How to Prepare for Top Surgery: What to Know Before Your FTM Mastectomy

To prepare for top surgery, stop smoking and all nicotine at least four weeks before your operation, stop aspirin two weeks before, keep your weight stable, get any long-term conditions under control, set up your home so you can rest with your arms low for two weeks, and arrange a responsible adult to stay with you for the first 24 hours. The rest is planning: choosing a technique with your surgeon, booking time off, and knowing what to expect on the day and in the first six weeks.

This guide brings together what you should know before FTM top surgery, also called FTM chest surgery or an FTM mastectomy. It covers choosing a technique (our guide to FTM top surgery options goes into more depth), the consultation, getting your body ready, what to buy, time off and travel, surgery day and the emotional side. Your surgeon’s personal instructions always come first.

How Do You Prepare for Top Surgery? A Timeline

• Two to three months before: have your consultation, agree a technique, and start any health changes your surgeon asks for, such as stopping smoking or getting blood pressure or blood sugar under control.
• Four weeks before: stop all nicotine, including cigarettes, vapes, patches, gum and pouches, and stay off it for four weeks after surgery.
• Two weeks before: stop aspirin unless your doctor has told you to keep taking it. Book time off work and confirm who will take you home.
• The week before: attend your pre-operative assessment, buy your recovery supplies, prepare meals and move everyday items to waist height.
• The day before: follow your fasting instructions and pack your bag.

Which Type of Top Surgery Is Right for Me?

There is no single FTM mastectomy. The right technique depends on your chest size, how much the chest droops, your skin elasticity and your nipple size and position, as well as your priorities, such as scar position or keeping nipple sensation. We offer five techniques:

• Double incision with free nipple grafts: tissue and excess skin are removed through two horizontal incisions, and the nipples are resized and repositioned as grafts. It suits most medium and larger chests, but nipple sensation is reduced.
• Nipple-sparing double incision: similar scars, but the nipple stays attached to a bridge of tissue, giving a better chance of keeping sensation. It suits moderate chests.
• Inverted T (anchor): adds a short vertical scar and can keep the nipple attached in some larger chests.
• Keyhole top surgery: tissue is removed through a small incision at the lower edge of the areola. No skin is removed, so it suits only small, firm chests.
• Periareolar top surgery: a ring of skin is removed around the areola, which tightens the skin and reduces the areola. It suits small to moderate chests with good elasticity.

Keyhole and periareolar surgery are often confused, but they are different operations: keyhole removes no skin, while periareolar removes a ring of skin around the areola. Some people choose top surgery without nipples for a smooth, flat chest, which is covered on our non-binary top surgery page.

Before your consultation, think about which trade-offs matter most. If keeping nipple feeling is a priority, say so, as it may favour a nipple-sparing technique if your chest is suitable. If a flat, even contour matters most, double incision often gives the most reliable result.

What Happens at a Top Surgery Consultation?

At Centre for Surgery you do not need a gender dysphoria diagnosis, a GP referral or a WPATH letter for top surgery. A formal psychological report is not required, although we recommend one if you are early in exploring gender-affirming care. Top surgery is for adults aged 18 and over.

You can start with a virtual consultation, which helps if you live outside London. A face-to-face consultation is still needed before surgery, so your surgeon can examine your chest and plan the technique. The consultant who assesses you is the consultant who performs your surgery. Your surgeon will:

• ask about your goals, any hormones you take, and your health, medicines and allergies;
• examine your chest, skin and nipple position, and recommend a technique;
• explain the likely scars, the effect on nipple sensation, the risks and the recovery;
• give you a written quote and instructions to prepare.

Write your questions down beforehand: which technique is recommended and why, where the scars will sit, and what happens if a revision is needed. Our guide on choosing the right surgeon for FTM top surgery has more ideas.

Top surgery is permanent, so we recommend a two-week cooling-off period between your consultation and surgery. It is a recommendation rather than a rule, and further consultations before surgery are free if you have more questions.

How Do I Get My Body Ready for Top Surgery?

Stop smoking and all nicotine

Nicotine narrows small blood vessels and reduces blood flow to healing skin and nipple grafts, raising the risk of wound breakdown, infection and graft loss. In a 10-year series of 180 gender-affirming mastectomies, smoking was one of the factors that significantly predicted complications^[1]. We ask everyone to stop all nicotine, including vapes, patches, gum and pouches, for four weeks before surgery and four weeks after. Your GP or pharmacy can arrange free NHS stop smoking support.

Stop aspirin and review your other medicines

Stop aspirin two weeks before surgery, as it increases the risk of bleeding. If you take it for a heart or circulation problem, speak to the doctor who prescribed it before stopping. Tell your surgeon about every medicine, supplement and herbal remedy you take, as some anti-inflammatory painkillers and supplements also affect bleeding, and your surgeon will tell you which to pause.

Keep your weight stable

Aim to be at a steady weight you can maintain, as large changes afterwards can alter how your chest looks. Avoid crash diets: your body needs good nutrition, especially protein, to heal. If you plan to lose a lot of weight, it is usually better to do so first.

Higher body weight carries some extra risk, mostly of minor problems. A 2024 national study of 2,317 patients in the Annals of Plastic Surgery ↗ linked higher BMI with greater odds of complications such as wound infection or readmission, but no patient had a severe complication whatever their BMI^[2]. A larger national analysis reached similar conclusions^[3], and a 2026 study of 530 patients managed with careful perioperative protocols found no difference in complications across BMI groups^[4]. Your surgeon will explain what your weight means for you.

Manage long-term conditions and stay active

Diabetes, high blood pressure and asthma should be well controlled before surgery; uncontrolled diabetes in particular slows healing and raises the risk of infection. A check with your GP in the months before surgery is worthwhile. Regular walking helps your circulation and recovery, but there is no need to build up your chest muscles beforehand. Keep alcohol to a minimum and sleep well in the final week.

Do I Need to Stop Testosterone Before Top Surgery?

No, you do not usually need to stop testosterone before top surgery. It does not carry the clotting risk that would mean pausing it, and stopping it can be disruptive for no clear benefit. Your surgeon may ask you to skip your dose on the day of surgery and will confirm this at your pre-operative assessment. Tell the team the type, dose and timing of your hormones.

The research supports this. A 2023 study of 490 patients in Plastic and Reconstructive Surgery ↗ compared people who stopped testosterone, people who continued it and people who had never taken it, and found no difference in haematoma, seroma, blood clots or overall complications^[5]. A 2026 systematic review and meta-analysis in Aesthetic Plastic Surgery ↗ of 15 studies found bleeding under the skin was somewhat more common in people taking testosterone, but stopping it before surgery did not reduce that risk^[6]. Continuing your hormones is reasonable, and your team will watch closely for bleeding whatever you take. Do not change your hormones around surgery without speaking to your prescriber.

Should I Keep Binding Before Top Surgery?

Most people can keep binding until the week of their operation. The aim is to arrive with healthy, unbroken skin. Binding too tightly or for too long can cause pain, skin irritation and breakdown. In a survey of 1,800 people who bind, pain often began within the first year, while skin problems and rarer effects such as rib fractures could take years to appear^[7].

Use a binder that fits properly, take regular breaks, never sleep in it, and let any rashes or broken skin heal before surgery. Tell your surgeon about any skin problems on your chest. Our guide to chest binding before FTM top surgery explains how to bind safely.

What Should I Buy Before Top Surgery?

For the first two weeks you will keep your arms below shoulder height, sleep on your back and avoid lifting. A practical top surgery checklist:

• Button-up shirts or zip-up hoodies, loose enough to go over your compression binder, so nothing goes over your head.
• Extra pillows or a wedge pillow to sleep propped up on your back, and a small cushion to go between you and the seatbelt on the way home.
• Slip-on shoes and trousers with an elastic waist.
• Easy meals and snacks, cooked ahead or stored within reach.
• A water bottle with a straw, wet wipes and dry shampoo for the days before you can shower normally.
• Your compression binder, which the clinic will confirm with you in advance, and any medicines prescribed to take home.

Before surgery day, move cups, plates, toiletries and clothes from high shelves and low cupboards to waist height, and wash your bedding so you come home to a clean bed.

How Much Time Off Work Do I Need for Top Surgery?

Most people return to desk-based work within about two weeks, sometimes sooner if they can work from home. If your job involves lifting, reaching overhead or physical effort, plan for around six weeks off or on lighter duties.

Do not drive until you can move your arms freely, wear a seatbelt comfortably and make an emergency stop. For most people this is one to two weeks, once they no longer need prescription pain relief; your surgeon will advise you, and it is worth checking with your insurer. The gym and heavy lifting wait until about six weeks.

Can I Travel to London for Top Surgery?

Yes. You can start with a virtual consultation from home, and most people travelling from outside London need only one or two trips before their operation.

Top surgery is a day case, so you leave our hospital the same day. A responsible adult must take you home, or back to your hotel, and stay with you for the first 24 hours after your anaesthetic; we cannot discharge you without one. If you travel to London for top surgery, we advise staying locally until your wound check 7 to 10 days after surgery. Your patient coordinator can share options at partner hotels close to Baker Street, and overnight nursing after surgery can be arranged in advance. Our guide to travelling to us for surgery covers the practical details. Allow around two weeks before a short-haul flight, longer for long-haul, and confirm the timing with your surgeon.

What Happens on the Day of Top Surgery?

You will be told when to stop eating and drinking. Wear a loose button-up top, leave jewellery at home, and bring a list of your medicines. At our Baker Street hospital you will meet your surgeon and the consultant anaesthetist; your surgeon will confirm your consent and mark your chest. Top surgery is carried out under TIVA (total intravenous anaesthesia), so you are fully asleep, and usually takes two to three hours. If drains are used, they usually come out within the first few days. Most people go home the same day in their compression binder once they are comfortable, eating, drinking and walking.

What Should I Expect in the First Weeks After Top Surgery?

• Week 1: rest, walk little and often, sleep on your back and keep your arms below shoulder height. Most people feel tightness and soreness rather than sharp pain.
• Day 7 to 10: your first wound check.
• Weeks 2 to 6: gradually do more, return to desk work, and keep wearing your compression binder for six weeks.
• From 6 weeks: your surgeon reviews you, and most people can return to the gym and heavy lifting.
• 3 months: a further assessment. Scars keep fading for 12 to 18 months.

In the first 24 hours after surgery you have your surgeon’s direct number. After that, call us on 020 7993 4849, 9am to 6pm, Monday to Saturday; out of hours, call NHS 111, or 999 in an emergency. Our FTM top surgery recovery guide sets out the week-by-week picture.

How Do I Prepare Mentally for Top Surgery?

It is natural to feel a mix of excitement, relief and nerves as the date gets closer. It helps to:

• Set realistic expectations. Your chest will be swollen at first; the shape takes around three months to show and scars a year or more to settle.
• Expect a low patch. Many people feel tired or flat in the first week or two while life is restricted. It usually passes as you recover.
• Line up your support. Decide who will help at home and who you can call. Our article on supporting your partner through top surgery is a good one to share with them.
• Find peer support. UK organisations such as TransActual ↗ share information and links to support groups.

If you have doubts, talk them through with your surgeon before you consent.

How Much Does Top Surgery Cost in the UK?

The cost depends on the technique: double incision with free nipple grafts is more involved than keyhole or periareolar surgery and is priced accordingly. Your written quote sets out exactly what is included. Our FTM top surgery cost guide explains current prices. Finance is available, subject to status. If you have private medical insurance, check with your insurer.

Should I Have Top Surgery on the NHS or Privately?

Top surgery is available on the NHS for adults who meet the criteria, through a GP referral to an NHS gender dysphoria clinic ↗, assessment there and referral to a surgical team. Waiting lists are long, which is why many people choose private surgery, where you can book a consultation directly. Our guide to NHS vs private FTM top surgery in the UK compares routes, waiting times and costs.

Frequently Asked Questions

FTM Top Surgery in London

FTM top surgery at Centre for Surgery is performed by GMC-registered surgeons at our CQC-regulated Baker Street hospital, rated Good overall by the CQC, for trans men and non-binary people. We offer double incision with free nipple grafts, nipple-sparing double incision, inverted T, keyhole and periareolar top surgery, and you receive clear written instructions to help you prepare and recover. No diagnosis, referral or WPATH letter is needed. The consultant who assesses you at consultation is the consultant who performs your surgery. Your initial consultation is £100, redeemable against the cost of surgery if you go ahead.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Ederer IA, Spennato S, Nguyen CT, et al. A single-center 10-year experience of 180 transmasculine patients undergoing gender-affirming mastectomy while continuing masculinizing hormone replacement therapy. Aesthetic Plastic Surgery 2023;47(3):946–954. doi:10.1007/s00266-022-03213-x ↗
2. Hassan B, Schuster CR, Ascha M, et al. Association of high body mass index with postoperative complications after chest masculinization surgery. Annals of Plastic Surgery 2024;92(2):174–180. doi:10.1097/SAP.0000000000003737 ↗
3. Marquez JL, Sudduth JD, Patel AA, et al. The association of body mass index category and postoperative complications in gender affirming mastectomy for chest reconstruction. Transgender Health 2025;10(2):178–184. doi:10.1089/trgh.2023.0112 ↗
4. Shah N, MacLeod E, Kirkham K, Armstrong K. Masculinizing chest surgery outcomes by body mass index and American Society of Anesthesiologists class in ambulatory care. Journal of Plastic, Reconstructive and Aesthetic Surgery 2026;114:172–179. doi:10.1016/j.bjps.2026.01.002 ↗
5. Robinson IS, Rifkin WJ, Kloer C, et al. Perioperative hormone management in gender-affirming mastectomy: is stopping testosterone before top surgery really necessary? Plastic and Reconstructive Surgery 2023;151(2):421–427. doi:10.1097/PRS.0000000000009858 ↗
6. Phuyal D, Yacoub S, Belardo ZE, et al. The impact of testosterone supplementation on surgical complications in gender-affirming mastectomy: a meta-analysis. Aesthetic Plastic Surgery 2026;50(11):4335–4347. doi:10.1007/s00266-026-05692-8 ↗
7. Peitzmeier SM, Silberholz J, Gardner IH, et al. Time to first onset of chest binding-related symptoms in transgender youth. Pediatrics 2021;147(3). doi:10.1542/peds.2020-0728 ↗

Related Articles

• What Are My Options for FTM Top Surgery?
• FTM Top Surgery Recovery and Aftercare
• Chest Binding Before FTM Top Surgery – How to do it Safely
• NHS vs Private FTM Top Surgery in the UK — Routes, Waiting Times and Costs Compared