Considering Top Surgery (Soliciting Advice)

Now that it’s summer and I’m nearly a year into my physical transition, I’m starting to think about whether or not I want to get top surgery. Let’s be clear here: for me, top surgery would be an elective rather than a necessary procedure. I totally understand that for most trans guys it is not an elective procedure, and if I had anything resembling full-grown breasts on my chest, I’m sure that it would be necessary for me as well, but I have the extreme fortune of having very little up top. My extra fat mounds don’t get in the way, don’t bounce when I run, and just look like nice pecs when lightly bound (which is every day). With muscle growth from T, I think that my chest looks pretty male to me even when it’s bare. Of course, I know it may not look that way to every one. With the exception of swimwear and sex, I would never allow myself to be seen by anyone without a binder on. The very thought fills me with horror. But with a binder on, I feel just fine. And, when I can see that my lovers see me as male and are not fixated on my chest, I feel fine as well, and am even comfortable having my nipples played with and chest slapped. (Again, it’s easy to tell the difference between gay male chest play and the kind of squeezing, caressing play that people tend to use with female breasts). For swimwear, I just wear a mesh tank top with a solid bar across the chest and my swim trunks. The top shows off my shoulder muscles and, more importantly, allows breeze, water, and sunlight to caress my torso. My teats are somewhat visible, but I think that I’m able to pass in it most of the time anyhow. In fact, at the beach house, I was wearing it for about 30 minutes in front of a trans guy friend. When I said I didn’t have to put on sunblock because of it, he asked with surprise if I was going to wear it the whole time at the beach. I said “yes,” and he immediately realized why, but this is exactly what I was going for – the ability, even from friends who are trans and know I’m trans, to forget that I haven’t had top surgery even while I’m in my mesh top. Of course, if I have to go into town in the mesh top, I do feel uncomfortable, but not in a totally nightmarish way.

Given that top surgery is not a necessity for me, here are some of the ways in which not having it is an inconvenience:

I do bind every day. This isn’t painful or uncomfortable, but it is a bit constricting, and hot in the summer. It’s bearable, because I don’t bind when I’m home alone. But then, I have to rush for the binder if a friend is dropping by or if a delivery person knocks on the door. Things that would be totally fun – like hosting an out-of-town visitor or sharing a vacation house with friends – become less fun when I have to bind every minute (except when I’m sleeping). Also, it restricts my clothing options. I’m very exacting. I don’t like it when any bit of binder can be seen under a pale or white t-shirt. I don’t like to wear shirts that are too tight or sheer, because I think that binder lines are visible or that my torso doesn’t look male enough. I can’t wear v-necks, tank tops, or summer T’s with wide armholes, because my binder would show. I get hot at dance parties and can’t strip to an underlayer. I hate sweating, because there’s nothing worse than a tight, soaking binder. And I can’t walk around shirtless showing off my cute torso. I’m a fag, and if I had top surgery, I would be extremely scantily clad most of the summer, not looking all butch in high-coverage, not tight muscle T’s.

I am ok having sex with guys who get my gender, but if I’m picking up a cis guy from the internet or a dance party, there is always that moment of discomfort if and when he takes my binder off, a discomfort that he can make worse or better (and I’ve experienced both). Sometimes I think a certain gay guy is cute, but flash to me taking off my shirt in front of him and refrain from doing anything further. Lately, I’ve been letting cis guys pursue me. I would feel more comfortable pursuing them if I had a chest that I was sure wouldn’t traumatize either of us.

I feel comfortable going to the beach with my friends, but what about with my family (who live, after all, in Puerto Rico)? What about in a foreign country (such as X, where I might go with my Pops)?

I feel comfortable looking at my chest in the mirror now, but let there be no doubt: I’m sure I would love to look at it if it were a male chest.

I feel male now, but I think that there would be a relief and certainty attached to not having breasts. Breasts are such a potent symbol of femaleness. It’s one thing to have a male-looking chest in spite of them, or to resignify them in your head so that they don’t mean femaleness; it’s quite another thing to not have them at all.

I can’t go to gay saunas or walk around a men’s locker room with a towel around my waist.

Those are all the negatives about not having top surgery that come to mind. Sometimes I think that, in the present, restricting certain aspects of my life because I have breasts is fine. I can handle it. It isn’t a big deal. It doesn’t cause me physical pain or major gender dysphoria. But when I think about doing this for an entire lifetime, I feel less sanguine. Who would want that? Why would I choose that when I have the option of having a male chest? It just doesn’t make much sense.

So here are some possible reasons not to have top surgery:

Cost. Of course it’s a lot, and it isn’t covered by my insurance. But on the other hand, I’m a professor now, and I don’t have to provide for a family. I could easily have more than the cost of the surgery saved up by the end of the year without even making an effort to save. In this I’m extremely privileged. So while the initial price tag seems large, I can definitely afford it.

Ties to a history of third-gender compromise. I have to admit, a part of me kind of likes binding and kind of likes having a not typically male chest. That is, I value how binding ties me to a certain historical experience – of passing women, of butch pain, of trans men before the era of physical transition, of third genders around the world who have dealt with less than ideally male chests. I value the historically rich art of resignifying and remapping bodies in which my lovers and I must become adept. I value having breasts that don’t mean “breasts.” I value binding before I go out as a daily practice of self-making. I value unbinding when I come home as an acknowledgement of my own comfort in being a man with the chest that I have. That said, I don’t think this is an experience that I need to have forever. I appreciate having had them, but if I had top surgery tomorrow, I don’t think I would need to “mourn” the loss of the historical experiences above (but I could be wrong).

Guilt in participating in an elective surgery. For a while, my lack of pain and dysphoria regarding my chest held me back from considering top surgery. I know so many people who experience or have experienced major pain and dysphoria regarding their chests. It seemed both frivolous and disrespectful to their experiences to traipse off and get top surgery without having to go through hell first. Surprisingly, talking to my Pops helped me get over this. She’s female-identified and quite large up top (horrifyingly large, actually). She is not trans, does not try to pass, does not bind, and understands her body as female, however, she told me that she was hoping to get a breast reduction. Part of her decision has to do with mild gender dysphoria, part of it is aesthetic, part of it has to do with back pain, and part of it has to do with minor inconveniences – having to rush for a bra when someone knocks at the door, having restrictions from certain types of exercise, and so on. When I told her that I felt ambivalent about getting top surgery because it seemed almost frivolous given the size of my chest, she said, “Well, it rides the line between cosmetic surgery and something else. But if you’re really committed to this [to trans-male identity]… (trails off). I mean, men who have that disorder [gynecomastia] get surgery. If you want to get it done in X, I could go with you.” A totally surprising conversation! Who’d have thought that my transphobic Pops would be encouraging me to get top surgery, much less offering to go with me? I was immeasurably touched. But her breakdown of top surgery for me as an elective surgery that isn’t purely cosmetic because it also effects both gender identity and lifestyle possibilities makes it finally feel within reach for me.

Loss of sensitivity. This, for me, is the the major concern. It is also what I have the least knowledge about. Until I started researching surgeries this summer, for instance, I had no idea the extent to which it was common for those who get the double incision procedure to have little or even no sensation in their nipples, little sensation in their chests, and no erotic sensation. I, however, would get the less common periareolar procedure done. Periareolar surgery is an option for people who have small chests and good skin elasticity (another reason to do it sooner rather than later). Its major advantages are that the scars, which are right around the nipple, are not easily visible and that, since the nipple itself isn’t removed and regrafted, there is little chance that the nipple will fall off and a good chance of maintaining sensation. Sensation in the nipples, however, might be weaker than before and less erotic, and sensation in the chest could still be patchy. At least, this is what I’ve gathered. I really don’t like the idea of numbness or patchy sensation in my chest. After all, one of the points of top surgery would be to allow me to feel reconnected to my chest and enjoy sensory experiences like not binding, feeling the sun and breeze on my chest on the beach, and baring my chest without discomfort to a lovers’ touch. I can’t imagine the disconnection of not having sensation in my chest. And maintaining sensation but losing erotic sensation in my nipples is definitely something to think about. I guess I would have to be prepared to lose a whole erogenous zone! It isn’t a necessary erogenous zone – I rarely touch my nipples when I jerk off, and I certainly don’t need nipple play to get turned on. I also think that, in spite of my being “comfortable” with nipple play, I’m also a bit uncomfortable with it and unconsciously try to move past it to other things. In sum, having the same degree of erotic sensation on a male chest would be ideal; losing an erogenous zone entirely gives me pause, but may not be all that significant to my sexual practice, considering my slight discomfort with certain types of nipple play; losing sensitivity entirely is something I’m not sure I can get past. If any of you have gotten periareolar and keyhole surgery and want to share your how you feel about sensitivity or lack thereof in the chest and nipples afterward, I’d really appreciate it. You can respond in the “comments” section of this post or email me privately at Actually, I’d appreciate hearing from anyone on any of the issues I raised in this post.

In sum, I have more research and thinking to do, but a part of me is beginning to think that it’s only a matter of time before I decide to get top surgery.

This entry was posted in butch, Sex, Third Gender, top surgery, transgender. Bookmark the permalink.

8 Responses to Considering Top Surgery (Soliciting Advice)

  1. I like that you wrote a post talking about what you have to lose. This is the kind of material that’s good to be “out there” on the Internet. I think most trans people believe (and most cis people believe about us) at some point/on some level that we don’t have a right to have any doubt about anything, or a right to be unwilling/hesitant to make certain sacrifices, and still ID as trans.

    When I first started out, I thought The Surgery was completely barbaric. I thought it was not something I would consider in a million years, but it wasn’t long until I was researching it on the Internet and going, “Holy sh*t – where am I going to get $10,000???” I have a big chest, but I can relate to feeling like it is elective – for me, it will be a nice thing to have when I do, to help me look male, but it’s nothing about the breasts themselves (at least not yet), just part of the means to the end.

    If I were you, I wouldn’t feel guilty over getting a surgery that you want. It isn’t taking anything away from a more dysphoric person for you to have it if you decide that you want it. Remember that post you wrote about transition-as-a-last-resort, and the anti-trans sentiment inherent in it?

    “No one would choose this if they didn’t *have* to!” – It really is a lie.

  2. genderkid says:

    I was ambivalent about top surgery too –even though I felt really disconnected from my chest– so I feel you with regards to having reservations. For me, the symbolism of having an atypical chest was one of the biggest reasons for hesitation (but I figured that, for me, the scars would be enough as bodily markers of my past).

    Having a flat chest is so relieving, though, that I haven’t mourned for any of the reasons I’d imagined. The only thing I miss is the sensitivity; I don’t have an active sexual life so I can’t comment on that, but I liked caressing my bare chest and I don’t do that anymore (it’s really nice to feel the flatness through a shirt, but I have large numb patches which are odd to touch directly).

    I think I can comment on the sensitivity because my surgery was similar to the periareolar method. I have extra incisions which extend horizontally from each nipple, but the nipple-areola complex was left in place, so I *think* the outcome would be similar in terms of nipple survival and such. At four months post-op, I haven’t regained any sensation in my nipples, nor in the whole area above the nipples (which I did NOT expect; I don’t think it’s common). According to my surgeon, the main chest nerve runs through the mammary gland, so it gets removed even with peri; but again, most people seem to lose only nipple sensation (if they lose any sensitivity at all). I do expect my nerves to regrow somewhat in the following months, but ultimately, sensation wasn’t as important to me personally.

    XXBoy had peri, and he answered lots of questions about sensitivity; you could try searching “ sensation”

    I hope you find the answers you need; this is a really hard decision to make.

  3. Faggot Boi says:

    @southcarolinaboy, Thanks for your appreciation. I too, noticed the links between this post and my earlier one. In the end, if I decide not to get top surgery, I think it won’t be guilt or unworthiness that keeps me away!

  4. Faggot Boi says:

    Thanks for your thoughtful response, genderkid. I too think I might not actually mourn my formerly atypical chest after surgery. Sensation really seems to be more of an issue for me. Thanks for the link to XXBoy. That was helpful. If you don’t mind, I’d like to hear back from you as the months progress on whether you regain sensation or even erotic sensation. Thanks for your support.

  5. genderkid says:

    No problem : ) I’ll keep you posted.

    I’ve been looking through the livejournal ftm community and there are lots of personal accounts about this topic. Someone even did a poll where people gave detailed answers about nipple sensation: (apparently, sensitivity continues to come in for a couple of years. Hooray!)

    You could also try surfing the various “surgery” tags:

  6. Koan says:

    Hey fb – Peri with Fischer here, no scars, moderate sensitivity. Can’t recommend her enough, hit me if you want to talk any details.

  7. anon says:

    Sensitivity is my big no 1 isse as well. I can’t imagine loosing erotic sensation in the nipples and it’s really refreshing to hear from someone who dates gay men,too and knows that nipple play doesn’t male you female. For me it’s not optional though. I can’t hide my chest size. And this really pushes me into a corner where I feel stuck. Very depressing.

  8. Faggot Boi says:

    @ Anon, I feel for you. It sucks to feel, as sometimes one does with transition, that one must sacrifice something regardless of the path one chooses. It would be better to not have to sacrifice anything! But I suppose, when that happens, one must go with what feels more necessary.

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