The Types of Top Surgery in the Philippines

What is Top Surgery?

Top Surgery is a medical procedure that some transmasculine people undergo to have their breast tissue removed and masculinize the chest.

Although it is possible to get top surgery in the Philippines, it is largely inaccessible and difficult to afford due to the lack of financial coverage by most healthcare providers.

What types of Top Surgery are available in the Philippines?

There are currently four (4) types of top surgery procedures available in the Philippines:

1. Periareolar Top Surgery

2. Keyhole Top Surgery

3. Double Incision Top Surgery

4. Inverted T-Anchor Top Surgery

Periareolar Top Surgery

Keyhole Top Surgery

Inverted T-Anchor
Top Surgery

Double Incision Top Surgery

Illustrations by Nique Dulay

Periareolar Top Surgery

• Average Cost: ₱ 80,000 to ₱ 150,000

• Ideal For: Individuals with small chests or minimal breast tissue and tight chest skin

• Incision Healing Timeline: 4-6 weeks

Pros:

• Little to no scarring

• Retains nipple sensation

• Quick recovery

• Low cost compared to other top surgery procedures

Cons:

• Prone to pleating and folds in the skin around the nipple known as the "sunburst" pattern

• May not result in a totally flat chest

• Nipples may not heal in idea positions after recovery

Periareolar top surgery is a type of top surgery wherein a donut-shaped incision is made around the nipples to reduce the size of the areola and match the average size of areolas found on male cisgender chests. An outer ring is marked around the nipples where the outermost layer of skin is removed.

Through the exposed layer of tissue, the surgeon will make an incision to get through the layers of the skin then remove breast tissue and flatten the patient's chest.

This type of top surgery is one of the most popular in the transmasculine community due to its lower cost and the lack of scarring left on patients. It achieves great lengths in alleviating one's gender dysphoria because it can provide a cis-passing result that other procedures are unlikely to achieve.

However, this type of surgery is only viable for patients who have very little breast tissue to begin with.

Keyhole Top Surgery

• Average Cost: ₱ 90,000 to ₱ 150,000

• Ideal For: Individuals with very minimal breast tissue and very tight chest skin

• Incision Healing Timeline: 4-6 weeks

Pros:

• Little to no scarring

• Retains nipple sensation

• Quick recovery

• Low cost compared to other top surgery procedures

Cons:

• Does not address excess chest skin

• May not result in a totally flat chest

• Nipples may not heal in idea positions after recovery

Keyhole top surgery is a type of procedure wherein semicircle incisions are made along the bottom of the patient's nipples. The surgeon then removes the unwanted chest tissue from this incision.

Only about 5% of patients qualify as ideal candidates for keyhole top surgery. It requires minimal chest tissue and elastic chest skin. Keyhole top surgery candidates must also be in good health and have a stable body weight to minimize risks during the operation and recovery.

Much like periareolar top surgery, keyhole top surgery is popular in the transmasculine community because of its cost and lack of scarring. It is able to provide patients with a flat and masculinized chest with minimal recovery issues.

Double Incision Top Surgery

• Average Cost: ₱ 150,000 to ₱ 250,000

• Ideal For: Individuals with large chests or plenty of breast tissue and saggy chest skin

• Incision Healing Timeline: 6-8 weeks

Pros:

• Guaranteed maximum flattening of the chest

• Results in a more masculine chest shape after recovery

• No risk for breast tissue regrowth

Cons:

• Creates highly visible scarring

• Long recovery period which may involve the need for drains

• Likely to reduce or totally lose nipple sensation

Double Incision top surgery is a type of procedure wherein a horizontal or U-shaped incision is made on the bottom of the chest or pectoral muscles. The skin is then pulled back from the incision to allow the surgeon to remove fat and breast tissue. The incisions are then stitched shut.

After the breast tissue and fat are removed, incisions are made to remove and relocate the patient's nipples as a graft. This is done because patients who undergo top surgery often have large and/or saggy breasts which result in the nipples naturally low-set. During double incision, the nipples are removed and resized to have smaller areolas that match the average size of areolas found on male cisgender chests. They are then stitched on the ideal placement to achieve a masculine result. Liposuction may also be conducted on the sides of the chest to lessen the risk of leftover folds known as dog ears.

This type of surgery is popular among patients with larger chests who wish to achieve a result wherein the chest is as flattened as possible. It normally results in a highly masculinized chest after recovery. During recovery, some patients may be required to use drains meant to collect and dispose of any leftover fluids and bleeding that may occur post-operation. It is also one of the most expensive types of top surgery and requires the most post-operation care.

Although it results in highly visible scarring, many surgeons in the Philippines offer interventions that can reduce scarring such as steroid injections and scar tape.

The Inverted T-Anchor procedure is done for patients with medium to large chests who wish to retain as much sensation as possible in their nipples and areolas. Like the Double Incision procedure, the Inverted-T Anchor procedure involves making two incisions along the pectoral muscle. The breast tissue is removed via these incisions.

However, the Inverted-T Anchor differs because it involves a vertical incision that runs below the areola to reduce the nipple-areola complex's size. This incision is done to avoid the need for nipple grafts and to retain the nerve that provides nipple sensation. Since the nerve is preserved, the nipple-areola complex is able to retain its blood supply and sensation. 

This top surgery procedure is most popular among plus-size members of the community who do not necessarily need 100% chest flatness. For some individuals, having a totally flat chest on a plus-size body may look and feel unnatural. With the Inverted T-Anchor procedure, they can achieve a chest with some weight, much like you would find on the body of a plus size cisgender male.

• Average Cost: ₱ 150,000 to ₱ 250,000

• Ideal For: Individuals with large chests or plenty of breast tissue and saggy chest skin and have nipples that sit below the chest muscle fold

• Incision Healing Timeline: 6-8 weeks

Pros:

• Guarantees 100% nipple sensation

Cons:

• Creates highly visible scarring

• Nipples may not heal in ideal position after recovery

• Does not result in a totally flat chest 

• Long recovery period which may involve the need for drains

Inverted-T Anchor Top Surgery

Illustrations by Nique Dulay