Chest masculinization mastectomy — usually called top surgery — is the most commonly performed gender-affirming surgery for trans-identified females, and the most commonly reversed one by detransitioners seeking reconstruction. It removes breast tissue and reshapes the chest to look male. It ends the ability to breastfeed, permanently alters chest sensation, and leaves scars that do not fade.

This page covers the surgical techniques, what the complication and regret research actually shows, and what detransitioners and trans-identified people say about their outcomes. It is not medical advice.

Techniques

Four main approaches exist. The choice depends on chest size, skin elasticity, and how much scarring the patient will accept.

Free nipple grafting is the most common technique overall. It is also the technique most likely to end breastfeeding permanently — a consequence that a 2023 case report found is routinely missing from counselling and consent documents (Gribble, Bewley & Dahlen 2023).

Complications

Reported complication rates vary widely depending on how "complication" is defined, which technique is used, and how long patients are followed. The range below is drawn from published series; it is not a single pooled number.

A 2023 single-centre series of 81 patients reported a 25% complication rate at 30 days and a 20% long-term complication rate, with a median cosmetic satisfaction score of 90/100. A separate series of 73 subcutaneous mastectomies reported a 2.7% major complication rate and a 5.4% revision rate. The spread between these figures illustrates how much the numbers depend on the cohort and the definitions used.

Two things the complication tables do not capture:

• Breastfeeding. Free nipple grafting almost certainly precludes it. Consent documents often say the outcome "cannot be predicted" rather than stating this directly (Gribble et al. 2023).
• Revision as a normal part of the process. Several surgical series report that a substantial minority of patients return for at least one additional procedure — scar revision, nipple adjustment, contour correction. This is often presented as routine rather than as a complication, but it means additional surgery, additional cost, and additional recovery.

Regret and satisfaction

The published regret literature for mastectomy reports very low numbers. The most-cited figures and their limitations:

The Bruce et al. study is the strongest methodologically — it used validated instruments rather than chart review — but its 59% response rate means 41% of the cohort said nothing. The non-responders were also further out from surgery, which is exactly the direction that would bias the result toward lower regret if late regret exists. The study's own authors note that the near-total absence of variance in regret scores prevented them from doing the subgroup analyses they had planned.

Cohn's broader point applies directly: follow-up windows of 2–5 years are shorter than the observed median time to regret in the detransition literature, which is often 7–10 years. A study that closes its window before regret typically arrives will not count it.

Detrans perspectives

Accounts from detransitioners who had top surgery cluster around several themes. Not all detransitioners regret it — some describe it as the least problematic part of their transition — but the regret accounts are specific and consistent.

Physical outcomes

Top surgery was the worst thing I've ever been through, and continues to be. My chest doesn't feel like a male chest, or like it used to as a child before I grew breasts. It feels numb and empty, and my skin around the scars feels very tight. It feels incredibly unnatural and distressing on a daily basis even over a year after getting the surgery, and I wish so much that I had had these kinds of doubts leading up to surgery that could've led me to reconsider.

Do not go under the knife if you are not 100% sure you want this. Reschedule if you don't want to cancel. Do not go in with any inkling of doubt in your mind, especially enough to come and post on here.

—Quiet-County-9236, detrans female

It's an amputation and it feels terrible. Nipple grafts and scars are both numb and painful somehow. I have constant phantom limb pain. It also looks very sunken in compared to my now female fat distribution on my stomach.

I thought I wanted it and begged my surgeon for a year. Now it's probably going to be the reason I end things. Think very carefully.

—xnyvbb, detrans female

No. It was extremely invasive, complications had me hours from death. 3+ years later it's the main reason my body feels so grotesque to me — clothes look awkward and are difficult to fit. If you're not super thin (= making a flat chest pretty much unnoticeable), it's near impossible to wear anything that opens up on the chest. I still don't have sensation in my nipples. They look bad, flat and it was supposed to be one of the top private surgeons in this country. To be completely honest, in terms of comfort, my chest causes me trouble and pain every day. I hated wearing bras too, I thought I hated my bigger breasts, but I'd do anything to have my body back.

—isteponmushrooms, detrans female

I had a lot of body issues before my surgery and during my transition, I chalked up a lot of it to needing to further myself into transition. Now, my breasts from binding really got messed, they were not pretty and I'm also over weight so when I had surgery I thought Id feel free. I just felt really weird. Empty. The bandages came off and my nipples looked awful. After healing a lot of my nipple fell off so now their sad little areolas, my scars are dark and unfortunately keloided, there's patchy areas where I can't feel anything and I doubt it's coming back since it's been a year. Also it didn't change my self hate, I got a flat chest to hate on now rather than my sad floppy chest.

—s1lk7, detrans female

Age and consent

A recurring theme is having been young, uncertain, and not adequately challenged by the surgical team.

I had top surgery at 16. I remember my surgeon asking me are you sure a few times and I remember not being sure and very quietly mumbling yes. No one was here for me. I'm 21 now and regret everything. But sometimes you just gotta accept it and make peace or you will be miserable. I do wake up depressed most days but I'm working on it. I had an eating disorder at 15 that magically went away one day and I didnt see myself as fat anymore. It was weird. Like a light switch. Same shit happened with the trans shit. I woke up one day feeling way different.

—gurodog, questioning own transgender status

Wasn't severely mentally ill, but I had top surgery at 19 and it's insane looking back that I was allowed to make that decision that young. I wasn't thinking about my future or my connection to my body at 19 at all. And you're right, amputation surgery is what it should be called because that's what it is. "Top surgery" kind of takes away from the seriousness of it all.

—noworm, detrans female

I had zero doubts. I was nineteen. But since then, I've detransitioned. If I had to give you advice, I'm not sure if I would be able to give you a straight answer. I do not regret it, yet I still miss my breasts. It's equally as freeing as it is disappointing. I've had to make peace with my new body and I wouldn't get reconstruction surgery because of this fact. It is possible to love yourself just the way you are. You do not need any surgeries or medical interventions of any kind to be at peace with yourself.

—Lusin3577, detrans female

Loss of function and future grief

For many years, I had the phantom limb syndrome. I expected my body parts to be there, I felt like they were there, but then they weren't. I felt tremendous trauma. Touching my chest, even a decade later, is painful. There is trauma in the tissues. When I reached 30, I experienced an overwhelming feeling to want to have a child and breastfeed — not possible. I felt desire to share my breasts with a sexual partner, something I had never experienced, but because I had surgery, I never got to experience what it is like to share my breasts with someone, and feel them touch them lovingly. I fantasized about what it would be like to share them, only to wake up from the fantasy to realize I took it way from myself. This has caused me so much grief, despair, hatred, and envy.

—blueyedreamr, detrans female

I'm sorry that it triggers you OP but when I agonize, I don't agonize over being flat chested. I agonize over having scars, nerve damage, not being able to breast feed, having no feeling in my chest, and seeing horror when I look in the mirror because it's not what it looked like before. You will never understand what it feels like to have undergone that kind of surgery or it's effects and be grateful that you never will.

—noworm, detrans female

The breastfeeding dimension has a published case study: a detransitioned woman who became pregnant after chest masculinization and experienced profound grief at her inability to breastfeed, compounded by maternity providers who did not understand her situation (Gribble et al. 2023).

Detransitioners who do not regret it

Honesty requires representing the other side. Some detransitioners describe top surgery positively:

Honestly, it was the best decision I ever made. I did it in my thirties so I had plenty of time to reach that point. It turns out all my dysphoria was just linked to my chest and having a masculine one was the only gender affirming thing I needed. If anything, it made me return to womanhood fully and happily. I'm just a flat chested queer woman and I get to exist. Give it years and years, and don't rule out a reduction if size is physically bothersome. And I really mean years and years.

—baffledpancake, detrans

I'm completely happy and comfortable with my top surgery and don't regret it at all. I forget what it was like to have breasts or what they look like on my body because my chest looking the way it does now feels so natural for me. I have a lot of empathy for other detrans women who deeply regret their mastectomies, but I really can't relate. The biggest sign for me before the mastectomy that it was the right choice was that I've felt uncomfortable with my breasts ever since they first developed… The fact that my desire for a mastectomy existed very strongly entirely separate from identifying as a man meant that when I eventually detransitioned, not being a man anymore didn't suddenly make me wish I had breasts again.

—knifedude, detrans lesbian

I have no relationship to the breasts that I don't have. It was an unnecessary surgery but I still think my body looks good with or without them.

—oldtomboy, detrans

Notice what the non-regretting accounts have in common in these samples: the desire for a flat chest predated and was independent of the trans identification, the surgery was in adulthood rather than adolescence, and the physical result was good. These are not guarantees — they are patterns in a self-selected sample.

Reconstruction after detransition

Some detransitioners pursue breast reconstruction; many do not. Reconstruction is itself a major operation with its own complications, and results are not the same as the original tissue.

I got a double mastectomy at 19, and then implants a few years later when i detransitioned. Went well, they look 100% normal in clothes and the scars don't show too badly, although i am looking at further procedures to reduce scarring (and also change the areolas).

—brundlefly93, detrans

Honestly if I could go back and get recon again I don't know that I would and I certainly would go with fat grafting over implants. I have under the muscle implants. It helps with regret feelings a BIT. BUT it's not breasts. It's not a functioning organ that tells me about my body and hormones and responds to touch and feeds my kid. It's a lump of silicon shoved under my pecs that hurts and causes strain on my muscles and I am constantly aware of. I can't move in certain ways any more and I am still grieving the loss of my breasts.

—thisonesathrowawway, detrans female

I had a mastectomy in my early twenties and it was botched so I cannot even get reconstruction such as implants or fat transfer, my only chance to have any kind of shape there is a pap flap surgery which is wildly expensive.

—AtmosphereNo4232, detrans female

Practical points that recur in these accounts: breast tissue removed in a mastectomy does not regenerate; some residual fat may redistribute with hormonal change but will not restore a breast; reconstruction options include implants, fat grafting, and flap procedures, each with trade-offs; and cost or insurance coverage is a real barrier.

Trans perspectives

Trans-identified people who are satisfied with top surgery describe it in strong terms — and several also make the point that risks are under-discussed within trans spaces.

I hated my chest for years and as a small guy (I'm only 4'10") with a huge chest (DD - DDD), binding was only partially successful in hiding it. Top surgery was a life saver — I finally felt more comfortable with my body, my clothes fit better, I didn't hate looking in the mirror, etc. That said, like any surgery or hormone, it isn't a cure all. There are certainly days (even 10+ after top surgery) where dysphoria pops up and I feel really uncomfortable and "booby" in all my shirts.

—Silverblatt, ftm

No. I'd prefer to have a flat chest with no scars, but I'd take a flat, scarred chest over the hellish dysphoria (and binding discomfort and skin infections and backache and inability to run/exercise comfortably and under moob sweat etc) I experienced before top surgery. I'm currently undergoing scar reduction treatment, but even without that, top surgery was a literal huge weight off my chest.

—Altaccount_T, ftm

From a trans commenter listing the risks for someone considering surgery — a list that reads much like what detransitioners say they wish they had heard:

Possible risks and complications of chest recontouring surgeries (seen in about 12% of these surgeries) include but are not limited to: bleeding, infection, unsatisfactory permanent scarring, hypopigmentation of the nipple areola area graft, chest unevenness/asymmetry, wound separation, partial or complete loss of nipple and areola, loss of nipple sensation, loss of erectile function, erotic sensation (permanent with free nipple grafting), hypersensitivity or pain of chest skin, nipple and areola which could be permanent, blood clots, difficult psychological adjustment, negative impact on relationships, no assurance of achieving the desired size/shape, need for revision or further surgery (1 out of 3 patients require additional procedures).

Apart from that I think often little focus is given to the permanent inability to ever breastfeed kids if you ever end up having them. Many people think in their teens they'll never want to have kids, but then change their mind when they're around 30, and not being able to breastfeed is a loss you might underestimate when you're young.

—HHGodbod, desisted male

One trans commenter describes a friend who later sought revision for an overly flat result:

A close friend of mine got top surgery and at the time, was just like "get all that tissue out, all of it", not quite accounting for the fact cis guys typically have pecs. They're a bigger person, so an entirely flat chest doesn't look/feel right to them and they've asked their surgeon (a few years after getting top surgery) if there were options for adding anything extra back in there.

—sugarskooma, ftm

Questions worth asking before surgery

Drawn from the accounts above — not medical advice, just the things people in these threads consistently say they wish they had thought about:

• Am I certain, or am I managing doubt? If you are posting on a forum asking whether to go through with it, that is itself information.
• How old am I, and how stable has my identity been over the last several years?
• Have I explored whether the discomfort is about breast size, early development, sexualisation, or trauma — rather than about having breasts at all? Would a reduction or a lift address it with less permanence?
• Do I want children, and have I thought seriously about breastfeeding as a possible future desire rather than an abstract one?
• What is the realistic complication rate for my specific technique and my specific surgeon — not the best-case number?
• What happens if I hate the result? What would revision or reconstruction actually involve, and what would it cost?
• Have I talked to people who regretted it, not only people who were satisfied?

If you have had a mastectomy and are detransitioning, the support directory lists gender-exploring therapists and detrans support groups, some with specific experience of post-surgical detransition and reconstruction decisions.

References

• Gribble, K. D., Bewley, S., & Dahlen, H. G. (2023). Breastfeeding grief after chest masculinisation mastectomy and detransition: A case report with lessons about unanticipated harm. Frontiers in Global Women's Health. study page, source.
• Cohn, J. (2023). The Detransition Rate Is Unknown. Archives of Sexual Behavior. study page, source.
• Bustos, S. S., et al. (2021). Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Plastic and Reconstructive Surgery – Global Open. source.
• Bruce, S. D., et al. (2023). Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy. JAMA Surgery. source.
• Masculinizing chest surgery for gender affirmation: A retrospective study of outcomes and patient reported satisfaction (2021). Annals of Surgery. source.
• Incidence of Complications in Chest Wall Masculinization for the Obese Female-to-Male Transgender Population: A Case Series (2021). Cureus. source.
• Chest Masculinization Technique and Outcomes in 72 Double-incision Chest-contouring Procedures with Free Nipple Grafting (2022). Plastic and Reconstructive Surgery – Global Open. source.
• Female-to-Male Chest Surgery in Transgender Patients: A Comparison Between 2 Different Techniques and a Satisfaction Study in a Single Center (2024). Journal of Clinical Medicine. source.
• Masculinizing chest wall gender-affirming surgery: Clinical outcomes of 73 subcutaneous mastectomies (2023). Journal of Plastic, Reconstructive & Aesthetic Surgery. source.
• Hematoma Following Gender-Affirming Mastectomy: A Systematic Review of the Evidence (2022). source.
• Nipple-areola complex reconstruction in transgender patients undergoing mastectomy with free nipple grafts: a systematic review (Bustos et al.). Annals of Translational Medicine. source.