Top Surgery Is Not The Same As Mastectomy: Here’s How

By Angelica Bottaro 

For those with gender dysphoria, living in a body that doesn’t feel like your own can be a difficult and heartbreaking experience. You know who you are, and yet for some reason, the reflection looking back at you is nowhere near in line with who you feel you are in your soul. For many, the decision to transition surgically is not taken lightly, but it does grant trans people the ability to live in the body they know they should have.

Surgical transformation can sometimes be done through top surgery, but many people confuse the former with having a mastectomy. The two are not one and the same but designed for entirely different reasons. For one, a mastectomy is the surgical removal of one or both breasts completely to help treat breast cancer. While top surgery is driven by gender dysphoria and can help those transitioning transform their bodies on the outside to who they are on the inside.

How The Procedures Work

Although both surgeries are designed to remove breast tissue, the two are strikingly different. For one, the reasons as mentioned earlier for their removal are entirely different. One is meant to save a person’s life from cancer, and the other is intended to save a person from the biological misstep that occurred when they were born. A total mastectomy involves removing all breast tissue from the clavicle to the inframammary fold in the armpit, known as the latissimus. In some cases of a mastectomy, the removal of the areola occurs as well.

On the other hand, top surgery doesn’t take as much away from the person because there is no risk of leaving cancer behind. Removing the breast tissue, extra skin if need be, and excess fat tissue on the chest is the objective. This flattens out the area and leaves behind both the nipple and the areola, along with the nerves, so that the chest is still intact; it is just flattened. Sometimes, a mastectomy is a small part of top surgery, but that doesn’t mean that all top surgeries are full mastectomies. 

Life-Changing v Life-Saving

As I mentioned, a total mastectomy is designed to save a person’s life. The procedure keeps cancer from spreading, which gives people a chance to live out their full lives. While top surgery isn’t considered to be a life-saver, it does dramatically change a person’s life and thus can improve their quality of life as well as their mental health. 

In one sense, top surgery can save lives by helping trans people live in the body they feel truly themselves in. Studies have shown that suicide attempts among young transgender people are alarmingly high at 41.8%.

With research surrounding transgender people and suicide, it’s easy to conclude that being able to change their bodies to match who they genuinely are could lower those levels of suicide attempts. In fact, research has shown that 67% of people thought about suicide before transitioning, with only 3% thinking about it after the surgery had been completed.

Another more recent study found that people who went through transitional surgery were rarely regretful of their decision and many transgender people experience better mental health following their procedure. Because of this, top surgery could be considered more than just life-changing; it also saves the lives of those who would otherwise fall to suicide.   

Is Top Surgery A Requirement?

Many transgender people don’t wish to go under the knife to surgically change their bodies and choose options such as hormone replacement therapy. Some will avoid medical intervention altogether and transition socially by changing their name and the gender they present. 

Research has shown that even social transition can alleviate and reduce suicidal thoughts by 29%. 

Overcoming Barriers

In many places, getting top surgery can be challenging to do. Some have laws against it, whereas others will make people jump through a copious amount of hoops just to be considered. Barriers, such as forcing someone to live as a specific gender for a year or subjecting them to heavy psychiatric evaluations, are often associated with an increase in the chances that someone will harm themselves. This is partly due to a failure to create a supportive social space for transgender people.  

Getting top surgery is a choice that every person must make on their own. It is highly personal and not taken lightly by those that decide to go ahead with it. The good news is that whether a person medically transitions or socially transitions doesn’t much matter. As long as they are free to live as their true selves, the mental health issues that plague the trans community can continue to decline.