Chest (Top) / Breast Surgery

To see Dr Avery, you will need a referral from your GP or another specialist who knows you well. Some people seek a consultation after speaking with family or friends, or following their own research into plastic surgery.

The initial consultation is an opportunity to discuss your personal reasons for considering surgery, your expectations, and any questions or concerns you may have. Dr Avery will take time to understand your health history and circumstances so that the information you receive is specific to you.

When you arrive at Avery, you will be welcomed by our Care Team and asked to complete a medical history form if this has not already been done. You are welcome to bring a supportive family member or friend with you to your consultation, should you wish, to help you collect and retain al of the information you need to make an informed decision about surgery.

As part of the consultation, Dr Avery will carry out an examination of the area of concern and provide information about whether surgery may be suitable for you. This discussion will include what the procedure involves, the possible risks and complications, and any limitations that may apply in your situation. The aim is to provide you with clear information about what surgery may or may not achieve, and whether it is an appropriate option for you.

Your consultation will also include discussion of the estimated costs associated with surgery.

After your appointment, our Care Team is available to answer any further questions, including those relating to fees and practical next steps.

At Avery, our focus is to provide you with accurate and personalised information to support your decision-making process before, during, and after surgery.

Masculinising chest (top) surgery

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.

As with all surgical procedures, chest (top) /breast surgery does have risks, despite the highest standards of practice. It is not common practice for any surgeon to outline in detail every possible side effect or rare complication. However, it is important that you are informed of the more common risks and the less common but potentially very significant complications, so you can carefully weigh the potential benefits, risks, and limitations of surgery. It is usually possible to provide a more comprehensive list of potential risks and complications related to surgery, so that any risks particularly relevant to an individual can be identified and discussed further.

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.

Recovery after chest (top) / breast surgery varies depending on the individual, the technique used, and whether any additional procedures are performed. Some people may need an overnight hospital stay, while others may remain longer. Time away from work can range from 2–4 weeks, depending on the extent of surgery and the type of work undertaken.

Bruising, swelling, and discomfort are expected after surgery. These effects improve gradually over time, although the pace of recovery differs between individuals. Supportive garments or dressings may be recommended for several weeks to assist with comfort and healing.

Pain management is planned prior to discharge and may be adjusted during the recovery period as required. Follow-up reviews help to monitor healing and guide the return to usual activities.

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 hospital stay after chest (top) / breast surgery varies depending on the extent of the procedure, the surgical approach, and individual recovery. Some people may be discharged on the day of surgery, while others may remain in hospital for one or more nights. Discharge decisions are based on clinical assessment, pain management, and the level of support available at home.

Surgical drains are soft, flexible silicone tubes that may be placed during surgery to remove blood or fluid from the area. They are sometimes used to reduce the risk of fluid build-up, which can contribute to discomfort, infection, or wound-healing problems. Drains may also help a surgically created space close more effectively.

Whether drains are used depends on the type of surgery performed and the amount of space created during the procedure. They are commonly used in double-incision top surgery and may be used in some cases of limited-incision surgery. The decision to use drains is made during the operation based on surgical findings and clinical judgement.

Recovery after top surgery varies between individuals and depends on the surgical technique, overall health, and type of work or daily activities. Some people may require around two weeks away from work for initial rest and light activity, while others may need longer. Return to driving or work depends on individual comfort, healing progress, and clinical review.

By about six weeks, many people are able to increase their activity levels, although restrictions may still apply depending on the extent of surgery and recovery progress. Scar healing is gradual, and changes in scar appearance may continue for 12–18 months.

The timing of returning to exercise after top surgery varies between individuals. Light activity such as gentle walking is often encouraged in the first couple of weeks. More strenuous activity is usually increased gradually between 2–6 weeks, depending on comfort levels and recovery progress.

By around 6 weeks, many people are able to resume a broader range of physical activities, but full return to pre-surgery activity levels may take longer, sometimes up to 12 weeks or more. The exact timing should be guided by your recovery and advice from your surgical team.

Some degree of discomfort and restricted movement is expected after top surgery. The extent varies between individuals and depends on the surgical approach and the body’s healing response. Pain is usually managed with medications prescribed in hospital, and may also be supported by dressings, supportive garments, and activity modification.

Excessive movement of the operated area is generally limited in the first weeks, and activity is gradually increased under guidance from your surgical team. If pain increases or recovery does not progress as expected, further review may be required.

Please allow two hours 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.