Breast Reduction vs. Top Surgery: Uses, Benefits, Side Effects, and More

Both breast reduction and top surgery are elective procedures that remove unwanted tissue, skin, and fat from the chest area. Despite their similar goals, there are key differences between these two treatments. 

This article discusses breast reductions, top surgery, cost, similarities and differences, and how to cope with possible side effects. 

What to Know About Breast Reduction

A breast reduction is the surgical removal of breast tissue. It decreases breast size but does not entirely remove them. 

How Does It Work? 

A plastic surgeon removes unwanted or extra breast tissue, fat, and skin during a breast reduction. The goal is a breast size that is more proportionate to the body or to relieve discomfort caused by larger breasts.

Breast reduction is a permanent, highly successful surgery. However, your breasts can change with pregnancy, weight gain, age, or hormonal fluctuations. 

Breast Reduction Procedure 

Breast reductions occur at a hospital or surgery center. After receiving general anesthesia, your plastic surgeon will make an incision to remove excess tissue, fat, and skin. Their technique will vary based on your desired results.

Your surgeon will reposition the nipple and tighten the skin to reshape the breast. They will close the skin with sutures, adhesives, or surgical tape. 

You may have temporary drains to prevent excess fluid from collecting under the skin. If you do, your provider will remove them within a week or two of surgery.

Side Effects 

As with all surgeries, there is a risk of complications or side effects, including:

• Nausea or vomiting
• Pain
• Bleeding
• Blood clots
• Anesthesia side effects or complications 
• Allergies
• Infection
• Poor incision healing
• Necrosis (tissue death) 
• Scarring 
• Swelling

In addition, breast reduction surgery could result in the following:

• Irregular breast shape or asymmetry
• Decreased nipple sensation (which can be permanent)
• Inability to breastfeed
• Loss of the nipple or areola
• Increased breast firmness
• The need for additional surgeries
• Breast fat necrosis

Prices and Where to Get It

If you are considering breast reduction surgery, look for a board-certified plastic surgeon with experience in breast reduction and reconstruction. 

The average price in the United States is $5,913. Talk with your healthcare provider's office and ask if the following fees are included in their price: 

• Anesthesia 
• Lab or diagnostic tests
• Prescriptions 
• Post-surgical bras or garments

What to Know About Top Surgery

Top surgery is considered gender affirmation (confirmation) plastic surgery. It helps transgender or nonbinary individuals transform their chests to match their gender identity. 

How Does It Work?

Female-to-male (FTM) or transmasculine top surgery involves removing skin and breast glands to create a more masculine look and feel. It helps transmasculine people assigned female at birth change their chest to match their self-identified gender.

Top surgery is a permanent and highly successful procedure. Transmasculine people feel that it helps with their gender dysphoria. Most state that they feel more confident and less anxious after top surgery.

Many people feel less restricted and can be more active after top surgery, especially if they were chest binding before.

Top Surgery Procedure 

A plastic surgeon performs top surgery in a hospital or surgery center. The steps are as follows:

• General anesthesia: You will receive sedation, a medication that causes you to sleep during surgery. 
• Breast tissue removal: The surgeon removes the breast tissue and extra skin through an incision and possibly liposuction.
• Adjustments and contouring: Breast tissue, skin, nipples, and areolas are adjusted to create a more masculine look and feel.
• Drains and closure: Temporary drains are placed under the skin to reduce the risk of fluid buildup. The surgeon closes the incision with sutures, skin adhesives, or surgical tape. 
• Recovery: Most people go home after the sedation wears off. It’s best to have help the first few days. 

Side Effects 

In addition to general surgical risks and side effects, top surgery comes with a chance of:

• Fluid accumulation (seroma)
• Nipple and areola loss
• Loss of nipple sensation
• Dissatisfaction with results
• Psychological distress while adjusting to your new body
• Additional surgeries

Prices and Where to Get It

For those considering top surgery, look for a board-certified plastic surgeon with experience in FTM or transmasculine top surgery. 

The cost ranges from $5,000 to $10,000. Talk to your surgeon's office to learn about additional expenses related to the facility, lab tests, or anesthesia. 

Check with your health insurance provider before the procedure to see if they cover surgery and ask about deductibles and your maximum out-of-pocket expense. 

Which Treatment Is Best for You?

Breast reduction surgery is best for those with large breasts that cause:

• Physical pain, such as shoulder, neck, and back discomfort
• Activity limitation
• Skin irritation or frequent rashes
• Shoulder grooving
• Numbness in your hands and fingers 

FTM top surgery is best for you if you have the following:

• Gender dysphoria and wish to have a more masculine chest
• Chest dysphoria that can’t be resolved non-surgically
• Experience with chest binding to feel more comfortable with your chest
• A letter of recommendation from a mental health professional supporting your decision

Can Breast Reduction and Top Surgery Be Used Together? 

FTM top surgery involves removing skin and breast glands to achieve a flat chest appearance more consistent with a masculine look. Those who desire breast reductions simply to make their breasts smaller should not get top surgery.

If you’ve had a breast reduction before top surgery, your surgeon may adjust the location and length of your incision. These adjustments help avoid undesirable aesthetic results, such as excess skin. This could mean that your incision site may be more visible.

Coping With the Side Effects

If you experience excessive bleeding, shortness of breath, chest pain, lightheadedness, dizziness, or leg swelling, call 911 to rule out a medical emergency.

Pain

Plastic surgeons usually approach pain prevention with a numbing injection during surgery that continues to work for a few days. In addition, they may prescribe the following:

• Anti-inflammatory medications (either steroidal or non-steroidal anti-inflammatory drugs—or NSAIDs)
• Narcotics
• Natural remedies, such as Arnica
• Muscle relaxers

Nausea

Crackers, ginger cookies, ginger ale or Sprite, ginger tea, or a cool rag on your head are home remedies for nausea. Your surgeon may also recommend medications such as: 

• Phenergan (promethazine) 
• Zofran (ondansetron)
• Transderm Scop (scopolamine)
• Benadryl (diphenhydramine)
• Bonine or Dramamine (meclizine) 
• Reglan (metoclopramide)

Negative Emotions

The initial effects of either surgery will change as swelling decreases and everything settles. It can take some time to get used to the results. Post-surgical depression can occur, especially during the adjustment period.

Talk to a loved one, support group, or healthcare provider about any negative emotions you are experiencing. 

Scarring

Over time, your incisions will heal and begin to scar. Plastic surgeons are highly experienced in minimizing scarring; they usually fade over time, within months or years. Many people use creams or patches after the wound is healed to speed up this process; however, it's important to wait until your surgeon says it's OK to use these. 

If your scars don't fade appropriately, your provider may recommend laser therapy, scar massage, or other medications.

Infection and Poor Wound Healing

Take prescribed antibiotics and maintain good handwashing and incision care to prevent infection. Stay hydrated and eat nutritious foods to support wound healing. 

If your incisions are not healing properly, alert your healthcare team immediately. Improper wound healing could make scarring and discoloration more prominent.  

Decreased Nipple Sensation

Decreased nipple sensation can be challenging in an intimate relationship. Before surgery, talk to your partner about how this could affect your sexual intimacy and ways to overcome this change if needed.

Summary

Breast reduction and FTM top surgery are elective procedures that remove tissue, skin, and fat from the chest area. 

Generally, a breast reduction is performed when large breasts are causing physical or emotional problems. Some breast tissue remains with breast reductions.

FTM top surgery involves breast reduction and contouring to create a more masculine look. Plastic surgeons perform this procedure for those who are experiencing gender dysphoria and want their appearance to match their identified gender. 

Side effects include general surgical side effects such as pain, nausea, anesthesia complications, and more. Both surgeries can result in undesired results, potential loss of nipple sensation, possible nipple or areola loss, and scarring.

A Word From Verywell

Being uncomfortable in your own body can cause a range of distressing emotions, including frustration, loneliness, anxiety, anger, or sadness. Regardless of the reason for your discomfort, talk to your healthcare provider for help planning to address your concerns.