Nonbinary top surgery: options, risks, costs, and how to choose

If you're exploring nonbinary top surgery, take a breathyou're in the right place. Here's the short version: you can tailor chest masculinization, reduction, or enhancement to match how you want your chest to looknipples, scars, contour, and all. Your goals don't have to fit a binary mold, and your care shouldn't either. Below is a clear, honest guide to options, candid risks and recovery, costs and insurance, and how to pick a surgeon who truly listens.

What it is

Nonbinary top surgery is a form of gender affirming surgery that shapes your chest to align with how you see yourself. Some people want a very flat chest. Others want a subtle reduction or a neutral, androgynous look. Some want enhancement for fuller contours. The point is choiceyour chest, your rules.

How is this different from "FTM/MTF" labels? Those labels can feel limiting, as if there are only two endpoints. Nonbinary top surgery focuses on flexibility: incision choices, areola size, nipple position or removal, degree of flatness or fullness, and even scar style. Instead of fitting into a box, you and your surgeon design the chest that matches your unique goals.

Who is it for? Anyone seeking relief from gender dysphoria, a boost in gender euphoria, or alignment between body and identity. You don't need specific pronouns or to be on hormones to qualifythough policies vary by clinic and insurance. Many surgeons use an informed consent model, and professional guidance like WPATH SOC8 supports individualized care (see guidance quoted by organizations such as the World Professional Association for Transgender Health and affirming clinics; for example, the Gender Confirmation Center explains flexible pathways for letters and hormones in plain language, according to their overview).

Benefits can be powerful: relief from dysphoria, comfort in clothes, confidence at the beach or gym, and a closer relationship with your body. Limits are real too: scars are permanent, sensation can change, and revisions sometimes happen. The goal is informed choicenot perfection, but alignment.

Top options

There isn't one "right" way to do nonbinary top surgery. There are techniques, each with pros, cons, and aesthetic trade-offs. Here's a quick, friendly primer so you can start getting a feel for what might fit you.

Chest masculinization

This is breast removal with contouring. Different techniques fit different chest sizes, skin elasticity, and goals. Surgeons at major centers outline the following common options (you'll see slightly different naming between clinics and academic sites such as Johns Hopkins' gender-affirming program):

Keyhole (very small incision at the areola edge) and Periareolar (incision around the areola): These are great when you have a smaller chest and good skin elasticity. Scars can be minimal and close to the areola. Trade-off: less control over contour and areola placement; higher chance of needing a minor revision if extra skin remains.

Double incision (horizontal or slightly curved incisions across the lower chest) with or without free nipple grafts: Often used for larger chests or reduced skin elasticity. Pros: excellent control of chest shape and nipple position. Cons: longer scars and a higher chance of sensation changes, especially with free nipple grafts.

Fishmouth, lollipop, or buttonhole: These are variations in incision and nipple handling meant to balance scar placement with shape control. A "buttonhole" (or pedicle-preserving) approach aims to keep the nipple attached to its blood and nerve supply, which may help preserve some sensation; candidacy depends on anatomy and surgeon expertise.

Nipple choices: Keep your nipples as-is, resize, relocate, graft them in a new position, or choose a no-nipple outcome for a sleek, scar-only look. Areola sizes vary widely; surgeons can aim for traditionally "male" areola diameters (often 2230 mm) or a custom size to suit a more neutral aesthetic.

Breast reduction

If you want flatter-but-not-flat, a reduction can remove significant tissue while keeping a gentle contour. Some call it a "radical reduction" when the goal is an androgynous chest without going fully flat. Surgeons can shape the chest and adjust nipple size/height for a neutral look rather than a traditionally feminine or masculine one. It's a great middle path if your nonbinary transition isn't about eliminating all fullness.

Chest enhancement

Yes, nonbinary top surgery can also mean adding volume. Some people want an androgynous or softly feminine contour that feels right for them. Options include implants (saline or silicone) or fat grafting (moving fat from one area to the chest). Fat grafting can be subtle and natural-looking but may take multiple sessions. Implants offer predictable volume and shape. Think of this as sculpting rather than "going one way or the other."

Scar aesthetics

Scars tell a storyand you get a say in the script. Incisions can be straight, gently curved, diagonal, "fishmouth," or around the areola for minimal visibility. Lower, straighter scars can hide under many tops; curved scars can follow the natural pec line for a sculpted vibe. Areolar-only incisions are subtle but not always feasible. The trade-off is visibility versus control: the more freedom a surgeon has to remove skin and shape, the more likely longer scars are needed.

Sensation and nerves

Let's talk feelingliterally. Some techniques can preserve more sensation, especially when the nipple remains attached to a tissue pedicle. With free nipple grafts, sensation often decreases; some tactile sensation can return over time, but erotic sensation is less predictable. A few surgeons offer nerve grafting (neurotization) to try to improve outcomes, but expectations should be grounded: it can help, not guarantee. Nerves heal slowlythink months to a year or more. It's okay to ask your surgeon exactly what they do to protect sensation and what their real-world outcomes look like.

Make it yours

Nonbinary chest aesthetics aren't a single look; they're a spectrum. Imagine a mixing board:

• Flatness vs. gentle fullness
• Areola size and position
• Nipple presence vs. no-nipple sleekness
• Incision location and length
• Muscle contour emphasis (subtle vs. sculpted)

You can nudge each slider until your chest feels like "you." One client I spoke with wanted a small, high areola and soft fullness because they loved a dancer's silhouette. Another chose double incision with no nipples for a minimalist, clean look. Both felt deeply rightand that's the point.

Plan visually

Bring photo examples to consultsscreenshots, mirror selfies, even binder photos. Some surgeons have sizers for augmentation or can simulate areola positions. Ask to see nonbinary top surgery results in their portfolio, not just "male chest" photos. You deserve to see outcomes that match your aesthetic language.

Eligibility basics

Do you need hormones first? Usually not. Many clinics do not require HRT before chest masculinization or reduction. For augmentation, hormones aren't strictly required either, but your surgeon may discuss how HRT can influence skin and tissue quality. Policies vary by clinic and insurer. Current standards like WPATH SOC8 emphasize individualized care and informed consent, and large centers echo that approach in their patient materials.

Letters and documentation

Self-pay often uses informed consent. Insurance may require one or more mental health letters documenting persistent gender dysphoria and your capacity for informed decision-making. It's not about "proving" your identityit's a bureaucratic checkbox to unlock coverage. If this part feels stressful, you're not alone. Many clinics guide patients through it step-by-step and offer templates.

Risks and trade-offs

Let's be candid, because you deserve the full picture. Common surgical risks include bleeding, infection, seroma (fluid build-up), asymmetry, "dog ears" at the ends of incisions, scarring, changes in sensation, and possible need for a revision. That sounds like a lot, but remember: a skilled surgeon, good pre-op health, and diligent aftercare lower the odds. Academic programs like Johns Hopkins outline these risks clearly, and affirming clinics like the Gender Confirmation Center discuss technique-specific pros and cons in detail.

Technique trade-offs

Double incision with free nipple grafts offers strong control over chest shape and nipple placement but carries more visible scars and a higher chance of decreased sensation. Periareolar or keyhole minimizes scarring but can offer less skin removal and contour control; some people need minor revisions to fine-tune shape. Pedicle techniques aim to preserve blood flow and nerves to the nipple, which may help sensation, but they're not always possible depending on chest size and skin laxity.

Lowering risk

• Choose a surgeon with substantial experience in nonbinary top surgery and ask about complication and revision rates.
• Pause nicotine at least several weeks before and after surgery; it affects healing.
• Health optimization helps: manage conditions, stabilize weight if you plan changes, and align medication timing with your surgeon's advice.
• Follow aftercare to the letter: compression, drain care if used, incision hygiene, and activity limits.

Recovery guide

Recovery is a season, not an afternoon. Most people feel groggy and sore the first few days, then steadily better. Expect a compression garment and possibly drains for a short period, depending on technique and surgeon preference.

Week-by-week snapshot

• Week 1: Rest, short walks, compression on, drains if used. Arms low; reach is limited. Pain is manageable with meds; many people describe tightness more than sharp pain.
• Week 2: Drains (if placed) often out. Swelling persists. Light daily tasks are okay. Many return to desk work around now, if comfortable.
• Weeks 34: Range of motion improves; gentle arm movements approved. Still avoid heavy lifting, stretching your arms high, or intense cardio.
• Weeks 68: Many resume exercise with surgeon clearance; high-impact or chest-focused training reintroduces slowly.
• Months 36: Swelling fades, shape refines. Scars are still pink but softening.
• Months 618: Final results settle. Scars mature from pink to paler/hyperpigmented lines depending on your skin.

Scar care and sensation

Once your incisions are fully closed (get the green light from your surgeon), silicone sheets or gel, gentle taping, and consistent sun protection can help scars mature more smoothly. Some folks explore microneedling or medical tattooing later to blend color or create artistic areola designs. Sensation often returns in patches and wavestingles, itchiness, zaps. That's nerves regenerating. It can take a year or longer; patience truly matters here.

Everyday life questions

• Sleeping: Back sleeping at first with pillows for support. Side sleeping usually returns within a few weeks.
• Showering: Typically allowed after a couple of days once dressings are changedfollow your surgeon's instructions.
• Clothing: Loose button-ups are your best friends. Compression garments stay on as directed.
• Binding: You can usually retire your binder post-op, but confirm your timeline; early compression is surgical-grade, not a binder.
• Chestfeeding: If future chestfeeding matters, discuss it before surgery. Tissue removal and nipple techniques can affect milk production and latch.

Costs and access

Let's talk moneybecause it's part of real planning. Self-pay prices vary by region and surgeon. As a ballpark, many sources list chest masculinization in the $6,000$12,000+ range and augmentation in similar or slightly higher ranges depending on implants vs. fat grafting. These figures often include surgeon fees, facility, and anesthesia, but always ask for a detailed breakdown and whether revisions are included or discounted within a certain window. According to patient-facing roundups and clinic estimates, costs can span wider for complex cases or combined procedures.

Insurance coverage

Coverage is more common today, but requirements can be fussy. Expect preauthorization, letters, and possibly photos. If you're denied, appealsuccess rates improve with a clear letter, citations to standards of care, and persistence. Medicare covers medically necessary gender affirming surgery on a case-by-case basis. If your ideal surgeon is out-of-network, ask about single-case agreements or out-of-network benefits. Keep copies of everything.

Size-inclusive, affirming care

If you've run into strict BMI cutoffs, know this: policies vary widely. Some surgeons operate safely across a broad range of bodies and tailor anesthesia and aftercare to you. Ask specifically about experience with larger bodies, drain use, VTE prevention, and scar management. Your body deserves respectful, evidence-based carefull stop.

Choose your surgeon

Picking a surgeon is part research project, part vibes check. You're not just buying a procedureyou're choosing a partner in your care.

What to vet

• Board certification in plastic surgery or a relevant surgical specialty.
• High case volume in nonbinary top surgery, not just "FTM" cases.
• Before-and-after photos that match your aesthetic goals (flat, reduced, enhanced, with/without nipples).
• Transparent complication and revision rates.
• Clear aftercare plan and access for questions.

Questions to ask

• Which techniques fit my chest and goals best, and why?
• Where will the incisions and scars be, exactly?
• What are the options for nipple size, position, or removal?
• What's your approach to preserving or restoring sensation? Do you offer neurotization?
• What complications do you see most, and how do you handle revisions?
• How do you support patients with larger bodies or medical conditions?

Green flags and red flags

Green flags: they listen without pushing you into a binary look, mirror your language and pronouns, explain trade-offs clearly, and make risks understandable. Red flags: dismissing your goals, refusing to show nonbinary results, glossing over sensation risks, or pressuring you to conform to a template chest. Trust your gutcomfort matters.

Real stories

Here are three quick snapshots that might spark ideas:

• Example A: A radical reduction with slightly higher, smaller areolas for a neutral silhouetteperfect under a tee, still soft without a binder.
• Example B: Double incision with no nipples for a minimalist look; scars placed low and gently curved along the chest for a clean line.
• Example C: Augmentation with modest implants to create balanced, androgynous fullness; the patient wanted to feel empowered in fitted tops and on stage.

What surprised people in recovery? Energy dips around week two, sudden surges of emotion (grief, joy, reliefsometimes all in one day), and the odd "spark" feeling as nerves wake up. What helped: a comfy post-op nest, scheduled walks, a buddy to help with meals and medication, and a small journal to track progress and feelings.

Final thoughts

Nonbinary top surgery is customizable: flat, reduced, or fuller; with or without nipples; subtle or sculpted. The key is balancing the look you want with the realities of scars, sensation changes, costs, and recovery. Take time to compare techniques, review a surgeon's nonbinary results, and ask direct questions about risks, aftercare, and revisions. If you're ready, start a notes list of your must-haves and nice-to-haves, gather photo examples, and book a few consultations. Your chest should feel like you. You deserve care that listens and adapts to younot the other way around. What would make you smile when you look in the mirror? Hold on to that vision; it's your north star.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.