Chest (Top) / Breast Surgery

Your GP or another specialist that knows you well must make a referral to Dr Avery. The decision to have a consultation may be made after talking with family or friends or following your own research into plastic surgery and Dr Avery.

The purpose of your initial consultation with Dr Avery is to discuss your motivations for surgery and expectations from surgery. It is an opportunity to openly communicate what you want to change, alleviate or remove. We will discuss any concerns you may have about your potential surgery and its outcome. We will also collect information that is specific and tailored to you, to add to the knowledge you acquired through your research outside of the consultation process.

When you arrive at Avery, you will check in with our Care Team and complete a medical history form, if not already completed. We encourage you to bring a supportive family member or friend who can remain with you throughout the consultation if you like, and be a sounding board during your decision-making process following the consultation.

The consultation with Dr Avery will include an examination of the area of your body that you are concerned with and considering changing. Our aim will be to determine if plastic surgery can achieve what you hope it will, and if so, what specific plastic surgery procedures will address your concerns and meet your expectations in a realistic way.

Plastic surgery procedures can impact physical appearance and there may be a psychological response to the changes in your body after surgery. Besides the reasons for having plastic surgery, it is important to be fully aware of any potential limitations of the operation and how they apply to your unique situation. This includes the risks of having surgery and all of the possible complications that can occur after surgery, and what can be done if these occur.

We will discuss what the surgery involves, how it relates to you specifically given your uniqueness and current state of health, what the possible risks of the surgery are, and then decide if having the surgery is a safe and appropriate choice for you as an individual.

Your consultation will also include a discussion of the estimated financial implications of having this surgery or surgeries that were discussed with Dr Avery.

After your consultation, our Care Team will be there to talk through any further questions you have, including the cost of the surgery.

At Avery, our goal is to ensure you are equipped with the knowledge needed for you to feel empowered throughout the decision-making process, surgery and post-surgery.

Masculinising chest (top) surgery [KG1]

Top surgery is typically sought by trans people presumed female at birth (PFAB), including men and non-binary people.

Surgical considerations involve the removal of breast tissue to create a flat chest contour and adjustment of the nipple and areola complex, including its size and position on the chest, as appropriate for the altered chest contour.

The goal of this surgery is to create a chest contour and appearance consistent with a more masculine chest. Masculinising top surgery may help improving poor posture and/or pain and skin irritation from frequent firm binding of the chest and breasts.

There are generally three surgical options that are primarily influenced by breast/chest size and the associated skin excess as well as the quality of the skin:

Limited incision top surgery

Often referred to as keyhole surgery, the removal of the breast tissue, is performed through an incision along the outer border of the lower half of the areola.

If the areola size needs to be reduced, an incision around the whole circumference of the areola can be performed, either at the time of breast tissue removal or as a second procedure. This limited incision or single-incision surgery results in a scar at the border of the areola and the skin of the breast and may not be visible to others with a shirt off.

Double incision top surgery

For larger breasts where there is excess skin that needs to be removed in addition to the breast tissue, it is not possible to ‘hide’ the scar at the areola margin. In this case, an incision is usually made in the lower crease of the breast or the infra-mammary fold, through this incision the breast tissue is removed along with excess skin to create a flat chest contour.

The second incision relates to the areola and nipple complex which is removed, reduced if required, and replaced on the chest in an appropriate position. This technique is referred to as a nipple graft. The double incision top surgery results in a scar around the areola which may heal in a manner that is not very visible, and also a second generally longer scar on the lower part of the chest, curving up toward the armpit, that will generally be visible for some time with a shirt off. This scar may fade and become difficult to see over time, potentially hidden following significant hair growth that may occur with any hormone therapy.

Some people may elect to not keep the nipple and only have the incision along the lower crease or infra-mammary fold.

Nipple and areola pedicle

In this procedure, the nipple and areola remain attached to the body on what is known as a pedicle of tissue that maintains blood supply and potential sensation to the nipple and areola. Skin is removed from the chest to an extent that the resultant scar cannot be hidden around the new areolar position and will generally be similar in size and location to that of the double incision technique. The main advantage of this technique if appropriate relates to nipple and areola sensation and blood supply.

Feminising breast implants/augmentation

Feminising breast implants/breast augmentation is typically sought by trans people presumed male at birth (PMAB), including women and non-binary people.

Feminising chest surgery as part of the gender affirmation generally involves the use of silicone breast implants. These implants are commonly placed via an incision in the lower breast fold, to sit either in front or behind the pectoralis major chest muscle. Breast implants are foreign material and typically are not lifelong devices. The benefit of breast augmentation is often the alignment of physical appearance with gender. Detailed information regarding breast augmentation can be found here.

Regardless of the technique used, a number of potential risks exist with chest/breast surgery.

As with all surgical procedures, chest (top) /breast surgery does have risks, despite the highest standards of practice. It is not usual for any surgeon to outline every possible side effect or rare complication of a surgical procedure. However, it is important that you have enough information about the most common risks to fully weigh up the benefits, risks, and limitations of surgery.

The following possible complications are listed to inform and not to alarm you. There may be other complications that are not listed. Smoking, obesity, and other significant medical problems will cause greater risk of complications.

• Heart and circulation problems can occur. A blood clot can develop, usually in a deep leg vein. A clot can move to the lungs, heart or brain, where it can be life threatening.
• A chest infection may develop after a general anaesthetic.
• A sore throat, caused by the breathing tube used during anaesthesia, can last for several days.
• An infection may require antibiotic treatment.
• Excessive bleeding from the wound, which may require surgical intervention.
• Poor and slow healing of the chest tissue with the possibility of wound breakdown.
• An adverse reaction to anaesthetic.
• Asymmetry: symmetry cannot be guaranteed and differences in size and shape/contour may occur. The position of the nipples may also vary slightly.
• Loss of sensation in nipple and areola: Some patients have a loss of sensation or altered sensation in the nipple and areola. This is usually temporary. Sensation may take several months to return to normal or near normal. In some cases, despite the nipple and areola remaining attached to their nerve supply throughout surgery, the loss of sensation may be permanent. If the nipple and areola are removed and grafted into their new position, the loss of sensation is always permanent.
• Loss of nipple and areola tissue. In rare cases the nipple and areola can lose its blood supply and die. Reconstruction in the form of a skin graft from another part of the body will be required to rebuild the nipple and areola at a later stage.
• Another procedure may be needed to remove excess skin if large amounts of mammary gland or fatty tissue have been removed and the overlying skin has not adjusted to the new chest size.
• Especially in patients with large amounts of tissue being removed, breast lumps may be noticed a few weeks after surgery. These are likely due to small collections of blood (haematomas) or small areas of dead fat cells that are still healing.
• Permanent pigment changes in the chest area may occur.
• A keloid scar and hypertrophic scar are surgical scars that become inflamed, raised and itchy. People with a history of developing these types of scars are more at risk. Keloids and hypertrophic scars can be annoying but they are not a threat to health.

An overnight stay in hospital may be required post-surgery to aid with your recovery. Depending on the complexity of the surgery and any additional procedures, up to 2-4 weeks off work may also be recommended.

There will be some bruising and swelling, which generally subsides about 2 weeks after the operation. You will be required to wear a compression garment or bandages for up to 6 weeks to provide support and reduce post-operative pain or swelling.

A customised pain relief program will be created for you and issued before you leave the hospital. If circumstances change at any stage during the recovery period, then the pain medication can be adjusted accordingly.

The financial aspects of your surgery are as important as the medical elements when planning for surgery. At Avery, the surgeries we offer fall into three different financial categories: Self-funded – aesthetic surgery; self-funded – plastic and reconstructive surgery; and health insured – plastic and reconstructive surgery.

To make sense of these three financial categories, we have created a detailed price guide to help you understand what may or may not be covered by your health insurer/Medicare and your out of pocket expenses.

To download this guide, please click here.

For more information or to book a consultation, please contact our team on 02 4002 4150.

The length of your hospital stay will depend on the extent of the surgery and the help available to you at home. Most people having double incision top surgery will stay in the hospital for one or two nights. Some patients are able to go home the day of surgery if the pain is under control and they have an adult to stay with them the first night following surgery.

Surgical drains are soft flexible silicone tubes that are placed within a cavity or space created via surgery. Surgical drains are used to help remove blood and fluid that leaks from body tissue following surgery. In addition to removing any blood and fluid (which may increase the risk of discomfort, infection or wound healing problems), surgical drains may also help a surgically created space collapse down and allow body tissues to stick to each other and aid the recovery process. Surgical drains may be used if there is a large potential space created, which happens in most cases of double incision top surgery and some cases of limited incision top surgery.

Recovering from surgery is a gradual process rather than a single point in time. In general, you will require two weeks off any work, focusing on resting and doing small amounts of activity only. After two weeks, depending on your comfort level and the demands of your job, you may be able to return to work and may feel comfortable enough to drive. By six weeks most people will have only minimal restrictions on activity if any, and any surgical wounds should require relatively minor care to help the scar obtain its optimal appearance.

Wounds from surgery of any sort can take up to 18 months to start fading.

Simply walking is advised and is recommended during the first 2 weeks after surgery. An increase in activity is encouraged between 2-6 weeks, limiting this increase based on how your body feels and responds. From 6 weeks you can be mostly unrestricted with exercise but it may not be until 12 weeks following surgery that you feel you are back to pre-surgery fitness, or even improved from your pre-surgery fitness if physical symptoms and restrictions have been addressed with surgery.

Pain following top surgery will vary depending on the extent of surgery. Pain immediately after surgery may be reduced by the use of local anaesthetic at the surgical site given during the surgery. The pain will also be managed with tablets or injections as required. Physical measures such as the dressings and supportive garments as well as limited movement and possibly ice packs will all help minimise any pain. Pain is usually well tolerated within a few days after surgery with all these measures. If your pain is increasing following surgery this is usually a sign that you may need a review to ensure your recovery is proceeding as expected.

Dressings and supportive garments will offer support to the wounds and the areas of your body that are still recovering. You will be also be advised to restrict excessive movement of the surgical area in the first two weeks after surgery. A good general rule throughout your recovery is if an increase in movement or activity does not increase any discomfort or swelling, then it is probably safe and this gradual progression back to ‘normal’ will be encouraged.

Please allow an hour for your time with Avery. This will include meeting with Dr Avery and the Avery care team.

Dr Avery operates at the accredited Lingard Private Hospital. This is to ensure your operation takes place in an environment governed by the guiding principle of safety to ensure your surgical experience is the best it can be.