Breast
Gender Affirming Mastectomy
Chest masculinization surgery for transgender men and non-binary individuals. Removes breast tissue and reshapes the chest contour and nipple position.
Overview
Gender-affirming mastectomy, also called chest masculinization or top surgery, removes breast tissue and reshapes the chest to create a more masculine contour. The nipple-areolar complex is repositioned and resized in the same operation. Several techniques exist — double incision with free nipple grafts, periareolar, keyhole, and others — and the choice depends on the patient's chest size, skin elasticity, and nipple position. Dr. Azadgoli's role is to provide a thorough surgical evaluation and a result that aligns the patient's body with their identity.
Who it's for
The right candidate.
Transgender men, non-binary individuals, and patients seeking chest masculinization. Candidates are typically on a gender-affirming care plan that includes hormonal therapy and other components as appropriate; this is not required but is common.
Technique
How it's done.
Several techniques exist — double incision with free nipple grafts (most common, used for larger chests), periareolar, keyhole, and others. The choice depends on chest size, skin elasticity, and existing nipple position. Nipple position and areola size are reshaped at the same operation.
Where this happens
Our own surgery center.
One roof, one team.
Dr. Azadgoli operates at The Practice Healthcare's fully independent, on-property ambulatory surgery center — a Medicare-certified, physician-led facility recognized by Newsweek as one of California's top centers for independent, privately owned surgery.
Consultation, surgery, aftercare, and recovery all happen in one building, with the same team. No outside hospital. No new staff to meet the day of surgery. The same person who checked you in at the consult is there when you wake up.
What to expect
From consultation to recovery.
Outpatient under general anesthesia. Compression vest for four to six weeks. Drains stay in for one to two weeks. Most patients return to desk work at one to two weeks, full activity at six to eight weeks.
Insurance & coverage
Patient Advocacy handles the paperwork.
Our advocacy team verifies benefits, pursues pre-authorizations, and appeals denials. You don't navigate insurance on your own.
Most plans now cover gender-affirming top surgery as medically necessary care, particularly with a letter from a mental-health provider documenting gender dysphoria and a treatment plan. Our Patient Advocacy team handles pre-authorization, gathers required letters, and works with your existing care team. Plan-specific coverage varies; we confirm yours before scheduling.
How we work with insurance
- 1 Verification by expertsOur advocacy team verifies your benefits before any procedure — so we know exactly what is and is not covered.
- 2 Patient advocacy & follow-throughWe aggressively pursue pre-authorizations, appeal denials when appropriate, and hold carriers accountable to their commitments.
- 3 Financial transparencyYou receive a clear written estimate of potential out-of-pocket costs. No surprises on the day of surgery.
- 4 Collaboration with carriersOur team handles documentation and communication directly with your insurance company.
- 5 Options & supportIf a procedure is not covered, we walk you through cash-pay options, financing, and other pathways to care.
FAQ
Common questions.
Do I need to be on hormones?
Not required. Many patients are on testosterone before surgery; some are not. Hormonal status affects the tissue thickness and the planning, which is discussed in consultation.
Will I have sensation?
Nipple sensation is reduced or absent after the double-incision technique because the nipples are removed and grafted. Periareolar and keyhole techniques preserve more sensation but are limited to smaller starting chest sizes.
Will I be able to go shirtless?
That is the goal. The result reads as a male chest with appropriate nipple-areolar position and size.
Will insurance cover this?
Increasingly, yes. Many plans now cover gender-affirming surgery as medically necessary care. Our advocacy team works through the pre-authorization and documentation. Whether your specific plan covers top surgery is something we confirm before scheduling.
What are the different technique options?
Double incision with free nipple grafts (used for larger chests, most common). Periareolar (for smaller chests, preserves more sensation). Keyhole (for the smallest chests with very minimal skin laxity).
Will my nipples have sensation?
Sensation is reduced or absent after double-incision technique because the nipples are grafted. Periareolar and keyhole techniques preserve more sensation but are limited by starting chest size.
How long until I can be active again?
Most patients return to desk work at one to two weeks. Light exercise at four weeks, full activity (including weightlifting) at six to eight weeks.
Ready to discuss gender affirming mastectomy?
Schedule a consultation with Dr. Azadgoli and her team to explore your options.
Request a consultation