Can You Still Get Breast Cancer After Top Surgery?

Top surgery reduces the risk of breast cancer, but it does not eliminate it. FTM top surgery removes most of the breast tissue from the chest, and with it most of the cells that could become cancerous. However, a thin layer is always left under the skin and beneath the nipples to keep them healthy and to avoid a hollow look, so a small risk remains. Breast cancer after top surgery is uncommon, but it can happen, which is why chest awareness and a clear plan for screening still matter.

This guide explains how much top surgery lowers your risk, what the research shows, how testosterone and family history fit in, and what NHS guidance says about breast screening for trans men and non-binary people after top surgery. If you want to know how much tissue each technique leaves and how that tissue behaves with weight, testosterone or pregnancy, our guide to whether breasts can grow back after top surgery covers that in detail.

Does Top Surgery Reduce the Risk of Breast Cancer?

Yes. Breast cancer starts in the cells of the breast’s glands and ducts, so removing most of that tissue removes most of the places where cancer could begin.

No large study has measured exactly how much top surgery lowers the risk, but the best population data come from the Netherlands. In a 2019 nationwide cohort study published in the BMJ ↗, which followed 1,229 trans men receiving gender-affirming hormone treatment at an Amsterdam gender clinic, four cases of invasive breast cancer were found. That was about a fifth of the number expected in cisgender women of the same age^[1]. The authors concluded that trans men have a lower risk of breast cancer than cisgender women.

For comparison, Macmillan Cancer Support ↗ explains that a risk-reducing mastectomy, the operation offered to people with a very high inherited risk, lowers the risk of breast cancer by about 95%, but that even then it is not possible to remove every last cell of breast tissue. Top surgery is designed to shape a flat chest rather than as a cancer operation, so it greatly reduces the risk rather than removing it.

Can You Still Get Breast Cancer After Top Surgery?

Yes, although it is rare. The tissue that remains after top surgery is real breast tissue, and it can develop the same changes as breast tissue anywhere else.

Surgeons deliberately leave a thin layer of tissue under the chest skin to keep the skin’s blood supply healthy and to avoid a sunken or uneven contour. How much is left depends partly on the technique:

• Double incision with free nipple grafts allows the most complete removal, as no tissue needs to be kept under the nipples. Double incision top surgery suits most chest sizes.
• Techniques that keep the nipple attached, such as keyhole, periareolar and nipple-sparing double incision top surgery, keep a stalk of tissue under the nipple to carry its blood and nerve supply, so slightly more tissue remains.

A 2021 review of oncological safety in gender-affirming mastectomy, published in Plastic and Reconstructive Surgery ↗, notes that techniques vary significantly in how much breast tissue they leave, and that the long-term effect of this on cancer risk is not yet known^[2]. The review recommends that surgeons aim to remove all visible breast tissue within the limits of the technique, that the removed tissue is sent for analysis, and that patients are taught chest awareness afterwards.

Cases of breast cancer after top surgery have been reported. A 2022 review in the Annals of Plastic Surgery found 36 previously published cases of breast cancer in trans men, two-thirds of them diagnosed after gender-affirming mastectomy, and half of those found when the removed tissue was examined under the microscope^[3].

Unless you are at high inherited risk, the choice of technique should still be driven by your chest size, skin and goals; our guide to FTM top surgery options explains how surgeons match the technique to the chest.

Can Breast Cancer Be Found During Top Surgery?

Occasionally, yes. When the tissue removed during top surgery is sent for histology, a pathologist examines it under the microscope. Most results are normal, but a few show changes that raise future risk, such as atypical hyperplasia, or early cancer nobody knew was there.

In a 2020 study published in Modern Pathology ↗, pathologists reviewed 447 specimens from gender-affirming chest surgery and found atypia or ductal carcinoma in situ (DCIS, a very early, non-invasive form of breast cancer) in 11 people, or 2.5%^[4]. The authors called for culturally sensitive screening plans for trans men.

Larger reviews show that invasive cancer found this way is rare. A 2025 scoping review pooled nine studies covering 3,869 routine top surgery specimens and found 42 cases of atypia, 5 of DCIS, 1 of Paget’s disease and 3 of invasive ductal carcinoma^[5]. In a single-centre study of 865 people having gender-affirming mastectomy or breast reduction, high-risk or malignant findings were found in 12 of 1,730 breasts (0.7%), and people under 25 were much less likely to have any incidental finding than older patients^[6].

An abnormal result is uncommon, but it changes what happens next: atypical hyperplasia may mean closer follow-up, and any cancer is referred to a breast team for treatment.

At Centre for Surgery, histology is charged separately where tissue is sent for analysis, and your coordinator confirms this in advance; you can discuss whether it is worthwhile with your surgeon at your consultation. It is particularly worth considering if you are older, have a family history of breast cancer or have noticed any lump in your chest.

Should I Have a Mammogram Before Top Surgery?

Most people having top surgery are young and do not need breast imaging beforehand. Imaging may be recommended if you are of screening age, have a lump or other symptom, or have a strong family history or known gene variant^[2]. In a 2026 study of 368 people having chest masculinisation surgery, 11% had imaging first, mostly for age or family history, and finding cancer before surgery allowed the operation to be planned around it^[7]. If you are due a mammogram or have any breast symptoms, tell your surgeon and arrange it through your GP before your operation.

Does Testosterone Increase Breast Cancer Risk in Trans Men?

Current evidence does not show that testosterone increases the risk of breast cancer in trans men^[2]. In the Dutch cohort, trans men on hormone treatment had a lower rate of breast cancer than cisgender women^[1].

Studies of tissue removed at top surgery point in the same direction. The longer people had taken testosterone, the more their breast glands had shrunk (lobular atrophy), and some benign lesions such as cysts and fibroadenomas were less common^[4]. In the study of 865 patients, the length of time on testosterone was not linked to more serious incidental findings^[6].

Long-term data are still limited, and the body converts some testosterone into oestrogen, which can affect hormone-sensitive cancers. This is not a reason to avoid testosterone, but if you are ever diagnosed with breast cancer, your oncology team and prescriber should review your hormone treatment together.

Should I Tell My Surgeon About a Family History of Breast Cancer?

Yes, always. A family history of breast or ovarian cancer, or a known gene variant such as BRCA1 or BRCA2, can raise your lifetime risk considerably, and it may change how your top surgery is planned.

This is more common than people expect. In a 2026 study of 284 people having top surgery at one academic centre, a third reported a family history of breast cancer. Among the 79 people whose risk could be calculated with a standard risk model, 43% were at intermediate or high risk. Two of the 15 people who had genetic testing carried a disease-causing variant, and four high-risk people chose a risk-reducing mastectomy instead of a standard top surgery^[8].

Tell your surgeon at consultation if:

• a parent, sibling or child has had breast or ovarian cancer, especially under the age of 50;
• several relatives on the same side of the family have had breast, ovarian, prostate or pancreatic cancer;
• a male relative has had breast cancer;
• you or a relative has a known BRCA1, BRCA2 or other cancer gene variant;
• you have had radiotherapy to the chest, or previous breast biopsies showing atypical changes.

If your family history suggests a higher risk, ask your GP about a referral for genetic counselling. A genetics or family history service can assess your risk, discuss testing and advise whether you need earlier or more frequent checks. If you are found to be at high risk, your surgeon may suggest involving a breast surgeon before your top surgery so that the operation can be planned with cancer risk in mind, as the most complete removal can affect the final chest contour.

Breast Cancer Screening for Trans Men in the UK

The NHS Breast Screening Programme ↗ invites people registered with a GP as female from age 50 up to their 71st birthday. The first invitation arrives sometime between 50 and 53, and after that you are invited every 3 years, not every year. Screening uses mammograms, which X-ray the breast while it is pressed between two plates.

Whether you are invited depends on the sex recorded at your GP surgery, not on whether you have had surgery. The government’s guidance, NHS population screening: information for trans and non-binary people ↗ (updated September 2026), says:

• If you are registered with your GP as male, you will not be invited for breast screening.
• If you are registered as male and have had top surgery, the guidance advises you to have a conversation with your surgeon about the amount of breast tissue you have remaining. If they confirm you still have breast tissue, you can ask your GP to refer you for mammograms at a hospital near you.
• If you are registered as male and have not had top surgery, and you are aged 50 or over, the guidance suggests you talk to your GP, who can arrange a referral for mammograms.
• If you are registered as female and aged 50 up to your 71st birthday, you will be invited routinely. The guidance recommends you consider screening if you have not had top surgery or still have breast tissue.

In practice, the NHS notes that if you were assigned female at birth and have had top surgery, it is unlikely that you will be able to have a mammogram. There is often too little tissue left to position between the plates, particularly after double incision surgery. After keyhole or periareolar surgery, or if you have more tissue left for another reason, a mammogram may still be possible. If screening mammograms are not suitable for you, chest awareness becomes your main safeguard, and any symptom should be assessed at a breast clinic, where ultrasound or other imaging can be used.

If you are not sure how much tissue you have left, ask at your follow-up appointment or contact the clinic, and keep a copy of your operation note and any histology report to share with your GP. Our guide comparing NHS and private FTM top surgery explains how private care links in with your GP.

What Is Chest Awareness After Top Surgery?

Chest awareness means knowing how your chest normally looks and feels, so that you notice changes early. Clinical examination remains the most common way cancer in residual tissue is detected^[2], so this matters more than any single test.

Give your chest time to settle first. In the first few months it is normal to feel firm lumps, ridges and areas of hardened fat along the scars and under the nipples, and parts of the chest will be numb. Our FTM top surgery recovery guide explains what is normal during healing, and your surgeon reviews you at six weeks and assesses you again at three months. Once your chest has settled, usually after about three to six months, start getting to know your new baseline:

• Look at your chest in the mirror with your arms by your sides and then raised, checking the skin, scars and nipples.
• Feel the whole chest, including along and under the scars, around and behind the nipples, up to the collarbone and into each armpit, using the flat of your fingers.
• Check regularly, for example once a month, so you learn what is normal for you. Numb areas will not warn you of tenderness, so feel them carefully.

Lumps from scar tissue usually soften over the first year. A lump that is new, growing or different from the rest of your chest after that time should be checked. Our guide to top surgery scars describes how scars change as they mature.

What Are the Signs of Breast Cancer After Top Surgery?

The symptoms are the same as for breast cancer in anyone, but after top surgery they may appear near the scars or nipples. See your GP promptly if you notice:

• a new lump or thickening in the chest, along a scar or in the armpit, especially if it is hard, painless or fixed;
• a nipple that turns inwards or changes shape;
• discharge from a nipple, particularly if it is bloody;
• a rash, crusting or a sore around a nipple that does not heal;
• dimpling, puckering, redness or swelling of the chest skin;
• swelling in the armpit or around the collarbone.

Most lumps after top surgery turn out to be scar tissue, fat necrosis or a small cyst, but they still need to be assessed. Tell your GP that you have had top surgery and that some breast tissue remains, so that they refer you to a breast clinic rather than assuming cancer is impossible. If you are still within your aftercare period, you can also contact us on 020 7993 4849, 9am to 6pm, Monday to Saturday.

Is Top Surgery the Same as a Mastectomy?

Top surgery is a type of mastectomy, but it is not the same as a mastectomy for breast cancer. A gender-affirming mastectomy aims to remove breast tissue while shaping a flat, masculine chest, with careful attention to contour, scar position and nipple size and placement. A mastectomy for cancer, or a risk-reducing mastectomy for someone with a BRCA variant, aims to remove as much breast tissue as possible, and contour is a secondary concern.

That is why a standard top surgery should not be thought of as cancer prevention, particularly if you are at high inherited risk.

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 adults aged 18 and over. We offer double incision with free nipple grafts, nipple-sparing double incision, inverted T, keyhole and periareolar top surgery, as well as top surgery without nipples, and your surgeon will ask about your personal and family history of breast cancer and explain how much tissue each technique leaves. No diagnosis, GP referral or WPATH letter is needed, and the consultant who assesses you is the consultant who performs your surgery. Your initial consultation is £100, redeemable against the cost of surgery if you go ahead; our FTM top surgery cost guide explains what the price includes. Finance is available, subject to status: see our finance options.

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

References

1. de Blok CJM, Wiepjes CM, Nota NM, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ 2019;365:l1652. doi:10.1136/bmj.l1652 ↗
2. Salibian AA, Axelrod DM, Smith JA, et al. Oncologic considerations for safe gender-affirming mastectomy: preoperative imaging, pathologic evaluation, counseling, and long-term screening. Plastic and Reconstructive Surgery 2021;147(2):213e–221e. doi:10.1097/PRS.0000000000007589 ↗
3. Parmeshwar N, Song S, Alcon A, Kim EA. The incidence of breast cancer after gender-affirming mastectomy in transmen. Annals of Plastic Surgery 2022;88(4 Suppl 4):S332–S336. doi:10.1097/SAP.0000000000003083 ↗
4. Baker GM, Guzman-Arocho YD, Bret-Mounet VC, et al. Testosterone therapy and breast histopathological features in transgender individuals. Modern Pathology 2020;34(1):85–94. doi:10.1038/s41379-020-00675-9 ↗
5. Chu C, Goldman J, Joung H, et al. Breast cancer incidence among patients undergoing chest masculinization surgery: a scoping review. Annals of Surgical Oncology 2025;33(1):138–145. doi:10.1245/s10434-025-18156-1 ↗
6. McCaffrey RL, James AJ, Torres-Guzman RA, et al. Incidence of high risk and malignant pathological findings in transgender and gender diverse individuals undergoing gender-affirming mastectomy. Annals of Surgical Oncology 2024;31(12):8086–8092. doi:10.1245/s10434-024-16005-1 ↗
7. Schuster CR, Aslami ZV, Taccheri C, et al. Preoperative breast cancer screening before chest masculinization surgery. Breast Cancer Research and Treatment 2026;217(2). doi:10.1007/s10549-026-07967-9 ↗
8. Cronin JE, Aryanpour Z, Durden JA, et al. Identifying breast cancer risk in patients undergoing gender-affirming chest masculinization surgery. Journal of Surgical Oncology 2026;134(1):25–30. doi:10.1002/jso.70272 ↗

Related Articles

• Can Breasts Grow Back After Top Surgery?
• What Are My Options for FTM Top Surgery?
• How to Prepare for Top Surgery: What to Know Before Your FTM Mastectomy
• NHS vs Private FTM Top Surgery in the UK — Routes, Waiting Times and Costs Compared