A Guide to Top Surgery in the UK

Top surgery, also known as gender affirmation surgery, is a form of cosmetic procedure that either removes or enhances the breast tissue for a more masculine or feminine appearance. The nipples and chest are also reshaped during the procedure to create a natural look for transgender and non-binary people.

Top surgery can be life-changing for our patients. It can give them a new sense of confidence and freedom and help them feel comfortable in their bodies, often for the first time. At Enhance Medical Group, we are proud to perform male-to-female (MTF) top surgery for our patients. Here, we explain how you can access gender affirmation surgery, how much it costs, what happens during the procedures, and the requirements and guidance for MTF surgery at Enhance Medical. Unfortunately, we don’t currently offer female-to-male (FTM) top surgery.

Types of top surgery

There are two types of gender affirmation procedures in the UK, female-to-male (FTM) and male-to-female top surgery (MTF). Both aim to align a person’s physical appearance with their gender identity. They are typically performed after hormone therapy and sometimes non-surgical procedures such as body contouring.

Male-to-female (MTF) surgery

Male-to-female top surgery, also known as feminising chest surgery, is a cosmetic procedure that uses breast augmentation to transform the male chest into female breasts as part of a gender reassignment. Many trans women take female hormones to encourage breast development. MTF surgery can be used instead of or in conjunction with that process to increase the size of the breasts and give them a more feminine-looking shape. 

Male-to-female top surgery can be performed using breast implants, fat transfer or both. The right option will depend on the patient’s aesthetic goals and the surgeon’s recommendations. 

• Implants

Depending on the tightness of the skin, tissue expanders may have to be used to stretch the skin before the implants can be inserted in a separate procedure. The implants will be inserted under the pectoral muscles in the chest to create feminine-looking breasts. Implants give patients more flexibility over the size and shape of their breasts and can provide a more significant increase in cup size than a fat transfer procedure. 

• Fat transfer

Alternatively, fat can be transferred from the abdomen or thighs and injected into the breasts to increase their size and fullness. Fat transfer tends to look and feel more natural as it uses the body’s own fat, although size increases are more subtle, with a maximum gain of around one cup size. 

Female-to-male (FTM) surgery

Female-to-male top surgery involves the removal of breast tissue and skin to create a flatter and more masculine chest. Also known as chest masculinisation surgery, the procedure involves the removal of breast tissue, fat and excess skin to create a natural-looking male chest.  As part of the procedure, the nipple and areola are usually removed and repositioned, and their dimensions can also be surgically reduced if necessary. 

Two main surgical techniques are commonly used in FTM surgery, with the most appropriate method depending on the size of the breasts and the level of skin elasticity. Both are typically outpatient procedures that are performed under general anaesthetic and take between three and four hours. 

• Periareolar

In a periareolar procedure, a circular incision is made around the edge of the areola. A second, larger circular incision is then made to create a doughnut-shaped segment of skin that allows the breast tissue to be removed. The surgeon will also use liposuction to provide additional contouring to the chest area.

This surgical method typically results in minimal scarring and leaves the nipple stalk intact. That helps to preserve nipple sensation and the natural appearance of the areola. This technique is best suited to individuals with small to medium-sized breasts who only require the removal of a moderate amount of skin. 

• Double incision

Patients with larger breasts or breasts that droop or sag are candidates for the double incision technique. A horizontal incision is made at the top and bottom of the chest muscle. The skin can then be pulled back to reveal the breast tissue, which is removed. The nipple is removed and resized before being reattached to the chest in a more masculine position. Liposuction may also be used to remove excess fat and contour the area.

The benefit of the double incision technique is that it enables the surgeon to perform substantial chest contouring and remove larger amounts of chest tissue. That can lead to a flatter and more masculine chest profile. 

Accessing top surgery in the UK

Gender dysphoria is the official name given to the feeling of distress and unease people feel when their biological sex does not match their gender identity. Treatment for gender dysphoria is available on the NHS. The treatment options offered by the NHS intend to help people live in their preferred gender identity or as non-binary.   

Adults with gender dysphoria are referred to a gender dysphoria clinic. There they can access psychological support, cross-sex hormone therapy and speech and language therapy. Not everyone chooses to have hormone therapy as it takes time to see results and patients must take the hormones for the rest of their lives to maintain them. 

Gender affirmation surgery becomes an option when patients have socially transitioned to their preferred gender identity for at least a year. At that point, the doctors at the gender dysphoria clinic can refer the patient to a private clinic for MTF or FTM top surgery. 

If you are seeking private care, the following criteria has to be met in order to access top surgery in the UK:

• A formal diagnosis by a qualified gender specialist, psychiatrist, or clinical psychologist. (Qualified here means a clinician who is registered with the appropriate body for their profession within the UK e.g. – GMC or HCPC).
• Lived continuously for at least 12 months in the gender role that is congruent with their gender identity and can evidence this via a healthcare professional.
• Evidence by the healthcare professionals supporting their transition, that the patient has access to mental health support for their surgical transition and if they have any existing or profound mental health concerns, they can evidence they have received active treatment for this and have had a period of stability with their mood for more than 3 months.
• Provide a referral/supporting letter recommending surgery from an NHS gender identity clinic, OR a private Gender Specialist

Can I get top surgery without taking hormones?

You do not need to be taking testosterone for masculinisation or oestrogen for feminisation to have gender affirmation surgery. Although hormone therapy can be effective, it is limited by factors such as genetics, and there are also several physical factors it cannot change, such as height and the broadness of a patient’s shoulders. There can also be concerns about side effects, such as weight gain and fertility issues. For some, that means hormone therapy is not the right course of action. 

Patients who choose not to take hormones can still have top surgery, and not taking hormones will not impact the results of the surgery in any way. 

How much does top surgery cost?

The cost of gender affirmation surgery differs depending on the type of surgery you have (FTM or MTF) and the specific techniques involved. 

• In the UK, the average cost of female-to-male top surgery is around £8,000, although it can range from £6,000 to £10,000.
• Male-to-female top surgery is generally cheaper, with average prices of around £6,500 for breast implants and £7,500 for fat transfer. 

At Enhance Medical, MTF top surgery costs start at £4,595. As we own our hospitals, and only use our dedicated in-house surgeons, we can pass our savings, such as overheads and agency fees, to our patients to ensure we can offer the best possible cosmetic surgery pricing and the best & dedicated care in the UK. We also offer monthly finance options.

Is top surgery free in the UK?

Patients who have been diagnosed with gender dysphoria may be eligible for female-to-male and male-to-female top surgery on the NHS. However, the waiting lists are long and patients can wait several years. 

That’s why some people choose to go private. At Enhance Medical, you can have your first consultation within days and we can perform the procedure within weeks to give you a significant boost in confidence and enhance your quality of life.

Requirements for Top Surgery with Enhance Medical

At Enhance Medical, patients must meet the following requirements in order to have top surgery:

• Step 1: a formal diagnosis of gender dysphoria
• Step 2: have lived continuously in their gender role for at least 12 months, evidenced by a healthcare professional
• Step 3: have evidence from a professional that they have the right support system in place for a successful surgical transition

Safe, affordable and high-quality top surgery with Enhance Medical

At Enhance Medical, our over 35 years of experience as one of the UK’s leading cosmetic surgery providers ensures you achieve the shape that feels right in a safe and supportive environment. We offer personalised treatment plans to meet your unique needs and goals and provide comprehensive, high-quality care at every stage of the procedure, from the initial consultation to the post-operative aftercare. 

Find out more about cosmetic surgery at Enhance Medical and get in touch to book your free consultation at one of our clinics throughout the UK.