Top Surgery And What You Need To Know

Top surgery jitters? Doing the countdown already? Congratulations! One of the best days of your life is coming soon.


It doesn’t matter if it’s in a couple of months or in a couple of years. All that matters is now, you have found it necessary to prepare physically for it.


Before we dive into the exercises I have personally done to prepare, here’s a bit of reading so you can learn more about top surgery.


What is Top Surgery?


 DISCLAIMER: I am not a medical professional and the information about to be shared are purely based on personal experience. It would still be best to consult with your physician or surgeon before engaging in any type of activity.


For those who are not familiar with this procedure, top surgery is basically dual mastectomy done with more focus on aesthetics. The aim is to remove the existing breasts for the chest to seamlessly resemble a cis male chest.


This procedure is not exclusive to those who identify as transgender men and is not required to be considered a transgender man. However, some surgeons would require a consent or certification that the person is diagnosed with gender dysphoria and would need the surgery as part of their gender transition.


The female chest is one of the major reasons why a lot of trans men experience dysphoria. Dysphoria is being uncomfortable with your current state of life and for trans men, it is usually gender dysphoria. We are not comfortable being in the body that we are in and the female chest is one of the physical manifestations of being a female.


For most trans men, top surgery is the pinnacle or the peak of their transition. This is what majority of trans men save up every bit of money they have. This is how we define freedom.


top surgery transgender


Before you say anything, please do not involve the topic of religion and not being satisfied with the way the Universe created all things. This is not the platform to voice it out on. Thank you.


top surgery collage


top surgery philippines
7 hours post op, November 2014


There are many types of surgeries available today and the most common would be:


  • Double Incision
  • Peri-areolar
  • Keyhole

Double Incision Mastectomy


top surgery double incision


Double incision, as you can see, involves two (sometimes one) incisions along the inframammary fold or under the breast. This is the most common procedure done all over the world.


The advantage of this procedure is it takes care of any excess skin, loose skin, and almost completely removes the breast tissue along with fat. This would also give the surgeon and the patient a choice as far as nipple placement is concerned. Almost no revision is necessary in most cases.


The obvious disadvantage would be one or two scars that may extend as far as the back, depending on the case. If you develop keloids, this will be a problem unless you are completely fine with having scars on your chest. Sometimes, the chest would also appear too flat unless the patient works out the chest area after the recovery process.


Peri-areolar mastectomy


top surgery peri areolar


Peri-areolar mastectomy is when the incision is along the circumference of the nipple-areola complex. This is the procedure that yours truly underwent. Typically this is recommended for those on the smaller side, commonly below a Cup A and pushing to a small B.


Obviously, the advantage is there is less noticeable scarring and a more natural transition to a cis male chest. The breast tissue is also removed with some fat removal to maintain the chest contour.


A disadvantage that I can note is the higher possibility of revision and/or liposuction. Another would be the possibility of scar stretching as you can see on this photo. There is not much control or freedom over nipple placement as only minimal skin is removed or trimmed off.


Keyhole Mastectomy


top surgery keyhole


And lastly, keyhole surgery involves just a moon or crescent shape incision on the bottom part of the nipple-areola complex. This procedure is the least invasive of all 3 procedures mentioned. There will be minimal scarring with only a possibility of scar stretching.


Like peri-areolar mastectomy, keyhole would also limit the freedom for nipple placement and the possibility for revision will also be there.


For all procedures, the risk of nipple death is present. This is when the nipple, due to the trauma it will receive during surgery, loses blood supply and results in necrosis or tissue death. Literally, there are some guys whose nipple just fell off.


Which procedure is best for you?


This would highly depend on your preference and the opinion of your surgeon.


I initially wanted to go with the double incision to just take care of everything but my surgeon recommended against it as he saw I formed really dark and raised keloidal scars.




But the most important factor that he saw was that fact that I was able to build my chest well enough to qualify for peri-areolar surgery.


How long do you need to build your chest for top surgery?


Truth be told, if your nutrition is on point, you don’t waste time in the gym, you focus on quality movement and progression, I’d say you can do it in about 3 months. No bull.


Some guys are told to lose some body fat first prior to surgery and that advice actually makes sense. Not only would you be in a better physical state when surgery day comes but it will also provide a better canvas for your surgeon to work with.


Real talk coming: If you have a lot of blubber, it’s like letting your surgeon work blind. Remember, he has to see where your pectoral muscles are to help him contour the incisions. You need to make your surgeon see what would work best for you.


Some guys don’t have a lot of muscle built yet and it would greatly help your surgeon if you built it up to at least an acceptable amount.


Think of your surgeon as an artist. You are the canvas and the surgeon is the artist. A bad piece of canvas won’t always produce great results. Sure, your surgeon’s skills should compensate but come on, it wouldn’t hurt to give your surgeon the advantage and pleasure to design your chest.


Personally, I gave myself 1 year to prepare physically for top surgery. I cleaned up my diet, focused on quality workouts and focused hard on recovering and growing. Towards the latter part of the process, I tried to cut as much body fat as possible.


The results? My chest dropped to smaller than an A cup. Smaller than when I initially went for a consultation. Then on surgery day, my surgeon showed the amount they took from my chest. It was not even enough to create 1 boob. For real guys.


The Workout Tips for Top Surgery


So if you are ready to start preparing for top surgery, here are some things I have personally done to help me get the best results possible. The earlier you can start preparing, the better it will be.


If you are getting surgery in a couple of months, no worries. These tips would still work for you.


 1. Set a goal


Of course, your goal is to get the best top surgery results. But to get those results, which do you need to do first? Drop fat or build muscle?


Remember, dropping fat may sacrifice a bit of muscle mass. Conversely, building muscle may result in fat gain especially if your nutrition sucks.


To drop fat, work with a calorie deficit of 300-500 calories daily with high protein to try and preserve as muscle mass possible.


To gain muscle, work with a calorie surplus of 300-500 calories daily. Depending on the way your body takes food, I normally increase carbs during this period and drop my protein just a little bit.


In general, if you have fluff, lose the fat before bulking.


2. Prioritize nutrition


I just discussed calories…again.  You know the drill already.


You are what you eat. Your results are what you eat.


So if you eat poorly, well. I don’t think you need more words to help you visualize how you’d end up as.


To get an idea of how to work your nutrition, check out my Fat Loss 101 series starting with Part 1.


3. The Big 5


During my preparation, I was doing mainly compound lifts or multi-joint exercises. My gym time was 4x a week initially then increased it to 5x a week. The big 5 barbell moves are:




I never really worked with dumbbells except for the last 2 months of my preparation for top surgery. The same goes for machines; never really used them except for the latter part as the day got closer.


Why the Big 5? They give you more bang for your buck because they target a lot of muscle groups in a single move. The more muscles you recruit, the more your body will be triggered to grow.


I also did some Olympic lifts like the Clean because it helped with burning off the fat. In place of this, you can do HIIT as well. It’s your choice what type of cardio you want to do or If you need it. Here’s a video I did last year with a sucky power clean and some deadlifts and some push presses.


4. Quality over Quantity


The Big 5 exercises would typically require you to haul big ass weights since it uses up a lot of muscles and the opportunity for the GH (growth hormone) to be released is greater.


However, do not fck up these exercises because that’s like volunteering for an injury.


Focus on quality movement and focus on mind-muscle connection to make sure you are working the correct muscles. Do not butcher these exercises because they can definitely butcher you back. Trust me.


5. Recovery


Perhaps the most important aspect of preparing or surgery is resting and allowing your body to recover.


On surgery day, you need to be at your prime and healthiest self. I stopped working out 1 week prior to surgery to allow my body to recover and was taking at least 1000mg of Vitamin C every day for a month prior to the date.


You cannot sacrifice your heart working overtime on surgery day especially if you will be going under General Anesthesia (I wasn’t under GA). You cannot sacrifice your recovery over injuries that may even push back your surgery date.


The priority on surgery day is for your chest to heal perfectly and you do not want a sprain or a torn muscle to compete with the white blood cells that are trying to help your chest get better. And believe me, recovery after surgery is a whole new beast in itself which I will discuss in another post.





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Top Surgery And What You Need To Know
Article Name
Top Surgery And What You Need To Know
Different top surgery procedures and things you can do to prepare your body for the big day.
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The Trans Lifter
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