Top surgery is formally known as subcutaneous mastectomy when it involves removing breast tissue (masculinizing) or augmentation mammoplasty when it involves adding breast volume (feminizing). In broader medical settings, these procedures fall under the umbrella of gender-affirming chest surgery, sometimes listed as chest masculinization or chest feminization.
Masculinizing Top Surgery Terminology
The most commonly referenced version of top surgery is masculinizing chest surgery, which removes breast tissue to create a flatter, more traditionally masculine chest contour. The medical term is subcutaneous mastectomy, meaning the removal of breast tissue from beneath the skin. Within that category, several specific techniques have their own names.
Double incision mastectomy is the most common approach. It’s typically recommended for people with moderate to large breasts. The surgeon makes horizontal incisions above and below each breast, removes the tissue and some excess skin, then repositions the nipples as free grafts. Because the nipples are detached and reattached, there is a possible loss of nipple sensation afterward.
Periareolar mastectomy (also called keyhole top surgery) is an option for people with very small breasts and minimal excess skin. The surgeon makes a cut along the lower half of the areola and extracts breast tissue through that opening. This technique may preserve sensation to the nipple because the nerve connections are less disrupted, and it leaves less visible scarring.
Subcutaneous mastectomy with nipple preservation is a related approach where incisions are made along the breast crease. It works best for smaller chests and allows the nipples to remain attached on a pedicle of tissue rather than being removed and grafted back on.
Feminizing Top Surgery Terminology
When top surgery adds breast volume, the formal name is feminizing augmentation mammoplasty. This is essentially breast augmentation performed as part of gender-affirming care. The procedure uses silicone or saline implants, chosen based on body frame and desired size and shape. Some patients also benefit from fat grafting, where fat is taken from the belly, hips, or thighs and transferred to the chest to create additional fullness in specific areas, either alongside implants or on its own.
Feminizing top surgery can also include breast lifts or breast reductions, depending on the individual’s goals and what hormone therapy has already achieved in terms of breast development.
Non-Binary Chest Surgery Options
Not everyone pursuing chest surgery wants a fully flat or fully augmented result. Non-binary individuals sometimes opt for a “radical reduction,” which significantly decreases breast size without removing all tissue. Going from a DD cup to an A cup, for example, would fall into this category. Medically, this is still classified as a breast reduction, but the goals and aesthetic targets differ from a standard cosmetic reduction.
Nipple options also vary. You can choose to have nipples grafted back on in a traditional position, placed differently, resized, or removed entirely. Some people prefer no nipples at all for a smoother chest appearance. These choices are part of the surgical planning conversation and don’t change the core procedure name.
What Recovery Looks Like
For masculinizing procedures, numbness or decreased sensation across the chest and armpits is common in the weeks after surgery but typically improves over several months. The periareolar approach has the best chance of preserving nipple sensation, while double incision carries the highest risk of permanent sensation changes because the nipples are fully detached and regrafted.
Serious complications are relatively uncommon. Hematomas (collections of blood under the skin) occur in roughly 1 to 2% of cases, though rates as high as 5 to 11% have been reported in certain subgroups. Nipple graft loss happens in about 1% or fewer cases. Infection after masculinizing chest surgery is rare.
How It’s Coded for Insurance
If you’re navigating insurance coverage, the diagnosis that supports authorization is typically coded under gender identity-related categories in the ICD-10 system (the standardized coding system used for medical billing). The specific diagnostic codes include F64.8 and F64.9, which cover gender identity disorders. Your surgeon’s office will pair these diagnostic codes with the appropriate procedural codes for the specific technique being performed. Knowing the formal medical name of your procedure, whether that’s subcutaneous mastectomy or augmentation mammoplasty, can help when communicating with insurance representatives or reviewing policy language about what’s covered.