Top surgery isn’t one operation — it’s a family of techniques, each suited to different bodies and goals. This guide walks through what shapes the decision and the options available, so you can choose the approach that’s right for you.
You can also browse before & after results, see pricing & financing, or read about our approach to gender-affirming care. You don’t have to figure it out alone — that’s what your consultation is for.
What shapes your options
There’s no single “best” technique. The right choice depends on your chest, your skin, and what matters most to you — five things guide the decision:
- Chest size & tissue. Smaller chests with good elasticity can suit keyhole or periareolar approaches; medium to larger chests are often best served by double-incision.
- Skin elasticity. Firm, elastic skin re-drapes over a flatter contour with less scarring; looser skin usually calls for more skin removal.
- Nipple sensation. Nipple-preserving techniques (keyhole, periareolar, buttonhole) tend to retain more feeling; free grafts trade some sensation for shape.
- Scarring. Where you’d prefer scars to sit — discreet around the areola, or along the lower chest — helps guide the approach.
- Your goals. A flat masculine chest, a softer contour, keeping or resizing the nipples — your vision leads the plan we build together.
Top surgery techniques
Get to know each approach below — open any technique to read the detail, then we’ll narrow it down together. For a deeper look, read our comparison of keyhole vs. double incision.
A common technique for larger chests, removing tissue and excess skin for a flat contour.
The double incision technique removes breast tissue and excess skin through two horizontal incisions across the chest, creating a flat, masculine contour. It is often recommended for medium to larger chests.
The nipples are typically resized and repositioned as grafts. Scars sit along the lower chest, where they tend to fade and become discreet over time.
Because the skin is closed directly, double incision usually does not require surgical drains. The nipple grafts are protected with a dressing for about a week while they heal, then cared for with a little ointment and light gauze as they settle.
Double incision that keeps the nipple attached to preserve sensation.
The nipple-sparing double incision keeps the nipple connected to its original blood and nerve supply on a tissue pedicle, rather than removing and grafting it.
This can help preserve nipple sensation; suitability depends on your chest size and anatomy.
Tissue removed through an incision around the areola, for smaller chests.
The periareolar technique removes tissue through a circular incision around the edge of the areola, leaving a scar limited to the areola border.
It is generally suited to smaller chests with good skin elasticity.
As with keyhole, a small drain is often placed for a short time to keep fluid from collecting, and is removed once the output settles — usually within about a week.
A minimal-scar option for small chests with firm skin.
The keyhole technique removes tissue through a small incision at the lower edge of the areola, without removing skin. The nipple stays attached, preserving sensation.
It is best suited to small chests with minimal excess skin and good elasticity.
A small drain is often used for a short time to keep fluid from collecting, and is removed once the output settles — usually within about a week. Because there are no grafts, gentle showering is typically possible within a couple of days.
A curved incision shaped to refine the lower chest contour.
The fishmouth technique uses a curved, tapered incision designed to refine the lower chest and minimize fullness at the edges.
It is one of several contouring options reviewed during consultation.
A vertical-scar technique balancing tissue removal and limited scarring.
The lollipop technique combines an incision around the areola with a short vertical incision, allowing more tissue and skin removal than periareolar while limiting horizontal scarring.
It can suit chests that fall between keyhole and double incision candidacy.
An anchor-shaped incision for significant tissue and skin removal.
The inverted T, or “anchor,” technique uses incisions around the areola, vertically, and along the lower chest to remove significant tissue and excess skin.
It allows precise reshaping for larger chests while repositioning the nipple.
Resizing and repositioning the nipples as grafts during top surgery.
With nipple grafts, the nipples are removed, resized and repositioned on the chest as skin grafts. This is common with the double incision technique.
Graft healing affects sensation; we review what to expect during consultation.
For the first week a dressing holds the grafts in place while the blood supply re-establishes, so the chest dressings are kept dry until your follow-up. The grafts can look dark or crusted at first and improve over the following month, with a little ointment and a light dressing to protect them as they settle.
A flat chest result without nipple reconstruction, by choice.
Some people choose top surgery without nipples — a smooth, flat chest with no nipple grafts or reconstruction.
This is a personal aesthetic choice, and Dr. Armstrong supports whatever outcome aligns with your goals.
Complementary procedures that can be combined with top surgery.
Top surgery can be combined with additional procedures — such as liposuction for refinement or revisions to earlier surgery — within a single coordinated plan.
We discuss any complementary steps that may help you reach your goals.
How we’ll choose together
Your consultation, step by step:
- Share your goals & history. We talk through what you want to achieve and review your health, so the plan fits you — not a template.
- Photos that help. For virtual or in-person visits, front, side and 45° photos let Dr. Armstrong assess your chest and discuss which techniques suit you.
- A personalized recommendation. You’ll leave with a clear, honest recommendation — the right technique for your anatomy and goals, with realistic notes on scars and sensation.
OHIP funding & referrals
Top surgery can be funded by OHIP or paid for privately. The OHIP-funded pathway requires a referral and an OHIP prior-approval letter from an Ontario doctor; no referral is required for the private pay pathway. Once a pathway has been selected, it cannot be changed.
OHIP covers the surgery itself; optional chest contouring during a mastectomy is not covered and carries an additional cost.
Read the full OHIP funding & referral process, including what your referral must contain and the private-pay options.
International & out-of-town patients
We welcome patients from across Canada and from abroad. Here’s how to plan:
- A virtual consultation comes first. Meet your surgeon, share photos securely, and complete your registration before you travel.
- Plan to stay about 5–7 days nearby, if possible. Typically one day before surgery and several days after — including a follow-up the day after surgery. Book your return flight for at least four days after your surgery date.
- Allow time to recover. Plan roughly two weeks of rest before returning to daily activities; your surgeon tailors all timelines to you.
- Bring a companion. A travel companion or caregiver is required for your recovery period. Travelling alone? Private nursing care can be arranged at an additional cost.
- Payment. International patients pay the full surgical cost upfront; financing and direct insurance billing aren’t available.
Where to stay
We partner with the Delta Hotels by Marriott Mississauga, connected to GraceMed Mississauga by an indoor corridor — you can be escorted to your room within minutes of your procedure. To book the partner rate, choose Special Rates → Corp/Promo Code and enter A3315 (available only through that link).
Getting here: Toronto Pearson International Airport is about 20 minutes away, and Billy Bishop Toronto City Airport about 30 minutes by car. Surgery fees don’t include travel, hotel or related expenses.
For the full picture, read our guides on traveling for top surgery and top surgery in Canada for international patients.
Frequently asked questions
Common questions about top surgery — candidacy, the procedure itself, recovery, aftercare, and scars & sensation.