What top surgery means

Top surgery is the colloquial term for chest masculinisation mastectomy — the surgical removal of breast tissue, performed on biological females as part of gender transition. It is one of the most common gender-affirming surgeries, and one of the most irreversible.

Detransitioners who have had top surgery describe a range of outcomes — from grief and phantom sensations to complications, regret, and the difficult process of reconstruction.

What detransitioners describe

Grief and loss

Please do not do it if you are feeling any uncertainty at all. I was completely sure it was what I wanted when I got the surgery four years ago at age 20, and now every day I grieve the loss of my breasts. Nobody ever wants to hear this when they're your age, but it's true—you are so young. Your brain hasn't finished developing. … Sometimes I just clutch my chest and cry, my hands fumbling desperately across my skin to feel even some phantom sensation of what I've lost. —thefuryofsilence, detrans female.

PLEASE think about this…. I fucking miss my tits. —ThatGirlChyna, detrans female.

Hi OP I'm in the same situation as you and it's a struggle everyday. I miss my breasts and every second I'm awake it feels like a part of me is missing. I wear prosthetics and I'm nowhere near as suicidal as I used to be. I'm also looking into breast reconstruction options. I wish I never had top surgery. I was only on T for half a year and the doctor somehow thought I was mentally stable even though I was taking 8 different psychotropics. —adisillusionedtruth, detrans female.

Complications and physical reality

I had a alot of body issues before my surgery and during my transition … 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 alot of my nipple fell off so now their sad little areolas, my scars are dark and unfortunately kelioded, 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. … I miss my nipples man. —s1lk7, detrans female.

Absolutely not. And I say that as someone who used to get pain in my breasts and vomited when they were touched. The scars are still painful and I got my surgery in 2017. My nipples are even more painful. It is agonizing to have them touched or rub on anything. It feels like they're going to tear off. —PeregrinePanic, detrans female.

Breastfeeding grief

It's not about the appearance at all; it's about the fact that I needlessly harmed myself permanently. … The most obvious function of breasts is keeping precious infants nourished and fed. Not being able to do that for my child hurts more than anything in the world. In both relationships and in motherhood, I'm constantly at war with the fact that I am always lacking something that other women naturally have/can provide. —thebestdeskwarmer, detrans female.

A published case report documented this exact experience — a detransitioned woman who became pregnant after chest masculinisation mastectomy and experienced profound grief at being unable to breastfeed (Gribble, Bewley & Dahlen 2023).

Phantom sensations and trauma

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. —blueyedreamr, detrans female.

Breast reconstruction

Many detransitioners explore reconstruction. The options include implants, fat grafting, or a combination. Results vary, and none restore the original tissue.

I had a long period last year where I mourned and cried over my top surgery and the fact of not being able to (when i do eventually) become a mother, i won't be able to breastfeed. … Time had to happen to help me realize I want my breasts back (as much as I could), so I had gotten breast implants placed 9 months ago. The process of it was long, but so worth it. It's not for everyone, but it helped me. —visionarty2, detrans female.

Getting breast reconstruction absolutely helped me get back to my normal life again. I was deeply unhappy with my top surgery results and could barely look at myself in the mirror … Since getting reconstruction and putting myself out there more I've finally built the confidence I never had before or during transition. —875857, detrans female.

But reconstruction is not a reversal:

I hope you'll look through the posts here of detrans women struggling to deal with their mastectomies / top surgeries. Implants are not the same as mammary tissue. Neither is a fat transfer. This surgery is not the panacea it is touted as by plastic surgeons, and it is not reversible. —rose_creek, detrans female.

Sorry this is completely wrong. There is no way to get your breasts back. Once they're gone … all you can do is inject fat in the area or get silicone implants to look like them. They are no longer functional and breastfeeding is impossible. Not to mention all the permanent scarring and nerve damage that happens during top surgery. —oldtomboy, detrans female.

Access asymmetry

One detransitioner noted a striking disparity:

As a "trans boy" who was literally in treatment for psychosis at the same time and from the same organization, it was easy peazy to get top surgery. Now as a CIS woman, which is how I've identified for 17 out of 18 years, they are making it hell to try and get reconstruction. —burner357517510, detrans female.

What the research shows

A 2023 case report published in Frontiers in Global Women's Health documented the first published case of a detransitioned woman grieving her inability to breastfeed after chest masculinisation mastectomy. The authors noted that breastfeeding is rarely discussed in consent processes, despite the procedure almost certainly precluding it (Gribble, Bewley & Dahlen 2023).

A 2021 survey of 100 detransitioners found that 49% cited concerns about medical complications as a reason for detransition (Littman 2021).

A 2023 survey of 78 detransitioners found that 28% had undergone surgery, and that the majority felt inadequately informed about risks (Littman et al. 2024).

Limitations

There is no large-scale study of top surgery regret rates. The existing research relies on small self-selected samples, retrospective self-report, and case reports. The honest answer is that we do not know how common regret is — only that it exists and is described in detail by those who experience it.

What detransitioners wish they had known

If you have doubts about it now, think how you will feel in a week if you have lost parts of your body you can never, ever get back. … This isn't a life-saving medical procedure. It's elective surgery. Nothing bad will happen to you if you push it out a month, a year, a decade, or get it never. But if you go through with it, you could have a lifetime of regret and despair. —pekingnoodle, detrans female.

Postpone the surgery; you can always always have it later, but you can never take it back. The people who are telling you that your feelings are "deceptive" are telling you that because they have their own horse in the race - if they already had the surgery, that's the only narrative they can believe in anymore … —Grey-Skies-Silflays, detrans female.

Being so mentally detached from your body is a sign that something else is wrong, something else that should be addressed. That didn't happen out of nowhere. People aren't born detached from their bodies like that. It happens because something negative happened in regards to how you perceive your body. —Werevulvi, detrans female.

Related pages

• Hysterectomy — related surgical procedures
• Detransition — why people reverse transitions
• Informed consent critique — what consent should include
• Detransition — why people reverse transitions
• Gender exploratory therapy — exploring causes before surgery

References

• Gribble, Bewley & Dahlen (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.
• Littman (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of Sexual Behavior. study page, source.
• Littman, O'Malley, Kerschner & Bailey (2024). Detransition and Desistance Among Previously Trans-Identified Young Adults. Archives of Sexual Behavior. study page, source.