FTN Top Surgery: Your Journey to an Authentic, Androgynous You21 min read

Dreaming of a chest that feels authentically you—not just masculine, but perfectly neutral? You’re not alone in seeking a result that honors your non-binary identity, and finding a surgeon who truly understands is the critical first step.

What is FTN Top Surgery? More Than Just a Flat Chest

FTN (Female-to-Non-Binary) top surgery is a specialized form of chest masculinization or contouring designed specifically for individuals who identify outside the gender binary. Unlike traditional FTM (Female-to-Male) procedures that typically aim for a completely flat, conventionally masculine chest, FTN surgery is highly customized to achieve a result that aligns with an individual’s unique sense of self, which may be androgynous, neutral, or otherwise non-binary. The primary goal is not simply tissue removal but the intentional shaping of a chest that affirms the patient’s specific identity. This requires a nuanced surgical approach that considers factors beyond simple flatness, focusing on creating a contour that feels authentic to the individual.

Understanding Non-Binary Chest Contouring

The aesthetic goals of FTN top surgery are diverse and deeply personal, reflecting the spectrum of non-binary identities. A surgeon experienced in these procedures understands that the objective is to create a chest that resolves gender dysphoria by matching the patient’s internal body map, which may or may not be traditionally masculine. This level of customization is the defining feature of the procedure. The surgical plan is developed in close collaboration with the patient to ensure the final outcome is congruent with their identity.

• Reduced Breast Projection: Many patients desire a significant reduction in breast tissue without aiming for a completely concave or flat appearance.
• Androgynous Contouring: The surgeon may strategically leave a small amount of tissue to create a softer, more androgynous chest shape rather than a defined pectoral muscle look.
• Nipple-Areola Complex (NAC) Customization: The size, shape, and placement of the nipples and areolas are critical for achieving the desired aesthetic, with options ranging from reduction and repositioning to complete removal.
• Minimized Scarring: Whenever possible, techniques are chosen to minimize visible scarring or place incisions in locations that align with the patient’s aesthetic goals.

The Importance of Individualized Goals

Effective communication between the patient and surgeon is the cornerstone of a successful FTN top surgery. Because there is no single “non-binary” chest appearance, the consultation process is an in-depth exploration of the patient’s desires, anxieties, and aesthetic preferences. A successful outcome depends entirely on the surgeon’s ability to translate the patient’s verbal descriptions and visual aids into a concrete surgical plan. This collaborative process ensures that the result is a source of affirmation, not a new source of incongruence.

• Using Reference Photos: Patients are encouraged to bring photos that show examples of chest shapes, nipple placements, or scar types they find appealing.
• Describing Feelings: Articulating how one wants to feel in their body (e.g., “neutral,” “unrestricted,” “able to be shirtless”) can be as helpful as describing a physical appearance.
• Discussing Anatomical Possibilities: The surgeon will explain what is surgically possible given the patient’s existing anatomy, skin elasticity, and tissue volume.
• Setting Realistic Expectations: A thorough consultation ensures the patient has a clear understanding of the likely outcome, including scar maturation and the final chest contour.

The Risk of an Incongruent Result: Why a Standard FTM Procedure May Not Be Your Goal

The most significant risk for a non-binary individual seeking top surgery is undergoing a procedure that does not align with their identity. A standard FTM surgery, while ideal for many trans men, can result in a chest that feels just as incongruent as their pre-surgical chest, creating a new form of dysphoria. This occurs when the surgical goal is assumed to be maximum flatness and a traditionally masculine contour, which may not be the patient’s objective. Failing to achieve an authentic result can have profound psychological consequences and may necessitate costly and physically demanding revision surgery. Choosing a surgeon with specific expertise in non-binary procedures is critical to mitigating this risk and ensuring the outcome is affirming.

When “Flat” Isn’t the Only Answer

The assumption that all top surgeries should result in a perfectly flat chest is a misunderstanding of non-binary identities. For many, the goal is a reduction or reshaping that creates a neutral or androgynous form. A chest that is “too flat” or overly sculpted to mimic male pectorals can feel alien and misaligned with their sense of self. Understanding the subtle but critical differences in surgical goals is essential for patient satisfaction and psychological well-being. The table below highlights key distinctions in approach.

The Psychological Impact of an Unintended Outcome

Receiving a surgical result that does not match your identity can be deeply distressing. Instead of alleviating dysphoria, it can replace it with a different, equally painful feeling of bodily incongruence. This can undermine the entire purpose of the surgery, which is to feel more at home in one’s body. The emotional toll can be significant, impacting mental health, social confidence, and overall quality of life. It underscores the importance of a meticulous pre-operative planning phase.

• Persistent Gender Dysphoria: The patient may continue to experience distress related to their chest, just for different reasons.
• Body Image Dissatisfaction: The new chest shape may feel “wrong” or “unnatural,” leading to poor body image and self-esteem.
• Social Anxiety: The individual may feel their chest “outs” them in a way they did not intend, or that it does not reflect how they wish to be perceived.
• Regret and Disappointment: The emotional weight of having undergone a major surgery without achieving the desired relief can be immense.

Avoiding Revision Surgery

Revision surgery is a viable option for correcting an incongruent result, but it presents its own set of challenges. It involves another surgical procedure with associated risks, recovery time, and financial costs. The most effective strategy is to avoid the need for revision in the first place by carefully selecting a primary surgeon. A surgeon who demonstrates a clear understanding of non-binary aesthetics and who actively listens to your goals is your greatest asset. Their portfolio should reflect an ability to produce a range of outcomes, not just one standard result.

• Seek a Specialist: Look for surgeons who explicitly mention non-binary or FTN top surgery in their practice.
• Review Photo Galleries: Scrutinize their before-and-after photos for a variety of chest contours, not just traditionally masculine ones.
• Ask Direct Questions: During the consultation, ask the surgeon how they approach non-binary procedures differently from FTM procedures.
• Trust Your Instincts: Ensure you feel heard, respected, and understood throughout the consultation process.

A Journey of Authenticity: Alex’s Story

The path to gender-affirming surgery often begins with a deep-seated feeling of disconnect between one’s body and internal identity. For many non-binary individuals, this journey involves not only the decision to pursue surgery but also the critical process of defining what an “authentic” body looks and feels like for them. This illustrative narrative explores a common decision-making process.

Initially, the primary goal might seem simple: to alleviate the dysphoria caused by a chest that feels fundamentally wrong. However, as research begins, it becomes clear that the standard surgical options may not be the right fit, prompting a deeper exploration of personal identity and aesthetic desires.

The Search for the Right Procedure

The initial phase of research often involves looking at the results of standard FTM top surgery. While inspiring for many, for some non-binary people, the realization dawns that a completely flat, masculine chest is not their goal. This can be a confusing and isolating moment, leading to the question: “Is there a surgical option for me?”

This is where the search shifts toward surgeons and techniques that offer customization. It becomes a process of learning a new vocabulary—contouring, tissue preservation, nipple-sparing techniques—and understanding that surgery can be a tool for nuanced sculpting, not just removal.

• Analyzing Photo Galleries: The focus shifts from looking for “flatness” to identifying subtle contours, nipple placements, and incision shapes that feel right.
• Reading Patient Accounts: Learning from the experiences of other non-binary individuals provides insight into what is possible and what questions to ask.
• Identifying Potential Surgeons: A shortlist is created of surgeons whose work demonstrates versatility and an understanding of androgynous aesthetics.
• Preparing for Consultations: Questions are formulated that go beyond “What technique will you use?” to “How can we work together to create a specific shape?”

Defining a Personal Aesthetic

The most empowering part of the journey is often the process of defining one’s own ideal chest. This is an introspective exercise that moves beyond binary ideals of male and female bodies. It involves envisioning a body that feels like home, free from the constraints of conventional gender presentation. This process is not about conforming to a new ideal but about creating a physical form that reflects a unique identity. It is a deeply personal and creative act of self-actualization.

• Gathering Visual Inspiration: This may include not only post-surgical photos but also anatomical drawings, art, or images of cisgender people whose chest shape is appealing.
• Considering Nipple and Areola Options: A crucial decision is made about the nipples—whether to keep them, resize them, reposition them, or remove them entirely for a smooth, neutral look.
• Mapping Scar Placement: The shape and location of incisions are considered, with a preference for scars that can be easily concealed or that follow the body’s natural lines.
• Communicating the Vision: The final step is to bring this well-defined vision to a surgeon, ready to have a collaborative discussion about turning that vision into a reality.

Crafting Your Ideal Chest: Key Surgical Considerations for Non-Binary Results

Achieving a truly affirming non-binary chest contour requires a surgeon to act as both a technician and an artist. The procedure is not a one-size-fits-all operation but a highly customized process tailored to your anatomy and aesthetic goals. The choice of surgical technique and its specific modifications are determined during your in-depth consultation. Several established surgical techniques can be adapted to meet non-binary goals. The key is how these techniques are applied—for instance, how much tissue is left for contouring and how the nipple-areola complex (NAC) is handled. Your surgeon’s experience with these modifications is paramount to a successful outcome.

Surgical Techniques for Androgynous Contouring

While many of the same foundational techniques from FTM surgery are used, the application is different. The surgeon’s focus is on creating your desired shape, which may involve preserving tissue in specific areas to avoid a “scooped out” or overly flat appearance.

The choice of technique often depends on your chest size, skin elasticity, and specific goals.

• Double Incision Free Nipple Graft (DI): This is the most common technique for larger chests. For a non-binary result, the incisions may be shaped differently (e.g., straight instead of curved), and a specific amount of tissue may be left behind to create a soft, androgynous mound.
• Periareolar or Keyhole: These techniques are suitable for smaller chests with good skin elasticity. They use small incisions around the areola or underneath it, resulting in minimal scarring, which is ideal for patients who prioritize avoiding visible scars.
• Buttonhole or Nipple-Sparing DI: These techniques preserve the nipple stalk, potentially maintaining more sensation. They can be an excellent option for achieving a reduction and lift while keeping the original nipple.
• “Lollipop” or Vertical Incision: This technique involves an incision around the areola and another vertically down to the chest fold. It allows for significant tissue removal and reshaping with less scarring than a full double incision.

Nipple and Areola Customization

The appearance and placement of the nipples and areolas are critical components of the final aesthetic. For non-binary individuals, there is a wide spectrum of preferences, and customization of the NAC is a key part of the surgery. This aspect of the procedure should be discussed in detail with your surgeon. Your options are not limited to a standard “male” nipple appearance. The goal is to create a NAC that feels congruent with your identity.

The Crucial Role of the Surgical Consultation

Your surgical consultation is the most important step in the planning process. It is a dedicated time for you to express your goals and for the surgeon to assess your anatomy and explain your options. This is a collaborative meeting to design your ideal outcome. Come prepared to have an open and honest conversation. The more information you can provide about your desired result, the better your surgeon can tailor a plan to meet your needs.

1. Gather Reference Photos: Bring images that illustrate the chest contours, nipple sizes, and scar placements you prefer. This provides a clear visual language for your discussion.
2. Write Down Your Goals: Make a list of your aesthetic objectives. Use descriptive words like “softer,” “flatter but not concave,” “neutral,” or “androgynous.”
3. List Your Questions: Prepare questions about the surgeon’s experience with non-binary patients, the techniques they recommend for you, recovery expectations, and potential risks.
4. Discuss Your Lifestyle: Talk about your activity levels and clothing preferences, as this can help inform the surgical plan to ensure the result fits your life.

The FTN Recovery Path: What to Expect

The recovery from FTN top surgery is a phased process that requires patience and adherence to post-operative instructions. While the timeline can vary based on the surgical technique used and individual healing factors, a general framework applies. Properly managing your recovery is crucial for optimal healing, comfort, and achieving the best possible aesthetic result. Your surgical team will provide you with detailed, personalized instructions for every stage of the process. Following these guidelines closely will help minimize complications and ensure your scars heal well.

The Initial Recovery Phase (Weeks 1-2)

The first two weeks are the most intensive part of recovery. Your primary focus will be on rest, pain management, and caring for your surgical sites. Mobility will be significantly limited, especially in your arms and upper body, to protect the incisions. During this time, you will likely have surgical drains in place to prevent fluid buildup and will be required to wear a compression binder.

• Pain and Swelling Management: You will be prescribed pain medication to manage discomfort. Swelling is normal and will be most pronounced in the first week.
• Drain Care: If you have drains, you will be taught how to empty them and record the output. They are typically removed within the first 7-10 days.
• Compression Garment: A post-surgical binder must be worn continuously as instructed to reduce swelling and support the healing tissues.
• Activity Restrictions: You must avoid reaching, lifting anything heavier than a few pounds, and strenuous activity. Most patients need to take at least two weeks off from work or school.

Intermediate Recovery (Weeks 3-6)

After your first major post-op appointment (usually around one week), you will begin to feel more comfortable and mobile. During this phase, you will gradually be cleared to resume light activities. The focus shifts to scar care and listening to your body’s limits. Swelling will continue to decrease, and you will start to see a clearer picture of your new chest contour.

• Returning to Light Activity: You can typically resume walking and other gentle activities. Driving may be permitted once you are off prescription pain medication and have sufficient range of motion.
• Compression Weaning: Your surgeon will advise you on when you can start spending time out of the compression binder, eventually discontinuing its use.
• Initiating Scar Care: Once the incisions are fully closed and any surgical tape is removed, you can begin scar care protocols, which may include silicone strips or gels and gentle massage.
• Continued Lifting Restrictions: You will still need to avoid heavy lifting (typically over 10-15 pounds) and strenuous upper body workouts to prevent straining the healing muscles and incisions.

Long-Term Healing and Results (6 Months and Beyond)

The healing process continues for many months after surgery. While you will be back to most of your normal activities after about six weeks, your final results will take time to fully emerge. Scars will mature and fade, and any residual swelling will resolve. Patience is key during this final phase. The chest contour will continue to settle and soften over the first year.

• Scar Maturation: Scars will initially appear pink or red and may be raised. Over 6-18 months, they will flatten, soften, and fade to a lighter color.
• Sun Protection: It is critical to protect your scars from sun exposure for at least the first year to prevent them from darkening permanently. Use a high-SPF sunscreen or keep them covered.
• Return of Sensation: Numbness in the chest and nipples is expected. Sensation may gradually return over months or even years, but some permanent changes are possible.
• Final Contour: The final shape of your chest will be apparent by about the six-month mark, with subtle refinements continuing for up to a year as tissues settle completely.

“I Finally Recognize Myself”: A Patient’s Perspective

The ultimate goal of FTN top surgery is to achieve a state of congruence, where one’s physical form aligns with their internal sense of self. This alignment provides a profound sense of psychological relief and embodiment that can be life-changing. For many, looking in the mirror post-surgery is the first time they truly recognize the person looking back. This experience goes far beyond simple cosmetic satisfaction. It is about resolving the deep, persistent distress of gender dysphoria and finally being able to exist comfortably and authentically in one’s own body.

Alleviating Gender Dysphoria

Gender dysphoria is the clinically significant distress or impairment caused by the incongruence between one’s assigned sex and gender identity. A chest that does not align with one’s identity can be a constant and painful source of this distress. Surgical affirmation is a medically necessary intervention that directly addresses and alleviates this condition. The reduction or elimination of this daily burden on mental health is one of the most significant benefits of the procedure. Clinical evidence consistently shows that gender-affirming top surgery leads to measurable improvements in mental well-being.

• Reduced Anxiety and Depression: Many patients report a significant decrease in symptoms of anxiety and depression following surgery.
• Increased Self-Esteem: Living in a body that feels like one’s own fosters a stronger sense of self-worth and confidence.
• Improved Social Functioning: With reduced dysphoria, individuals often feel more comfortable and confident engaging in social situations, from dating to professional interactions.
• Decreased Suicidal Ideation: For those experiencing severe dysphoria, top surgery can be a life-saving treatment that drastically reduces the risk of self-harm and suicide.

The Experience of Embodiment

Embodiment is the feeling of being “at home” in your body—of your physical self being an accurate and comfortable vessel for your identity. Before surgery, many non-binary individuals feel disconnected from their bodies, as if they are operating a machine that isn’t theirs. Top surgery can bridge this gap, creating a unified sense of self. This newfound feeling of embodiment permeates every aspect of daily life, removing barriers and creating a sense of freedom that was previously unimaginable.

• Freedom in Clothing: The simple act of putting on a t-shirt without the need for a binder or the anxiety of a visible chest can be incredibly liberating.
• Comfort in Physical Activity: Activities like swimming, running, or going to the gym are no longer sources of dysphoria, allowing for a healthier and more engaged lifestyle.
• Increased Physical Presence: Many people report feeling more present and grounded in their bodies, able to focus on the world around them rather than on their own physical discomfort.
• Authentic Self-Expression: With the physical barrier removed, individuals can express their gender identity more freely and authentically through their style, posture, and presence.

Your Journey Starts Now: Take the Next Step

Making the decision to pursue FTN top surgery is a significant step toward living a more authentic and congruent life. The journey is a collaborative one between you and your surgical team, designed to translate your unique identity into a physical reality. The process begins with a comprehensive, private consultation where your goals are the central focus. This initial meeting is an opportunity to explore your options, ask questions, and determine the best surgical path for you without any pressure or commitment. It is the foundational step in creating a plan that is tailored specifically to your body and your vision.

Your Personalized Surgical Plan

There is no standard template for FTN top surgery because there is no standard non-binary identity. Your procedure will be designed from the ground up to meet your specific aesthetic goals. During your consultation, we will work together to create a detailed surgical plan that addresses tissue contouring, nipple and areola customization, and incision placement. Our clinical team is experienced in the nuances of non-binary chest contouring and is dedicated to providing a safe, respectful, and affirming environment. We are committed to understanding your vision and using our surgical expertise to help you achieve it.

• In-depth Goal Assessment: We will discuss your desired outcome in detail, using your reference photos and descriptions as a guide.
• Thorough Anatomical Evaluation: The surgeon will assess your chest tissue, skin quality, and underlying musculature to determine the most effective surgical techniques.
• Technique Recommendation: You will receive a clear recommendation for the surgical approach best suited to achieve your goals, with a full explanation of the pros and cons.
• Transparent Discussion: We will cover all aspects of the procedure, including the recovery process, potential risks, and expected results, ensuring you can make a fully informed decision.

How to Prepare for Your Consultation

To make the most of your consultation, a little preparation can go a long way. Coming to your appointment with clear information and questions will facilitate a productive and empowering conversation. This is your opportunity to take an active role in designing your surgical outcome. Follow these steps to ensure you are ready for a successful consultation.

1. Document Your Goals: Collect images that reflect your desired chest shape, nipple appearance, and scar placement. Write a few notes describing your ideal result to help you articulate your vision clearly.
2. Compile Your Medical History: Make a list of any current and past medical conditions, previous surgeries, medications you are taking (including supplements), and any known allergies.
3. Prepare Your Questions: Write down all your questions for the surgeon. No question is too small. This can include inquiries about their experience, specific techniques, recovery details, or costs.
4. Schedule Your Appointment: Contact our office to book your confidential consultation. Our patient care team is ready to assist you in scheduling a time to meet with our surgeon and begin your journey.

Frequently Asked Questions about ftn top surgery

How do I ensure a surgeon understands I want a non-binary result, not a standard male chest?

Clearly articulate your specific goals during the consultation. Discuss the degree of flatness, the amount of tissue you may want to retain, and the overall contour you envision. A surgeon’s ability to engage in a detailed conversation about these nuances will demonstrate their understanding of your objectives.

What surgical outcomes are possible besides a completely flat chest?

A range of contours can be achieved. Options include a significant breast tissue reduction that retains a soft, non-masculine contour, or a chest shape tailored to your specific goals. The final result is determined by your anatomy and the surgical plan established with your surgeon.

Should I bring photos to my consultation to show my desired chest shape?

Yes, reference photos are an effective communication tool. Collect images that show specific elements you prefer, such as chest contour, nipple-areola complex size and position, or incision shape. This provides a clear visual guide for your surgeon during the planning process.

How can I find a surgeon who has experience with non-binary patients?

Review a surgeon’s professional website and photo gallery. Look for specific language that addresses non-binary or gender-affirming procedures and a portfolio that showcases a variety of chest contouring results beyond traditional masculinization. This indicates experience with diverse patient goals.

Aisha Williams

In the PACU, my world revolves around safely emerging patients from general anesthesia, managing their pain, and ensuring vitals are stable. I constantly address post-op concerns, especially ‘Can I fly soon?’, explaining the physiological risks of DVT and barotrauma based on the specific type and duration of their surgery.