About Top Surgery

Two types of top surgery

At Stanford Medicine Children’s Health, we offer reconstructive chest surgery to adolescents and young adults from board-certified plastic and reconstructive surgeons with advanced training and exceptional approaches to top surgery. We remove breast tissue and excess skin to create a masculine-looking chest. Top surgery is more than simply removing tissue. It includes careful contouring of muscle and nipple to create a pleasing, natural-looking chest. We offer two types of top surgery, determined by a teen’s unique shape. These include:

• Peri-areola approach. This plastic surgery is performed through a single incision, leaving a small scar that often remains camouflaged and barely visible. A half-moon cut is made around the bottom half of each areola—the pigmented skin that surrounds the nipple. With this surgery, often completed on youth with smaller breasts, the skin and nipple shrink naturally in place. Healing is generally one to three weeks, but every individual patient is different.
• Double incision. This is the most common type of top surgery; an incision is made along the border of the pectoral muscles that sit below the breasts. The cut is made in the shadow of the muscle to hide scars. Double incision surgeries are usually performed on teens with larger breasts, because the larger incision allows for ample breast tissue to be removed and for the trimming of excess skin to ensure a more masculine look. Healing typically takes six to eight weeks, but recovery can be different for every patient.
• Nipple surgery. Nipple surgery is included in top surgery. This is where our highly skilled, creative surgeons make a significant difference. By taking the innovative approach of leaving the nipple attached to the lower part of the breast skin, our surgeon preserves the nipple and its natural appearance. Just as important, this technique—offered by only a handful of centers in the nation—maintains blood flow, which means that teens are left with full to nearly full sensation for a more authentic experience. When breasts are exceptionally large, a nipple graft may be necessary to resize or reshape the nipples to make them smaller and oval for a pleasing masculine look. When grafting, nipples are gently removed and then positioned anatomically on the chest, where they reestablish blood supply and heal, typically in four to six weeks, but every patient’s recovery is different. If enhancement is needed down the road, our skilled 3-D tattoo artist can subtly improve results.