not all) trans men or non-binary people presumed female at birth will decide to get top surgery.

What is top surgery?

Top surgery involves the creation of a more masculine-looking chest. The first step is to remove breast tissue with a double mastectomy.

The excess skin near the breasts is then removed, and the nipple and areola are re-positioned. This helps create a natural, flat chest.

Top surgery has different approaches, such as whether the nipples are preserved and where the scars will be located. This is influenced by your anatomy and your surgeon’s advice.

How can you prepare?

Preparing for surgery echoes trying to live a healthy life. Firstly, if you smoke, talk to your GP about how they can help you quit. Smoking impairs healing, and this is particularly important for healing nipples.

Other ways you can prepare are eating well, getting enough sleep & exercise, and keeping your immune system strong.

Your surgeon may encourage weight loss before surgery to ensure you get desired results. Remember, you’re not alone in this journey.

Talking to your GP, a dietitian, or an exercise physiologist can make your preparation much more manageable.

How do you get top surgery in Australia?

Firstly, get a referral from your GP to a surgeon who does top surgery.

During your consultation, the surgeon will examine your chest, looking for any lumps or abnormalities. Some measurements are taken, and then you will discuss your options.

A second appointment with the surgeon is required to go through the surgery consent, where you will go through the benefits & risks as well as follow-up care.

Finally, the surgeon will ask you to get a ‘readiness for surgery’ letter from a mental health professional.

What’s a ‘readiness for surgery’ letter?

Surgeons in Australia practice the World Professional Association of Transgender Health (WPATH) Standards of Care.

Your surgeon will ask for a referral from a mental health professional (usually a psychiatrist or clinical psychologist) to help fulfil the criteria in the WPATH Standards of Care.

This includes persistent gender dysphoria, capacity to consent for treatment, age of majority (i.e. over 18 in Australia), and that any medical or mental health concerns are reasonably well controlled.

That means there’s no prerequisite to be on hormone therapy before surgery.

What happens after?

Just like any other surgery, expect discomfort, swelling, bruising & numbness.

Your surgeon will give you a compression garment to wear for a few weeks afterwards to help with these symptoms while you recover.

Recovery can sometimes take up to eight weeks. Scarring will depend on the approach of the surgery. Your surgeon will instruct you to look after your scars as they heal.

If you want to start your top surgery journey, a great place to start is the Australian Professionals Association for Trans Health (AusPATH) for a list of doctors and surgeons involved in gender affirmation.

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Dr Rhys Young

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