How Common Is Regret After Top Surgery? What the Research Shows

Regret after FTM top surgery is uncommon. Across the published research, around 1% of people regret gender-affirming surgery overall, and the rate after chest masculinisation (top surgery) is lower still, at under 1%^[1]. Studies that follow people for several years after FTM top surgery consistently report high satisfaction with the decision, and requests for reversal are very rare. Dissatisfaction with how the chest looks, such as a scar that has stretched or a nipple that sits slightly off, is more common than regret, and it can often be improved with revision surgery.

That does not mean regret never happens, and it is a fair question to ask before any permanent operation. This guide sets out the real figures, what the studies can and cannot tell us, how regret differs from dissatisfaction and detransition, and what helps you make a well-informed decision. It applies to trans men and to non-binary people considering non-binary top surgery, including options such as a flat chest without nipples.

Do People Regret Top Surgery?

A small number do, but the great majority do not. Most studies of chest masculinisation surgery report regret in a handful of people at most, and many report none.

The largest pooled analysis is a 2021 systematic review and meta-analysis in Plastic and Reconstructive Surgery Global Open ↗. It combined 27 studies covering 7,928 transgender people who had any type of gender-affirming surgery. The pooled prevalence of regret was 1%, and among people having transmasculine procedures it was under 1%^[1]. Of the 77 people in the review who expressed regret, fewer than half had what the authors classed as major regret.

For top surgery specifically, the strongest single study is a 2023 cross-sectional survey in JAMA Surgery ↗. Researchers sent validated regret and satisfaction questionnaires to everyone who had a gender-affirming mastectomy at a US centre over 30 years. Of 139 people who replied, a median of 3.6 years after surgery, the median regret score was 0 out of 100 and the median satisfaction score was the maximum, 5 out of 5. No one who replied, and no one who did not reply, had requested or undergone a reversal^[2].

Top Surgery Regret Statistics: What the Studies Show

Beyond the two studies above, other published research points the same way. The studies use different methods and definitions, so they should be read together rather than as one exact number.

• 0.2% to 0.3% in surgeons’ experience: a survey of gender surgeons who had treated between 18,125 and 27,325 people found 62 patients who expressed regret, across all types of gender-affirming surgery^[3].
• No regret at 3 and 12 months: a 2026 cohort of 100 people having gender-affirming mastectomy, with no reversal operations^[4].
• No reported regret over 13 years: a Portuguese reference centre’s series of 87 people, with a mean satisfaction score of 8.5 out of 10 among those who replied^[5].

How Reliable Are Top Surgery Regret Figures?

The research is consistent, but it has real limits, and it is worth being honest about them:

• Not everyone replies. In the 2023 JAMA Surgery study, 59% of eligible patients responded. People who are unhappy may be less likely to answer a survey from the team that operated on them, although the authors also checked records and found no reversals among non-responders^[2].
• Follow-up is often short. Many studies follow people for one to five years. Regret, where it happens, can surface later, so longer studies are still needed.
• Definitions vary. Some older studies used informal questions rather than validated regret scales, and the authors of the 2021 meta-analysis noted the subjectivity of how regret is assessed^[1].

Even so, no published study of chest masculinisation surgery has found regret to be common. The fairest summary is that regret is rare, that it is not zero, and that the decision deserves careful thought.

What Counts as Regret After Top Surgery?

People use the word “regret” for quite different experiences:

• Decisional regret means wishing you had not had the operation at all. This is what regret studies try to measure.
• Dissatisfaction with the result means being glad you had surgery but unhappy with part of the outcome, such as scars, dog ears at the ends of the incisions, asymmetry, or the size or position of the nipples. This is more common, and it is usually a question for revision surgery rather than reversal.
• Detransition means stopping or reversing some or all of a transition. It does not always involve regret, and many people who detransition do not regret earlier treatment.

A survey of gender surgeons published in 2021 classified the regret they had seen into three types^[3]. True gender-related regret, where a person’s sense of their gender had changed, accounted for 42%. Social regret, linked to things such as relationships, family, work or discrimination, accounted for 37%. Medical regret, linked to complications, function or the result, accounted for 8%. A large share of regret, in other words, is driven by circumstances around the person rather than by the surgery itself.

Detransition and Top Surgery: Is It the Same as Regret?

No. Detransition and regret overlap, but they are not the same, and detransition is often temporary.

The most detailed data on reasons for detransition come from a 2021 analysis of the US Transgender Survey in LGBT Health ↗. Of 17,151 people who had pursued gender affirmation in any form, 13.1% said they had detransitioned at some point. This figure is not specific to surgery: it includes people who paused social transition or hormones, often for a time. Of those who had detransitioned, 82.5% named at least one external reason, most often pressure from family or societal stigma, while 15.9% named an internal reason such as uncertainty about their gender identity. The authors noted that some people may later seek gender affirmation again^[6].

If the main pressures in your life come from outside, such as an unsupportive family or an unsafe workplace, it can help to think about how those might affect you after surgery, and to have support in place.

Some people who detransition later choose breast reconstruction; others keep a flat chest. Choosing reversal does not always mean regretting the original surgery.

Why Do Some People Regret Top Surgery?

Where regret or strong dissatisfaction does happen, the reasons usually fall into a few groups:

• A change in gender identity or how a person wants to express it. This is uncommon, but it does happen, which is one reason time to reflect matters.
• Social pressures after surgery, such as family rejection, discrimination or the end of a relationship.
• Unrealistic expectations. Top surgery can greatly reduce chest dysphoria, but it will not resolve every source of distress.
• A technique that did not suit the chest. For example, a small-incision approach on a chest with loose skin can leave excess skin, which may need a second operation. Our guide to FTM top surgery options explains how technique is matched to chest size and skin.
• Complications or a result that looks different from what was expected, such as wide scars, contour irregularities or loss of a nipple graft.
• Not feeling fully informed. In a 2025 long-term follow-up study, how well patients felt informed before surgery was closely linked with how satisfied they were years later^[7].

Bad Top Surgery Results: What If You Are Unhappy With How Your Chest Looks?

Unhappiness with how the chest looks is more common than regret, and it is quite different from regretting the decision. Typical concerns include:

• raised, stretched or dark scars;
• “dog ears”, small folds of skin and fat at the outer ends of the scars;
• asymmetry between the two sides;
• nipples that look too large, too small, too high, too low or too far apart;
• remaining tissue or a contour that is not as flat as hoped.

These are recognised and often fixable. In the Portuguese series of 87 people, 8% needed a secondary revision operation^[5], and in the 2026 cohort of 100 people, scar revision was the most common later procedure, usually done as a minor operation^[4]. Neither study recorded any regret.

The chest takes time to settle. Swelling, scar redness and contour changes continue to improve for up to 12 to 18 months, so we do not usually plan revision surgery until nine to twelve months after your operation, once the tissue has fully settled. Our guides to top surgery scars and dog ears after surgery explain what can be done. We offer revision surgery after top surgery, and your surgeon will advise whether and when it is worthwhile.

If your chest seems to be filling out again, our article can breasts grow back after top surgery? explains why and how it is treated.

Is Top Surgery Dangerous?

Top surgery is a major operation, but serious complications are uncommon. The risks that most often affect the result are:

• Haematoma (bleeding under the skin), which sometimes needs a return to theatre. In the 2026 cohort, 2% needed an urgent return for bleeding^[4].
• Seroma (fluid collection), usually managed by drainage in clinic.
• Wound healing problems and infection, which are more likely in people who smoke or vape nicotine.
• Partial or complete loss of a nipple graft, which is uncommon and more likely in people who smoke.
• Changes in sensation, especially after free nipple grafts. Our guide to nipple sensation after top surgery covers what to expect with each technique.
• Visible scars, which vary with technique and with how your skin heals.

At Centre for Surgery, top surgery is performed under total intravenous anaesthesia (TIVA), and we ask you to stop smoking and nicotine products for four weeks before and four weeks after surgery.

Can Top Surgery Be Reversed?

Yes, in the sense that a breast shape can be rebuilt, but top surgery cannot be fully undone. The breast tissue that was removed cannot be replaced. Reversal means breast reconstruction, usually with breast implants, fat transfer from elsewhere on the body, or a combination of the two, sometimes in stages. A reconstructed breast will not produce milk, and nipple sensation and appearance will differ from before. A 2026 case report described staged reconstruction using fat grafting alone in a person who had chosen reversal without regretting their original surgery^[8].

We offer top surgery reversal at Centre for Surgery. Our guide can top surgery be reversed? explains the options, recovery and what reconstruction can and cannot achieve.

What Are the Benefits of Top Surgery?

Regret is only half of the picture. The same body of research shows clear, lasting benefits for most people who have top surgery.

Chest satisfaction and quality of life

In a 2026 prospective study from Paris, 44 adults completed the BODY-Q questionnaire before surgery and six months after. Satisfaction with the chest rose from an average of 24 to 82 out of 100, and psychological wellbeing rose from 24 to 62. Patients’ expectations stayed stable after surgery, which the authors took as a sign of realistic counselling beforehand^[9].

A larger Swedish prospective cohort of 112 trans men and non-binary people, with a response rate above 90%, found significant improvements in emotional wellbeing, vitality and bodily pain one to three years after surgery, as well as greater congruence between gender identity and appearance^[10].

Benefits that last

Benefits do not seem to fade with time. In a 2026 survey of 152 people a median of 3.4 years after gender-affirming mastectomy, median BODY-Q scores were 87 out of 100 for the chest and 90 out of 100 for the nipples, with high scores for psychological functioning^[11]. Our article do I need FTM top surgery to complete my transition? explains why it is a personal choice rather than a requirement.

No more binding

Many trans men and non-binary people bind their chests every day before surgery. In a survey of 1,800 adults who bound, over 97% reported at least one negative effect attributed to binding, such as back pain, skin problems, overheating or shortness of breath, and binding more often was linked with more problems^[12]. Top surgery removes the need to bind. Until then, our guide to binding safely before top surgery explains how to reduce the risks.

How Can You Reduce the Risk of Regretting Top Surgery?

There is no way to remove all uncertainty from a permanent decision, but several things make regret less likely.

Take time to decide

You do not need a diagnosis, GP referral or WPATH letter for top surgery at Centre for Surgery, and we treat adults aged 18 and over. Your surgeon assesses whether surgery is suitable for you and discusses the risks and alternatives.

After your consultation, we recommend a cooling-off period of at least two weeks before you confirm your surgery date. It gives you time to read your written information, talk to people you trust and raise any further questions.

Get clear, specific information

Ask your surgeon to explain which technique suits your chest and why, where the scars will be, what will happen to your nipples, how sensation may change, what complications can occur and what revision or reversal would involve. Looking at real top surgery before and after photos helps you picture a realistic result, including how scars look as they mature.

Choose the result you want, not a default

Top surgery is not one-size-fits-all. You may prefer nipple grafts, nipple-sparing surgery or no nipples at all, and non-binary people sometimes want a result that is flatter but not traditionally masculine. Our guide on how to choose the right surgeon for top surgery lists useful questions to ask.

Have support around you

Support from friends, partners, peer groups or a counsellor can help both before and after surgery, particularly if you face pressure from family or at work. Feeling low or unsure in the first weeks of recovery, while you are swollen and in a binder, is common, usually settles as you heal and is not the same as regret. Our FTM top surgery recovery guide explains what to expect.

Questions to Ask Yourself Before Top Surgery

• What am I hoping top surgery will change, and what will it not change?
• Have I been living with this wish for some time, and has it stayed consistent?
• How would I feel if my nipple sensation were reduced?
• Do I want nipples, and if so, what size and position?
• Who will support me during recovery, and how will the people around me react?

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 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, revision surgery and top surgery reversal. No diagnosis or referral letter is needed. The consultant who assesses you at consultation is the consultant who performs your surgery, and we recommend a two-week cooling-off period before you go ahead. Your initial consultation fee is 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.

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

References

1. Bustos VP, Bustos SS, Mascaro A, et al. Regret after gender-affirmation surgery: a systematic review and meta-analysis of prevalence. Plastic and Reconstructive Surgery Global Open 2021;9(3):e3477. doi:10.1097/GOX.0000000000003477 ↗
2. Bruce L, Khouri AN, Bolze A, et al. Long-term regret and satisfaction with decision following gender-affirming mastectomy. JAMA Surgery 2023;158(10):1070–1077. doi:10.1001/jamasurg.2023.3352 ↗
3. Narayan SK, Hontscharuk R, Danker S, et al. Guiding the conversation: types of regret after gender-affirming surgery and their associated etiologies. Annals of Translational Medicine 2021;9(7):605. doi:10.21037/atm-20-6204 ↗
4. Libondi K, Libondi G, Sobieszek KA, et al. Early and late surgical complications after gender-affirming mastectomy in predominantly young adults: a single-center cohort study. Plastic and Reconstructive Surgery Global Open 2026;14(8):e7995. doi:10.1097/GOX.0000000000007995 ↗
5. Catalão I, Azevedo JM, Sítima M, et al. Mastectomy in transgender patients: the experience of a Portuguese reference center. JPRAS Open 2026;48:924–932. doi:10.1016/j.jpra.2026.01.044 ↗
6. Turban JL, Loo SS, Almazan AN, Keuroghlian AS. Factors leading to “detransition” among transgender and gender diverse people in the United States: a mixed-methods analysis. LGBT Health 2021;8(4):273–280. doi:10.1089/lgbt.2020.0437 ↗
7. Kwartin S, Skorochod R, Shapira E, et al. Long-term follow-up of gender-affirming chest masculinization: what have we learned about patient satisfaction and psychological well-being? Journal of Clinical Medicine 2025;14(4):1249. doi:10.3390/jcm14041249 ↗
8. Haley C, Roblee C, Lane M, et al. Patient-centered care in gender-affirming surgical reversal: a case report of breast reconstruction using autologous fat grafting and discussion on reversal, detransition, and regret. Annals of Plastic Surgery 2026;97(5):490–493. doi:10.1097/SAP.0000000000004837 ↗
9. Sprunger Y, Serror K, Aguglia R, et al. Patient-reported outcomes following chest masculinization surgery in transmasculine individuals: a prospective study. JPRAS Open 2026;50:493–502. doi:10.1016/j.jpra.2026.04.020 ↗
10. Gran I, Kamali A, Granath F, et al. Improved health-related quality of life and gender congruence after gender-affirming mastectomy: a prospective cohort study. Journal of Sexual Medicine 2025;22(10):1882–1890. doi:10.1093/jsxmed/qdaf203 ↗
11. Haley C, Roblee CV, Hamill JB, et al. Chest satisfaction and quality of life several years following gender-affirming mastectomy. Plastic and Reconstructive Surgery 2026. doi:10.1097/PRS.0000000000013184 ↗
12. Peitzmeier S, Gardner I, Weinand J, et al. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality 2017;19(1):64–75. doi:10.1080/13691058.2016.1191675 ↗

Related Articles

• Can Top Surgery Be Reversed?
• What Are My Options for FTM Top Surgery?
• How to Choose the Right Surgeon for FTM Top Surgery
• Can Breasts Grow Back After Top Surgery?