Nonbinary top surgery is a type of gender affirming care. It involves reduction, removal, or augmentation of the chest.

A nonbinary person may want their body to better align with their gender identity. This can mean different things to different people.

Top surgery may be an option for nonbinary people to get the results they are looking for.

Keep reading for more information on what nonbinary top surgery is, the different options available, costs and insurance coverage, and more.

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“Top surgery” typically refers to gender affirming procedures, which align with the gender a person would like others to perceive them as.

Top surgery often involves reducing (breast reductions), removing (mastectomy), enlarging (augmentation), or otherwise changing the shape of the chest.

There is no one correct way for a nonbinary or transgender person’s chest to look. Additionally, top surgery is not required for a person to consider themselves transgender or nonbinary.

The procedure can be one part of gender affirming care and may help reduce the risk of depression and suicide in transgender and nonbinary people.

A person who is interested in top surgery should discuss what they are looking for during a consultation with a surgeon. They may also want to see examples of the surgeon’s previous work.

Learn more about gender affirming care.

Once a person who was assigned female at birth (AFAB) goes through puberty, they may want to change the appearance of their breasts. They may be interested in reducing or removing breast tissue or increasing their breast size. People may also wish to remove their nipples, their areolas, or both.

They may want to have the surgery to avoid being misgendered or to better fit with their desired gender. There is no single correct option. A person should consider what makes them feel best.

Options for AFAB people include:

  • Breast reduction: Breast reduction involves the partial removal of breast tissue to help reduce the overall size of the breasts.
  • Breast removal: This is complete removal of breast tissue and reshaping of the chest. A person can opt to have their nipples grafted back on, placed in a new location, enlarged, shrunk, or reshaped. In a 2022 study, gender affirming removal (mastectomy) was the most common top surgery that transgender adolescents considered.
  • Breast augmentation: This procedure increases the size of the chest for a more perceived feminine look.

Selecting one option over the other or opting to not have any surgery does not make anyone more or less nonbinary. A person should choose what makes them feel best and most comfortable.

Learn more about top surgery.

People assigned male at birth (AMAB) have several options for top surgery as well, depending on their unique situation.

Some may identify as transfeminine, meaning they identify as more feminine than masculine.

Others may use hormone replacement therapy (HRT), another type of gender affirming therapy, during their transition process. They may develop breast tissue as a result of introducing these hormones.

Some people may want their chest to have a different shape.

Options for top surgery for AMAB people include:

  • Breast augmentation: AMAB people may want the appearance of a larger chest. Breast augmentation increases the size of the chest.
  • Breast reduction: An AMAB person may develop a larger chest due to HRT or just due to how their body develops. Breast reduction reduces the size of the chest without fully removing the breast tissue or completely flattening the chest. A person can discuss their desired effect with a surgeon to get the look they want.
  • Breast removal: Not everyone who identifies as transfeminine wants an enlarged chest. If breast tissue develops, they may want to remove the tissue completely.

There is no single correct top surgery option for AMAB people. People should consider the option that makes them feel the best.

An AMAB person can discuss their options and what they are looking for with a surgeon.

Read about gender affirming surgeries.

People with larger bodies should have access to the same top surgery options as people with other body types.

Healthcare professionals and insurance companies may deny a person top surgery because of their body mass index (BMI), using a clause that requires “medical conditions” to be “reasonably well controlled.”

The flaws of BMI

BMI is a calculation of a person’s body fat based on their height and weight. However, studies suggest it is a poor indicator of a person’s body fat percentage.

It can be misleading because the measure does not account for overall body composition. The BMI measurement overlooks bone density, muscle mass, and other considerations.

For additional information, talk with your doctor about other body fat assessment methods.

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A person with a larger body may find that medical professionals require them to lose a certain amount of weight before they will consider top surgery or any type of gender affirming procedure.

According to a 2021 study, empirical data does not support this view. Instead, the researchers argue that evidence does not support weight or BMI limitations for top surgery.

They also note that the World Professional Association for Transgender Health (WPATH) guidelines do not specify BMI as a requirement for surgery.

A person with a larger body may want to reshape, enlarge, or reduce their chest size using top surgery. However, they may need to look for a healthcare professional who does not have a BMI requirement for the procedure.

A person can use this resource to find gender affirming surgeons who do not have BMI requirements.

Whether a person needs HRT before top surgery depends on their desired outcome and their unique situation.

AFAB people may not need any HRT before top surgery to remove, enlarge, or reduce their chest size.

WPATH guidelines suggest that AMAB people receive 12 months of HRT before breast augmentation to allow the hormones to have their full effect. However, this is just a suggestion, not a requirement.

Insurance companies may require that a person receive HRT before surgery to document gender dysphoria. WPATH uses “persistent, well-documented gender dysphoria” as a guideline for top surgeries, and insurance may use HRT as documented proof.

Costs for nonbinary top surgery can vary based on the type of surgery and a person’s insurance coverage.

For example, the estimated range of cost for breast augmentation is $6,000 to 12,000.

Medicare covers gender affirming care, and many private insurance providers do as well.

However, both public and private insurance may require people to meet certain criteria and prerequisites before they will approve payment for care. This may include documentation from healthcare professionals indicating previous treatments, such as HRT.

Learn more about Medicare and gender affirming surgeries.

The following sections provide answers to frequently asked questions about nonbinary top surgery.

Are there options for nipple placement after nonbinary top surgery?

In general, yes. A person can discuss with a surgeon the placement, size, and shape of their nipples as part of their consultation. The surgeon can then place and shape the nipples according to the person’s desired effect.

Is nonbinary top surgery the same as breast reduction?

Breast reduction is a type of nonbinary top surgery. A person may instead choose augmentation or complete removal of breast tissue to flatten the chest.

Breast reduction surgery may also fall outside the scope of gender affirming care. A person with larger breasts may choose reduction to help relieve pain or discomfort, for psychological reasons such as self-consciousness, or both.

LGBTQIA+ resources

To discover more evidence-based health information and resources for LGBTQIA+ individuals, visit our dedicated hub.

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Nonbinary top surgery falls within the spectrum of gender affirming procedures. It involves reduction, removal, or augmentation of the chest.

A nonbinary person may choose to undergo any or none of these procedures. No single procedure works for everyone. People will typically choose what feels best for them.

Medicare and most private insurance companies cover gender affirming care. However, a person may need to provide additional documentation before their top surgery to get the insurance provider to cover the costs.