What’s the Difference Between Top Surgery and Mastectomy?

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The terms "top surgery" and "mastectomy" are often used interchangeably. However, the two are not one and the same. They are separate procedures designed for different goals.

This article discusses the differences between top surgery and mastectomy.

Woman showing breast cancer mastectomy scar
Peathegee Inc/Getty Images

What a Mastectomy Is Used For

A mastectomy is used to treat breast cancer. There are several reasons why a person may opt for a mastectomy, including:

  • Having a high chance of getting breast cancer a second time
  • Personal reasons in regard to diagnosis and treatments
  • If the breast-conserving surgery known as a lumpectomy is unable to remove all cancer in the breast

Mastectomy and People at High Risk

A person may get a mastectomy as a preventive measure because they are at an extremely high risk of developing breast cancer.

How It Is Performed

There are several ways to perform a mastectomy because there are various types available. The types and methods include:

  • Total (simple) mastectomy: The entire breast is surgically removed, including the breast tissue, chest muscle, skin, nipple, areola, and covering of the chest muscle.
  • Modified radical mastectomy: This is the surgical removal of everything that is removed in a total mastectomy with the addition of lymph nodes in the underarms.
  • Radical mastectomy: Although rare, a radical mastectomy involves the surgical removal of the entire breast, lymph nodes in the underarm, and the chest wall muscles that are found beneath the breasts.
  • Skin-sparing mastectomy: This procedure saves the skin that covers the breast tissue. It is done by surgically removing the breast tissue, areola, and nipple. In some cases, the breast is reconstructed using tissue from another area of the body or implants.
  • Nipple-sparing mastectomy: This surgery aims to save the nipple and skin that covers the breast tissue. Once the breast tissue is removed, the breast can be reconstructed.
  • Double mastectomy: This procedure involves the complete removal of breast tissue, skin, nipples, and areola. It is the same as a total mastectomy, except it is performed on both breasts.

When Should a Person Choose Mastectomy?

There are various reasons why a person chooses to have a mastectomy in their cancer treatment plan, such as:

  • They can’t have radiation.
  • They would rather have surgery over radiation treatment.
  • They have already had breast cancer in the past and treated it using radiation.
  • Breast-conserving surgery didn’t remove all of the cancer.
  • There are several areas of the breast that contain cancer.
  • There are tumors larger than 5 centimeters within the breast.
  • They are pregnant and don’t want to put the fetus at risk during radiation.
  • They have a genetic predisposition to a second case of cancer.

Side Effects

The side effects most associated with mastectomies include:

  • Bleeding
  • Infection
  • Pain or tenderness
  • Swelling
  • Clear fluid or blood buildup where the incision was made
  • Limited movement in the arm or shoulder
  • Chest or upper arm numbness

Postmastectomy Pain Syndrome Following Mastectomy

Postmastectomy pain syndrome, or PMPS, is a type of syndrome that causes nerve pain following the surgery. The pain develops in the chest wall and armpit and presents as a burning or shooting pain sensation. The pain can last for more than three months following the surgery, and roughly 28.2% of people who have a mastectomy develop this side effect.

What a Top Surgery Is Used For

Top surgery is a form of chest reconstructive surgery. When a person wants to change how their chest looks or its size, they will have top surgery.

This procedure is considered gender-affirming surgery for transgender individuals who wish to alter their chest to match their gender identity.

There are several top surgeries that can be done, including:

  • Female-to-male surgery
  • Female-to-nonbinary surgery
  • Male-to-female surgery
  • Male-to-nonbinary surgery

How Many Transgender People Choose to Have Top Surgery?

Roughly 8% to 25% of transgender adults in the United States have opted to have top surgery as gender-confirming surgery.

How It Is Performed

Various types of top surgery are performed in different ways. For female-to-male or female-to-nonbinary, breast tissue is removed and the chest is reshaped and flattened using a surgical method known as contouring.

Male-to-female top surgery is done by making an incision into the chest and inserting saline and silicone implants. The implants increase the size of the chest while adding shape. Incisions to open the chest for implants are done near the armpit, the areola, or directly beneath the area where the breast tissue meets the chest.

During all types of top surgery, the skin over the breast, the nipple, and the areola remains and is reconstructed to match the new appearance of the chest.

Top Surgery and Nonbinary Individuals

People who identify as nonbinary may to opt for top surgery that removes all breast tissue and reconstructs the chest to appear more masculine.

Side Effects

The most common side effects associated with top surgery are similar to those that occur in any surgery, such as:

  • Swelling
  • Pain in the chest area
  • Draining of excess fluid from the area

While these side effects are uncomfortable, they are often worth it for transgender individuals. Studies show that these surgeries can immensely improve the quality of life for transgender individuals.

Top Surgery and Scarring

While plastic surgeons aim to prevent as much scarring as possible, there is still a risk that scarring will occur.

What Makes Them Different?

While top surgery is sometimes called mastectomy, not all top surgeries are the same.

The main difference between the two is the goal they set out to accomplish. Mastectomies are reserved for people with breast cancer, whereas "top surgery" is the term assigned to people undergoing gender-confirming surgery.

For example, a total mastectomy is not the same as top surgery simply because of how much breast area is removed. Top surgery is most similar to a double mastectomy performed with skin and nipple-sparing surgical techniques.

The male-to-female top surgery process is entirely different from a mastectomy because no breast tissue is removed. Instead, an implant is added to the area. The only similarity is that some people who undergo mastectomies for breast cancer can have breast reconstruction and implant insertion done at the same time.

However, implant surgery is typically spread out over the course of two surgeries for those who are getting a mastectomy.

Can I Get Breast Cancer After Top Surgery?

Top surgeries to make breasts smaller don't always end with all breast tissue removed. Because of this, there is still a chance that a person may get breast cancer following top surgery. It’s crucial to keep up with screenings even after your transition.


Top surgery and mastectomy may seem similar, but the two are not the same. Top surgeries are used for gender-reaffirming purposes, and mastectomies treat breast cancer. There are various types of mastectomies, with only two being considered similar to top surgery.

Both procedures come with possible side effects, such as swelling in the area and pain. That said, a mastectomy and top surgery are often necessary, and the positive outcomes can be lifesaving and life-changing, respectively.

A Word From Verywell

Choosing to have surgery such as top surgery or a mastectomy can be a scary experience. Even if you know it’s necessary to either save your life or allow you to live happily in a body that feels right for you, it can be a hard decision.

That said, many people have undergone these procedures, and they are often safe and effective, leading to incredibly positive outcomes for those who opt into them.

Frequently Asked Questions

  • Is top surgery covered by insurance?

    While top surgery is often considered elective, many insurance providers cover the surgery. This is because they understand how necessary it can be for some people. If you are considering top surgery, contacting your insurance provider to see if it is covered on your current plan can help save you a lot of money.

  • Does top surgery reduce breast cancer risk?

    While a person who has top surgery can still get breast cancer, the removal of breast tissue to make breasts smaller lowers the risk greatly. With less tissue, there is less of a chance of getting cancer. That said, people who undergo top surgery should still get regular breast cancer screenings.

  • Who shouldn’t get a mastectomy?

    Mastectomies are often recommended and highly effective. However, there are instances in which the procedure is not likely to help. If the cancer has spread to other parts of the body, for example, a mastectomy will not work.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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