Gender Affirming Mastectomy - Top Surgery

Removal of chest tissue for a flatter, more contoured chest
Alleviates physical and social dysphoria
Modern private hospital
Comprehensive aftercare programme

What is Gender-Affirming Top Surgery?

Top Surgery is a gender-affirming procedure that involves the surgical removal of chest tissue and contouring of the chest to help align a person's physical appearance with their gender identity. It involves the removal of excess fat and skin, followed by a repositioning of the nipples and areolas to create a naturally flat chest appearance. Multiple surgical methods are used in Top Surgery procedures, depending on factors such as the patient’s chest size and skin elasticity.

Proven to alleviate the effects of gender dysphoria and complications from regular chest binding, Top Surgery is a deeply personal and transformative procedure which requires serious consideration and the highest standards of patient care. Pall Mall delivers safe and high-quality gender-affirming care, from your initial consultation to the procedure itself. Our surgeons will engage in open, respectful communication that prioritises your personal goals and desired care outcomes.

Your Top Surgery procedure:

Compression Vest & Stockings: We’ll provide you with a snug compression vest that will help your body to recover for two weeks after your surgery. As well as compression stockings to reduce swelling and aid healing.

Results: 80% of our Top Surgery patients return home on the same day. Pain and scars generally fade within a few months.

Drain-Free Surgery: Top surgery is a drain-free procedure, allowing for a more comfortable and convenient recovery process

Hospital Stay: You may need an overnight stay in our privately-owned Newton-le-Willows hospital. All of our overnight stays enjoy a room with en suite, Netflix and complimentary meals

Time Off Work: We recommend taking 2-3 weeks off desk jobs and 4-6 weeks from physically-demanding work after your procedure.

Sleep: Sleeping slightly upright on your back for 6 weeks will limit your arm movements during recovery. A v-shaped pillow can help to keep you comfy.

Am I eligible for Top Surgery?

At Pall Mall we’re proud to announce the commencement of our Gender-Affirming surgery and care services at our private hospital located between Manchester and Liverpool and look forward to supporting our patients through this life changing surgery. To register your interest in undergoing Top Surgery, please fill out the form, and our dedicated specialist Patient Liaison, Mamuna, will be in touch as soon as possible.

Fill Out the Form

There are some initial requirements that you must meet to be considered for this procedure. In order to be eligible for Top Surgery, you must:

Be over 18
Have a referral letter from a UK-based Gender Specialist
Produce up-to-date GP medical history records.
Maintain a BMI of 18-40 and be in generally good health
Stop smoking for a minimum of four weeks before the procedure, as this may impact healing. This includes any nicotine replacement therapy such as vaping, nicotine patches, gum etc.

Pall Mall cannot proceed to surgery without a referral letter from a licensed UK Gender Specialist. This is to ensure that a person has had the benefit of exploring their gender affirmation goals with a specialist in transgender health. There may be other medical conditions or risks, unrelated to your gender status, that prevent you from undergoing this surgery. Our Patient Liaison, Mamuna, can discuss this with you during your consultation.

Results of Top Surgery

Gender-Affirming Top Surgery is a highly transformative procedure which can result in improvements to a patient’s mental health and quality of life.

Following surgery, patients can expect to see an immediate change in the shape and formation of their chest. The absence of chest tissue will immediately be apparent, along with resized and repositioned areolas that result in a flat and naturally-masculine appearance.

It is also important to highlight that people who have undergone Top Surgery will have permanent, visible scarring as a result of their procedure. These will appear pink in the early months following the procedure, but will fade and become less prominent with time. In many cases, a patient’s positivity toward their new chest results in scarring becoming a source of pride.

Meet our surgeons

Every surgeon at Pall Mall Medical is fully accredited to practice as a plastic or general surgery specialist in the UK, comes from a relevant medical organisation and has accredited qualifications in aesthetic plastic surgery.

We are privileged to work with two leading surgeons and clinical experts in the field of gender-affirming care - Kate Williams and Chloe Wright. With over 20 years’ experience and more than 800 successfully-completed procedures between them, you can feel confident that you are receiving quality treatment and care from two of the UK’s foremost gender-related surgery specialists.

Kate Williams Gender-Affirming and Oncoplastic surgeon

Kate Williams

Kate Williams is a highly accomplished consultant surgeon specialising in gender-affirming and oncoplastic surgery. Her credentials include:

BSc (First Class Hons) in Clinical Science from the University of Leeds
MBChB Bachelor of Medicine (Surgery) from the University of Leeds
Research Fellow with the Royal College of Surgeons, England
MD Doctor of Medicine from the University of Manchester
Leading NHS consultant in Manchester, performing over 280 surgeries
Clinical Director for breast and chest wall surgical services at NMGH

Chloe Wright, Gender and Oncoplastic Surgeon

Chloe Wright

Chloe Wright is a Consultant Gender and Oncoplastic Breast Surgeon with extensive experience in both gender-affirming and breast cancer surgeries. Her credentials include:

MBChB Bachelor of Medicine from the University of Manchester
USA Medical Certification
National TIG Oncoplastic Fellowship
Consultant Oncoplastic Breast Surgeon at Bolton NHS FT
Consultant at Manchester Foundation Trust
Specialist advisor to the Care Quality Commission (CQC)
Trained in gender-affirming Top Surgery since 2009, performing over 500 procedures

Gender-Affirming Top Surgery procedures

Various surgical techniques can be used when performing Top Surgery. Your surgeon will support you in finding the most suitable technique for your body and your gender affirmation goals. Surgeries are performed under general anaesthetic and take under two hours to complete.

Periareolar

Periareolar Top Surgery involves making a circular incision around the border of the areola, followed by a second incision around the first one. Chest/breast tissue is extracted through these incisions and excess fat is removed. The larger incision is then reclosed and the areola is resized accordingly.

The Periareolar procedure is generally performed on patients with smaller chests and low levels of excess skin. It is best-suited to patients who desire minimal skin incision during their Top Surgery.

Double incision

The Double Incision is the most common surgical technique used in Top Surgery procedures. It involves complete removal and resizing of the nipples and areolas. Long horizontal incisions are used to remove the breast tissue, and excess fat is extracted through liposuction. Excess skin is removed if necessary, and the incisions are closed using specialised sutures to prevent skin puckering.

Double Incision Top Surgery is typically performed on patients with larger amounts of chest tissue which can not be sufficiently removed with a periareolar procedure. As nerves are severed during the removal of the nipple and areola, patients may not regain full sensation in this area. For patients with larger chests who are hoping to retain nipple sensation, our dermal flap surgery technique repositions the areolae while leaving them attached to their nerve supply.

Chest (breast) reduction

This is a surgical procedure aimed at reducing chest/breast size to align an individual's physical appearance with their gender identity. This procedure is particularly significant for individuals who may experience gender dysphoria related to chest/breast tissue. This procedure also offers a choice to the individual who may want to have some chest/breast tissue.

Revision surgery

We also offer revision surgery for people who have previously undergone a Top Surgery procedure elsewhere that did not meet their expectations or resulted in complications.

Revision surgery aims to correct aesthetic or functional issues from the initial procedure. This can include reshaping the chest/breasts, correcting asymmetry, or addressing complications such as scarring or changes in nipple sensation.

Dr Tang, GP at Pall Mall

What’s involved with the procedure?

Top Surgery is an intensive procedure which requires careful planning and comprehensive patient care. From pre-surgery consultation to the day of your procedure and the weeks and months that follow, it’s important to gain a full understanding of what to expect at every stage of the process.

Pre-op

Before your Top Surgery, you’ll need to complete a series of consultations to ensure that you are adequately informed and meet the relevant medical requirements. Following your initial call, you’ll attend a preliminary virtual consultation with our dedicated gender surgery Patient Adviser, Mamuna, to ensure that you are comfortable, well-prepared and happy to move forward. Kate and Chloe will then review information from your Gender Identity Clinic and make a decision on whether to proceed.

The next step is a relaxed first meeting with your surgeon via video consultation. It is helpful if you can show your chest to the surgeon during this consultation, but this can be avoided by simply answering some descriptive questions. There is a two-week cooling off period following this consultation, giving you sufficient time to make your final decision. You will receive a Patient Information Guide following your first consultation, which you can read and compile questions on before meeting your surgeon in person. A face-to-face surgeon consultation will be scheduled four weeks after your virtual meeting, after which a convenient date for your surgery can be selected.

The day of your surgery

Once the pre-surgery process is complete, your procedure can be scheduled for an available and convenient date up to six weeks after your initial consultation. The duration of your Top Surgery will depend on the number of surgeons overseeing the procedure, and can take anywhere from 90 minutes to three hours to complete. Upon your arrival at the hospital, the surgeon will visit your room to obtain your final consent and answer any last-minute questions about your procedure.

You will then meet with the Consultant Anaesthetist to agree on a plan for your pain control and ask any relevant questions.

Once the procedure is complete, dressings will be applied and your compression vest will be fitted. It’s important to arrange transport to and from the hospital on the day, as you should not operate a car for at least two weeks following Top Surgery. While 70% of patients return home on the day of their procedure, we recommend packing a basic overnight bag, in case you are required to stay.

Post-op

We are committed to ensuring that you remain as comfortable as possible during the post-operative recovery period. Due to the nature of Top Surgery, it’s important that you thoroughly understand all aftercare requirements and ask questions about anything you’re unsure of. A comprehensive post-operative care package will be discussed with your surgeon during consultation, and your local clinic will serve as your primary point of contact throughout the healing process. You will be provided with out-of-hours contact information during your consultation, which should be used in the event of any urgent post-op concerns.

Following your surgery, you may be provided with medicines to take home. Please take these medicines as prescribed, and continue taking any pain relief, HRT or birth control medication as normal. As antibiotics can impact the efficacy of the birth control pill, however, we do not recommend the concurrent use of both. You should also avoid using vitamins, herbal supplements, Omegas and aspirin for two weeks following your procedure, unless they have been prescribed to you by a doctor.

Maxine, Pall Mall Nurse

Comprehensive aftercare

Our commitment to patients doesn’t end following surgery, and we provide a comprehensive aftercare programme that has been specially developed with your comfort and best interests in mind. As one of the few clinically-led providers of gender affirming surgery in the UK, Pall Mall puts you in the best possible hands at every stage of the surgery process — ensuring that your safety and comfort are always the top priority.

Before leaving the hospital after your Top Surgery, you will be provided with a post-op leaflet, 24/7 emergency contact information and a booking for your first post-op check-up. Our specific aftercare package for Gender-Affirming Top Surgery includes a post-op dressing appointment 9-10 days after your procedure, as well as multiple surgeon reviews carried out over the ensuing 12-month period. All aftercare services are provided as part of our surgery packages — leaving no hidden costs or extra charges to worry about during your recovery.

Lorna, Cara and Shannon our amazing Pall Mall nurses

Why choose Pall Mall for your top surgery?

Pall Mall is one of the UK’s only private providers that is owned and led by doctors. This means that you receive quality care without compromise, and patient safety is prioritised to the highest clinical standards. We pride ourselves on delivering gender-affirming care that makes you feel confident about yourself at every stage of your journey — from that very first call to our comprehensive aftercare service.

When you choose Pall Mall for your Top Surgery, you benefit from:

Care Quality Commission (CQC) regulated service
General Medical Council (GMC) registered surgeons
State-of-the-art theatre facilities
The comfort of our privately-owned hospital
Comprehensive aftercare from our dedicated patient experience team
A dedicated team of gender affirming medical professionals who will be there to support you every step of the way

State-of-the-art private hospital

Our Newton-le-Willows hospital is a state-of-the-art private facility where we provide gender-affirming medical care in a safe and welcoming environment.

Our expert team of consultants, clinicians and surgeons provides a range of gender affirmation services, from diagnostics and consultancy to specialised Top Surgery procedures. With two modern theatres and industry-leading care, we cater to the individual needs of our patients in an environment of world-class medical standards.

Our discreet and compassionate CQC-registered hospital ensures a supportive space for all gender identities, where your wellbeing is always our highest priority.

Experience the difference of a privately-owned hospital and pioneering patient care when you choose Pall Mall for your Top Surgery.

Common questions about Top Surgery

Choosing to undergo Top Surgery is a big decision which requires significant thought and preparation. In order to uphold our leading standards of patient care, we endeavour to ensure that you have access to all the information that you need.

We are always on hand to provide advice, support and schedule appointments with our expert team. Please contact our dedicated Patient Advisor for more information on our gender affirmation services.

Will I be left with permanent scars?

Yes. All Top Surgery procedures result in some level of permanent scarring. Periareolar or keyhole procedures result in less scarring due to the relatively small size of incisions required. Double Incision surgery leaves behind more noticeable scars, which appear in the natural creases that sit below the pectoral muscles. Patients should nonetheless expect some level of lasting surgical markings following any variation of Top Surgery.

How long does it take to recover from Top Surgery?

Healing from Top Surgery is a delicate process that is unique to each individual patient. The full duration of your recovery period will depend on the surgical technique used and any post-operative complications that arise, but patients can expect to return to regular physical activity within 4-6 weeks.

What are the risks involved with the procedure?

Like any surgical procedure, Top Surgery carries the possibility of post-operative complications. You are likely to experience swelling, bruising and some discomfort for a few weeks post-op which can be managed with painkillers. In rare cases, patients may experience bleeding, infection, seroma, necrosis or loss of nipple sensitivity.

Is Gender-Affirming Top Surgery appropriate for non-binary people?

Yes. Top Surgery has shown to alleviate dysphoria and improve quality of life for individuals who seek this surgery. As traditional masculinizing surgery techniques may not align with the goals of some non-binary individuals, we offer personalised approaches to achieve the most gender-affirming results possible. These include unique nipple size and position adjustments, ‘nipple-free’ procedures without grafts, ‘non-flat’ contouring and traditional breast reductions.

Is Top Surgery reversible?

No, Top Surgery is not reversible. It is a significant surgical procedure that involves the permanent removal of breast tissue and reshaping of the chest. Due to the permanent nature of the procedure, individuals considering Top Surgery should carefully evaluate their decision and discuss it thoroughly with a qualified specialist.

How painful is the surgery?

Patients of Top Surgery commonly experience some level of discomfort and pain in the weeks following their procedure. While thresholds for pain vary from person to person, you are likely to feel sharp, short-term discomfort which can be relieved with pain medication.

How old do you have to be to undergo Top Surgery?

The minimum age for any Top Surgery consultation or procedure with Pall Mall Medical is 18. The maximum age for patients is 70.

Can you undergo Top Surgery without a referral?

It is best to discuss with our Patient Liason in the first instance. Some chest/breast reduction procedures for non-binary patients do not require a referral, whilst other surgery cannot proceed without a referral letter from a licensed UK Gender Specialist, as per WPATH and NHS service specifications.

Can you get Top Surgery on the NHS?

Yes, although the process of accessing these procedures can be complex and time-consuming. Private care offers a significantly quicker pathway and an increased level of comfort for patients.

Is Top Surgery covered by medical insurance?

Gender-Affirming Top Surgery is not guaranteed to be covered by all health insurance plans, and some patients may be required to pay out-of-pocket expenses. Each insurance provider has unique policies around gender-affirming procedures, so it’s important to verify and assess your options before proceeding.

Will I lose sensation after the surgery?

The likelihood of regaining full nipple sensation depends on the type of Top Surgery that is administered. Patients undergoing periareolar surgery retain sensation in more than 70% of cases, while about 30% of nipple graft double incision patients report a return of tactile sensation. If you have a larger chest and hope to preserve sensation in your nipples, the dermal flap surgical technique can be used.

When can I return to normal activities after surgery?

Gender-Affirming Top Surgery is a major procedure which will require a minimum period of 4-6 weeks’ rest before returning to regular levels of activity. We recommend taking 2-3 weeks off desk jobs and 4-6 weeks off demanding physical activity in the period following your procedure.

Always here to help, whenever you need us

You can also expect the utmost care from the moment you walk through the entrance of any Pall Mall clinic - not to mention qualified advice from the second you make your initial enquiry.