It can be difficult to find affirming, inclusive information about gender-affirming care in our increasingly anti-trans environment. However, if you know people who have had top surgery or have ever browsed an online group of people sharing photos of their first day wearing a favorite shirt with their new flat chest, you know that gender euphoria is a possibility.
You’ll find a wealth of information below, covering everything from surgical techniques and the insurance approvals process to surgery preparation and recovery.
What is top surgery?
According to the American Society of Plastic Surgeons, top surgery is a gender-affirming surgical procedure that flattens and “masculinizes” the chest. People who have this surgery, who are frequently transgender, transmasculine, and/or nonbinary, want to surgically alter their chests to better fit their gender. Unlike a mastectomy, which involves removing as much breast tissue as possible in order to prevent or remove cancer, top surgery can include chest contouring and customizing the placement and appearance of the nipples.
There are several different types of top surgery techniques, and a surgeon considers several factors, such as chest size, skin elasticity, and whether the person wants to keep nipple sensation, before recommending one for a specific person.
Will my insurance cover top surgery?
Insurance is increasingly covering top surgery, which can cost anywhere from $5,000 to $10,000 out of pocket.
Review your coverage documentation to determine your insurance coverage for gender-affirming top surgery.
If you have private insurance through an employer or through Healthcare.gov, your plan documents should list in-network providers who can perform the surgery, and one may offer partial coverage for an out-of-network provider. If you choose this option, you may be billed directly and must then seek reimbursement from your insurance company.
If you have Medicaid, your surgery may be covered, depending on where you live.
What if I don’t have health insurance?
Not everyone who wants top surgery has insurance or can get their carrier to cover it. In 2020, 31.6 million Americans, or nearly 10% of the population, were uninsured. Furthermore, transgender people have higher unemployment and poverty rates than cisgender people, making them more likely to be uninsured or underinsured.
If you fall into this category, one option is to look for community funding to cover the cost of the procedure as well as associated costs such as transportation and meals while you recover. You can apply for grants such as Point of Pride’s Annual Trans Surgery Fund and the Jim Collins Foundation grant. Another option, though no one should have to do it, is to use crowdfunding to fund your surgery.
Does my top surgery need to be “approved” in some way?
You should be familiar with WPATH: The World Professional Association for Transgender Health is a professional organization made up of clinicians and researchers from medicine, psychology, law, social work, counseling, psychotherapy, nursing, and other fields who are interested in understanding and treating gender dysphoria.
They publish the Standards of Care (SOC), a comprehensive document that contains clinical guidance for healthcare professionals who treat transgender and gender-diverse people. The SOC is meant to “assist in providing a framework” for how healthcare providers should provide gender-affirming treatment.
The SOC makes recommendations on what criteria a person should meet before receiving gender-affirming care, such as hormone therapy or surgery.
Although healthcare providers and insurance companies are not required to adhere to the SOC, many do. As a result, your surgeon’s office may require you to meet some (or all) of the SOC’s surgical criteria. Unfortunately, many surgeons will not proceed without proof that certain criteria have been met.
How do I find a good surgeon?
First, ensure that any prospective surgeons are board certified in plastic surgery and meet the rest of the American Society of Plastic Surgeons’ criteria. Consider hiring a surgeon who has experience not only as a plastic surgeon but also with top surgery and who has the best toolbox for performing multiple types of procedures to achieve top surgery.
In addition to ensuring that a surgeon has the necessary training and certifications, pay close attention to the overall vibe: Consider the surgeon’s bedside manner and personality; whether the staff appears to be trained to provide affirming care, and whether it is challenging to schedule an appointment or reach the front desk staff. When you schedule a consultation, which is usually the first step in pursuing top surgery, you’ll be able to get a sense of some of these.
