Is top surgery the same as a double mastectomy? Not quite. While both surgeries involve removing breast tissue, they are done for different reasons, use different techniques, and result in different physical appearances.

In this guide, we’ll explain how each procedure works so you can feel confident discussing your needs with your healthcare team.

Who Gets Double Mastectomy or Top Surgery?

Top surgery is gender-affirming medical care. It can give transgender and nonbinary people a more masculine or feminine chest that better aligns with their gender identity. Studies show that many transgender people have better quality of life after top surgery.

Mastectomy is a surgical procedure used to treat and prevent breast cancer and other conditions. It’s available to all people regardless of gender identity.

Top Surgery Options

Individuals evaluating top surgery may be curious about chest masculinization surgery. This procedure may be an option for transgender or nonbinary people who want a more masculine chest. The surgeon removes breast tissue in a way that’s similar to a mastectomy, then shapes the chest to create a masculine contour.

Sometimes chest masculinization surgery is called a subcutaneous mastectomy or male chest contouring procedure.

The other type of top surgery is chest feminization surgery, a type of breast augmentation. It may be an option for transgender or nonbinary people who want a more feminine chest. The procedure involves placing breast implants or performing a fat transfer (removing fat from one area via liposuction and transferring it to the breasts).

For the rest of this guide, as we compare top surgery with mastectomy, top surgery will refer to chest masculinization surgery.

What Surgical Differences Can Be Expected?

Top surgery and mastectomy both remove breast tissue. The surgical techniques are slightly different and are performed by different surgeons.

Mastectomy

Mastectomy is performed by a cancer surgeon called a breast surgical oncologist. Whether a mastectomy is performed to treat or prevent cancer, the goal is often to remove as much breast tissue as possible, according to a person’s treatment plan.

In a partial mastectomy (also called a lumpectomy), a small amount of tissue is removed. In a total mastectomy, all breast tissue and skin is removed. Sometimes the lymph nodes under the armpit need to be removed, too.

In a standard mastectomy procedure, the extra skin is removed. Some mastectomy techniques leave the nipple and areola intact, while others remove them completely.

In a skin-sparing mastectomy, enough skin is left behind to make room for breast implants (inserted as part of immediate reconstruction or at a later time). Sometimes skin-sparing mastectomy scars can be hidden under the natural fold of the breast, but not always.

Top Surgery

A plastic surgeon performs top surgery to remove breast tissue and create a more masculine shape. Some breast tissue may remain after surgery, depending on the surgical technique and a person’s desired result.

Removing more breast tissue, as with a double mastectomy, can create a hollow or sunken appearance in the chest.

The nipples and areolas are sometimes completely removed during top surgery. Other times, they’re removed and grafted back onto the chest, which is called a free nipple graft.

Excess skin is also removed, and some providers offer liposuction to further shape the chest.

As with a mastectomy, top surgery results in large scars across the chest. The scars are often positioned just under the pectoral muscles, allowing them to be somewhat hidden.

Qualifying for Mastectomy vs. Top Surgery

Mastectomy is a common surgical treatment if you have breast cancer and your oncologist believes surgery will benefit you. In these cases, you’ll be scheduled for a mastectomy or premastectomy treatment as soon as possible to prevent the cancer from spreading.

Some people get a mastectomy to prevent cancer. These individuals typically have a family history of breast cancer or gene mutations known to increase breast cancer risk.

Top surgery is generally a planned procedure rather than an emergency surgery. For that reason, surgeons may take time to ensure a person’s condition is optimal to prevent complications during and after surgery.

For example, some surgeons ask people undergoing top surgery to quit smoking, eat more protein, start exercising (especially the pectoral muscles), or achieve a certain body mass index (BMI) before the surgery. Changes like these can help improve anesthesia safety and healing.

You may also be asked to enroll in therapy or provide documentation from a mental health provider. Requirements can vary based on your surgeon or insurance company. Talk to your provider about what’s expected.

Healing and Recovery

Mastectomy and top surgery follow similar healing patterns and timelines. Your care team will provide specific instructions, but here’s a quick overview of what you can expect.

Drain Tubes

Fluid tends to collect in the space where the breast tissue used to be. You may be fitted with tubes that drain this fluid into small containers.

Drain tubes require special care and can be uncomfortable. But they’re critical for preventing infection and tracking your healing. You may also be asked to wear a compression wrap around your chest to minimize swelling, bleeding, and fluid buildup.

Activity Restrictions

You won’t be allowed to lift, push, or pull anything heavier than 5 pounds until cleared by your doctor. Plus, you may not be allowed to lift your arms above your shoulders. That’s because this movement can tug on the drains and incisions.

Expect to sleep on your back for several weeks after surgery for the same reasons.

Scar Care

Certain products may help reduce the appearance of scars or make them less itchy. Your care team can provide recommendations. Avoid exposing the scars to sunlight for at least a year to make them less noticeable.

Can You Get Top Surgery and a Mastectomy?

Yes, it’s possible to get top surgery and then need a mastectomy later on. Some breast tissue is left behind during top surgery, and it’s possible that cancer could form in this tissue. If that happens, you might need a mastectomy.

Ask your healthcare team what breast or chest cancer screening is appropriate for you after surgery, especially if you have an increased risk of breast cancer. Your plastic surgeon may recommend getting a mammogram before top surgery based on your age or known breast cancer risk factors. If imaging reveals something suspicious, you may need additional testing or a shift in the surgical plan to address it.

Top Surgery After Mastectomy

Some people might wonder if the opposite is true: Can you get top surgery if you’ve already had a mastectomy? Possibly.

If you’ve already had a mastectomy but want your chest to have a more masculine appearance, a plastic surgeon may be able to help shape your chest. However, scar placement may affect your results.

If you need a mastectomy and haven’t had it yet, tell your oncologist that you plan to get chest or breast gender-affirming surgery. Once they know that’s your goal, they can make some strategic decisions about placing scars, preserving nipples and areolas, and adding implants or tissue expanders if desired. This gives the plastic surgeon more to work with when shaping your chest.

Note that reconstructive surgery can happen at the same time as a mastectomy (known as immediate reconstruction). Or, it may happen as a separate surgery several months down the road (known as delayed reconstruction).

Find out if your cancer care team includes a plastic surgeon experienced in masculine chest reconstruction. This may affect whether you’re able to have an immediate reconstruction.