Top surgery has many names. Some names are more descriptive than others. Putting the surgery names aside, the goal of the procedure is to flatten the chest by removing the large majority (if not all) of the chest’s glandular tissue (breast tissue), some of the chest’s extra fat tissue, and sometimes extra skin. In addition, the procedure often can modify the nipples, and skin contour. Possible adjustments to the nipples include reduction of nipple diameter, reduction of nipple projection, and change in nipple position to a more natural position on a flatter chest. Top surgery can not be reversed later. The tissue removed is routinely sent to the pathologist for analysis. Top surgery does NOT modify underlying chest muscle. The procedure does NOT enter any deep organs.

The general goal of top surgery is to flatten the chest and remove tissue. Another goal of the surgery is to make the chest look and feel closer to the way you want. It is important for you to discuss with Dr. Mckee: what your specific goals of chest appearance are. In this way, you may discuss cosmetic preferences regarding the smaller details ( curved vs. straight scars, nipple size, nipple location,…) since there is some ability to modify the surgery according to your specific needs.   

Another general goal of top surgery is to remove the “dysphoria” and psychological stress that goes with the unwanted tissue on the chest - allowing you to feel more comfortable in your own skin (with your shirt on or off). Another goal may be to finally stop wearing the compressive chest binder that many top surgery patients regularly use to hide their chest tissue.

Some patients (but not all) have been prescribed testosterone by their doctors prior to surgery – which leads to some desired physical changes of the chest, and the rest of the body for those individuals. If you are taking prescribed testosterone, you may continue to take it throughout surgery.

Regarding the age of top surgery patients, the overwhelming majority of patients who undergoing top surgery with Dr. Mckee are 19 years or older. In British Columbia, the age of majority is defined as 19 years old, whereas in most other provinces the age of majority is 18 years old. In BC however, 18 year olds are considered minors. On rare occasion, with special consideration, we perform top surgery for 18 year-olds, for those patients who meet the strict criteria of a ‘mature minor’, and who are fully and legally able to consent for themselves by Canadian law.   In such rare cases, we obtain guidance from a variety of healthcare professionals and supportive parties who may support the patient in their decision making:  including the referring family doctor, psychologists, gender therapists, social workers, patient counsellors, pediatricians, and Trans Care BC. We also may obtain support from the hospital ethics board when needed. For an 18 year old patient (a mature minor in BC), we require a parent (or primary legal guardian) to be present for the consultation process, and to be supportive of the procedure. The ‘BC Infants Act’ gives a mature minor the ability to consent for themselves if the medical treatment is found to be in the patient’s best interest, and we gauge this with input from the patient, medical professionals involved, and parental guardian all being in unison. We do not operate on patients younger than 18 years old.

Informed consent specifically requires the mental capacity to do so, and requires the patient to be aware and properly informed of the options, implications, and possible risks.