As a plastic surgeon at Oregon Cosmetic and Reconstructive Clinic, I meet many patients who want clear information about gender-affirming top surgery and how it compares to a mastectomy done for cancer treatment or prevention. These procedures may sound similar, but they serve different goals, follow different principles, and create different outcomes. I want to walk you through these differences in a simple and supportive way.
How Gender-Affirming Top Surgery Is Different
Cancer-related mastectomy focuses on removing all breast tissue
Mastectomy for cancer treatment or prophylaxis is designed to remove as much breast tissue as possible. The goal is always medical: reduce cancer risk or treat an existing cancer. Because of this, the chest often looks flat but not sculpted, and surgeons do not routinely shape the underlying contour.
Top surgery focuses on creating a natural-looking masculine or nonbinary chest
Gender-affirming top surgery has a very different purpose. Here, my goal is to create a chest contour that aligns with the patient’s gender identity while still maintaining harmony with their unique anatomy. Instead of removing every bit of tissue, I often leave a controlled amount of tissue in specific areas to:
-
Create a natural slope
-
Add definition over the pectoralis muscle
-
Avoid hollowing or irregularities
-
Support the overlying skin
How much tissue remains depends on several factors, and this is where the artistic part of surgery really matters.
How I Tailor Tissue Contouring
Rib cage shape
The rib cage influences how much soft tissue I keep. A rounder rib cage may need a little more tissue to maintain a smooth contour. A flatter chest wall often allows more direct sculpting.
Desired aesthetic
Patients often share whether they want:
-
A more defined pectoral look, or
-
A softer, flat appearance
This preference guides how I shape and thin the remaining tissue.
Skin quality and elasticity
Skin plays a big role in choosing a safe and effective technique. I assess:
-
How much extra skin is present
-
Whether the skin has enough elasticity to shrink and re-drape
-
Where the skin folds naturally
-
Whether the nipple-areola complex can be preserved in place or needs repositioning
These details help me choose the technique that gives the most predictable and balanced result.
Surgical Techniques I Use
Double Incision Technique
This is the most common approach for patients with more breast tissue or extra skin. It allows me to:
-
Remove excess skin
-
Reposition or resize the nipple-areola complex
-
Shape the chest with precision
It creates strong, reliable chest contouring and typically avoids the need for later revisions.
Lower Elliptical Incision Technique
Some patients have moderate tissue with good skin quality. This allows me to:
-
Maintain a higher, natural areolar position
-
Create a flatter, clean contour
-
Use a shorter scar pattern
It’s a great option when the skin can re-drape smoothly.
Keyhole Technique
This is ideal for patients with:
-
Small breast volume
-
Tight, elastic skin
-
Minimal excess tissue
Through a very small incision—often around the areola—I remove tissue, shape the area, and maintain the nipple position without large scars.
Why This Surgery Feels So Meaningful to Patients (and to Me)
I feel truly honored to perform gender-affirming top surgery. Many patients tell me this procedure removes the daily mental load of binding, hiding their chest, or feeling self-conscious in public. After surgery, they often describe a sense of freedom, comfort, and alignment between their inner identity and outward appearance.
These stories remind me why this work is so impactful. Helping someone move through the world with ease—and with less emotional weight—is an incredibly gratifying part of my practice.
If you’re considering surgery, I encourage you to explore other helpful pages on my site, such as:
-
Scar care and healing: https://theocrc.com/scar-massage-silicone-sheeting
-
Hand and reconstructive services: https://theocrc.com/procedure/hand/injury
