The Moral Atrocity of “Top Surgery” (2024)

Beverly* from Oregon emails me: “Urgent need help with ROGD daughter please answer ASAP.” Her daughter announced out of the blue that she’s a boy (this is called Rapid Onset Gender Dysphoria, or ROGD). I’m a child and adolescent psychiatrist, and I receive messages like this almost daily. That’s because unlike most of my colleagues, I won’t automatically affirm a child’s new identity, or refer her to a clinic where she’ll be put on experimental hormone therapy.

Beverly has reason to panic. She learned not only that her daughter, a 15-year-old, has declared herself to be a boy, but that her daughter’s best friend and main influence, Mia, just had her breasts removed as part of her own male identification process. Beverly is beside herself. “Do doctors really do that to a 16-year-old?” she asks incredulously. “They sure do,” I reply.

Increasingly, confused girls with mental-health issues are lining up to have their breasts removed, erroneously believing my colleagues who tell them the operation will alleviate their emotional pain and allow them to emerge as their authentic selves. Girls as young as 13 are having “top surgery,” a euphemism for a bilateral mastectomy—the removal of both breasts—in order to create, as gender surgeons put it, a “masculinized” chest. “Bilateral mastectomy” sounds jarring and clinical; it’s a treatment for cancer, after all—one that women agonize over.

Mind you, these are the same people who insist that five-year-olds use anatomically accurate terms, not childish nicknames, for their genitals. They soberly instruct us to teach the words “scrotum” and “vulva” to kindergarteners. But the vague, trivial-sounding terms “top” and “bottom” surgeries—that language is fine. As if the consequences of those major operations—infertility, sexual dysfunction, infection, and chronic pelvic pain, to name a few—aren’t permanent and debilitating.

As an intern in pediatrics, when one of my patients needed a medical procedure, I was required to obtain informed consent from the parents or guardian of the minor. I was obligated to explain, accurately and comprehensively, the risks—both immediate and long-term—of the procedure. I wonder how accurate and comprehensive are the consents obtained by surgeons who perform double mastectomies on minors. Mia’s mother was almost certainly told that mastectomies for minors with gender dysphoria are evidence-based treatment, supported by well-documented standards of care. But did the surgeon mention that this deceptive reassurance is being challenged in court, with the help of an amicus brief by the Society for Evidence-Based Gender Medicine?

SEGM’s arguments against mastectomies for girls like Mia are compelling. They point out that long-term outcomes are highly uncertain and that many girls have untreated mental-health issues. They explain why the evidence supporting mastectomies in minors is low-quality and unreliable. According to SEGM, mastectomies on minors are an “experimental procedure on vulnerable youth” whose brains and identities are still developing. Leading gender clinics and psychiatric associations worldwide are rejecting these procedures. They’re saying that girls who want their breasts removed need in-depth psychotherapy, not a surgeon’s scalpel.

I know many girls like Mia, and I’m well aware that she can’t tolerate talking about her periods, let alone pregnancy, because she’s fleeing womanhood. But her identity is still evolving; if she’s like other gender-confused girls, she wore lace push-up bras less than a year ago. In the next decade, she will go through many more changes—and one of them, I hope, will be re-acceptance of her female biology. She may follow the same path as Daisy Chadra, a young woman who lived as a man for five years and had her breasts “amputated” (her word). What she lost is irreplaceable, but Daisy’s back at peace with her female biology. There appear to be thousands like her, who regret the medical and surgical interventions they believed would solve their emotional problems. Transgender activists claim regret is rare, but this de-transitioners’ site alone has 26,000 members. If Mia someday joins their growing ranks, she may experience her flat, scarred chest as a loss.

And what if she decides to have a child? The surgeon was obligated to discuss with the mother the consequences of Mia’s breast removal—not only to her daughter but also to her grandchildren. Because in this case, organ removal may have negative consequences for two generations.

Nursing is a cornerstone of mother-infant bonding, and when she signed on the dotted line, Mia’s mother agreed to deprive her daughter and grandchildren of the opportunity to nurse. At the moment, it may have seemed irrelevant, but for consent to be informed, the surgeon was obligated to consider long-term consequences. No bottle, pacifier, plush toy, bouncer, swing, rocker, sound machine, mobile, light show, or vibrating mat will soothe an unhappy baby like nursing. Breast milk is considered the gold standard by pediatricians and the World Health Organization. It provides lasting health benefits for both mother and child.

Mia cannot fathom the magic of mother-child bonding, or the many other wonders of her female biology. If she’s like most kids, her sex education, instead of inspiring a sense of awe for her female physiology, taught that the differences between herself and a guy are due to socialization, not biology—and that it’s normal for her to reject reality and identify as a boy. But her surgeon, and her mother, should have known better. Is it really necessary to point out that adults have more wisdom than children, and that they must resist their impulses to give in to a child’s demands just because she is distressed and feels certain?

The surgeons and “gender specialists” who support or perform these procedures on children must be held accountable. Take, for example, Johanna Olson–Kennedy from Children’s Hospital L.A., a pediatrician who believes that there should be no minimum age for a double mastectomy. What if a girl regrets it? Olson–Kennedy says: “If you want breasts at a later point in your life, you can go and get them.”

Children are being victimized on the altar of an ideology that seeks to obliterate a fundamental truth of civilization—the reality of male and female.

Finally, the investigations are starting. Let the truth come out: the radical social agendas that animate sexuality education; the capture of the medical, mental health, social work, and educational professions; the undermining and silencing of parents. Let’s hear expert witnesses explain the denial of biological truths, the false and dangerous promises made to vulnerable kids, and the informed consents for irreversible medical interventions that were hardly informed.

Give a public platform to the victims—those who’ve been sterilized and scarred, and their families, who’ve been traumatized and betrayed. When enough people learn the truth and stand up, when the dogma is successfully challenged, and when schools, doctors, and therapists promoting the dogma are exposed, we can start to write an end to this medical calamity.

* This and other names have been changed for this article.

Top image:Jon Wightman/iStock


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The Moral Atrocity of “Top Surgery” (2024)


What is the top surgery controversy? ›

Top surgery is a particular target for opponents of gender care, who object to allowing minors to undergo life-altering procedures at such a young age. Some children's hospitals and doctors providing top surgery have reported being harassed and threatened online for treating adolescents.

What are the cons of top surgery? ›

  • Poor wound healing.
  • Fluid buildup beneath the skin.
  • A solid swelling of clotted blood within your tissues.
  • Damaged or dead body tissue, such as in the nipple.
  • Scarring.
  • Not being satisfied with appearance after surgery.
  • An imbalance in chest tissue.
Jan 13, 2022

Do you have to have gender dysphoria to get top surgery? ›

For people to undergo top surgery, according to WPATH, they must meet these criteria: The person has persistent gender dysphoria that has been well-documented by a qualified mental health professional. They are able to make a fully informed decision and provide their consent for the treatment.

What is the legal term for top surgery? ›

What is top surgery? Top surgery is another name for chest masculinization or feminization.

What is the riskiest surgery in the world? ›

Most dangerous emergency surgeries
  • Partial colon removal.
  • Small bowel resection (removal of all or part of a small bowel).
  • Gallbladder removal.
  • Peptic ulcer surgery to repair ulcers in the stomach or first part of small intestine.
  • Removal of peritoneal (abdominal) adhesions (scar tissue).
  • Appendectomy.

What is the #1 surgery in the nation? ›

An appendectomy is the most common surgery in the US when it comes to general surgery. These surgical procedures can be scheduled or done on an emergency basis, depending on the condition of the appendix.

What is the success rate of top surgery? ›

A Top Surgery Revision is a secondary surgery that improves or corrects aesthetic irregularities resulting from Top Surgery. As with other plastic surgery procedures, a revision performed after Top Surgery can improve results. In total, 26.5% required secondary operations. The overall revision rate was 23.8 percent.

What is the success rate of female to male surgery? ›

Most people who choose these surgeries experience an improvement in their quality of life. Depending on the procedure, 94% to 100% of people report being satisfied with their surgery results.

How much is the average top surgery? ›

In general, the cost of FTM Top Surgery ranges from $6000–$10,000 USD. This may or may not include consultation fees, hidden fees and medical supplies.

What BMI do you need for top surgery? ›

Surgery is safest when the BMI is between 24-36.

Can top surgery reversed? ›

Keep in mind that the results of top surgery are considered permanent and are not reversible. As with any surgery, there are potential complications associated with cosmetic mastectomy. However, this is considered a very safe procedure, and most patients feel that the benefits outweigh the risks.

What happens if you don't treat gender dysphoria? ›

Although gender dysphoria is not a mental illness, when not addressed, it may lead to worsening mood issues, depression and anxiety, and may further complicate the issues the individuals may be having. Insurance may cover some illnesses associated with gender dysphoria and gender dysphoria care.

Is top surgery worth it? ›

The bottom line

Top surgery can be a life-saving, gender-affirming procedure for many people. It can help alleviate or lessen gender dysphoria and other challenges people face. There are many approaches to top surgery. And there are surgeons who specialize in particular techniques.

What is double top surgery? ›

The Double Incision Top Surgery procedure is the most widely-used technique and is ideal for those who are medium to large chested. During this procedure, the skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. (The muscle itself is not touched.)

Do top surgery scars go away? ›

The good news is that generally speaking, scars will fade and flatten on their own given enough time. It can take 12-18 months for scars to settle into their final appearance. You can speed things along by supporting your body during the healing process and following your surgeon's aftercare instructions.

What surgery has the lowest survival rate? ›

Seven Deadliest Surgeries
  • Removal of part of the colon (partial colectomy)
  • Gallbladder removal (cholecystectomy)
  • Appendix removal (appendectomy)
  • Peritoneal adhesion removal.
  • Small-bowel resection.
  • Peptic ulcer surgeries.
  • Abdominal incisions (laparotomy)

What surgery has the lowest fatality rate? ›

Appendix removal

The mortality rate for this type of surgery was 0.08 percent (the lowest of any surgery among the top seven), and the complication rate was 7.3 percent.

What is the safest surgery ever? ›

Bariatric Surgery Among the Safest Surgical Procedures

While any surgical procedure has risks, bariatric surgery has been found to be one of the safest surgeries to undergo. It is considered as safe or more safe when compared to other elective surgeries.

What is the mother of all surgeries? ›

Treatment for appendix cancer can be trying. The surgery has been nicknamed the MOAS (mother of all surgeries) as depending on how many cancer affected organs and tissues are removed, it can be the equivalent of several “major surgeries”.

What are the rarest surgeries? ›

  • Rare surgery to remove thyroid tumour saves woman's life. ...
  • Hyperhidrosis – Laparoscopic Lumbar Sympathectomy – a case report. ...
  • Thyroglossal Cyst – Endoscopic Excision – First of its kind in Kerala. ...
  • Pheochromocytoma Surgery – Rare Adrenal Surgery. ...
  • Liposarcoma. ...
  • Rare Keyhole Neck Surgery For 3 Year Old Girl.

What surgery has the shortest recovery time? ›

An ACL injury, for example, can take six months or more to recover from. Operating times, like recovery times, are the shortest for vasectomies and appendectomies. A vasectomy averages around 20 – 30 minutes while an appendectomy usually takes about an hour.

What age is best for top surgery? ›

The best candidates for male chest reconstruction

Though most individuals undergoing top surgery are 18 or older, younger individuals may be considered for the procedure if the patient, their legal guardians, and their mental health professional are in agreement that top surgery is appropriate.

Has anyone ever woken up during top surgery? ›

Very rarely — in only one or two of every 1,000 medical procedures involving general anesthesia — a patient may become aware or conscious.

What type of top surgery is most common? ›

The Double Incision Top Surgery procedure is the most often-used technique and is ideal for those who are medium to large chested. During this procedure, the skin on the chest is opened along two horizontal incisions, just cranial of the niple areola complex and in the inframammary fold.

Does female to male bottom surgery get hard? ›

People can expect to still have sexual arousal, erection, and org*sm after lower gender-affirming surgery. Sensation may depend on the type of surgery people have and surgery recovery times.

Is it better to have a male or female surgeon? ›

And the worst surgical outcomes occurred when female patients were treated by male surgeons. Compared with a female patient treated by a female surgeon, a woman treated by a male surgeon was about 15 percent more likely to have complications, be readmitted to the hospital or die within 30 days of the operation.

How long does female to male surgery take? ›

GCS, GRS Surgery normally takes approximately 4 to 5 hours to perform depending on the complexity of the surgery.

What is the most expensive surgery in America? ›

1. Exploratory chest surgery. The most expensive single medical procedure in America is exploratory chest surgery. Hospitals charge an average of $137,533 for similar pre-diagnostic surgeries.

Can MTF get bottom surgery? ›

MTF Bottom Surgery

These can include: Penile skin inversion vaginoplasty, with or without scrotal skin grafting. Revision vaginoplasty using small bowel or the rectosigmoid colon. Secondary genital reconstruction.

Who does the best top surgery? ›

Top Surgery is the most commonly performed surgery for trans masculine people, and may be the only surgical step taken in a FTM/FTN transition.
  • Dr. Thomas Satterwhite. ...
  • Dr. Scott Mosser. ...
  • Dr. John Henry Pang. ...
  • Dr. Angela Rodriguez. ...
  • Dr. Dev Gurjala. ...
  • Dr. Praful Ramineni. ...
  • Dr. Cassie Nghiem. ...
  • Dr. Dustin Reid.

What happens if you gain weight after top surgery? ›

Gaining weight very quickly or soon after surgery could affect your skin or scarring. In most cases, you would need to gain (or lose) a great deal of weight for the chest contour to change substantially. It is always best to discuss any plans for body changes with your surgeon before surgery.

What BMI is too high for breast surgery? ›

According to Dr. Platt, other similar studies with breast reduction patients have shown an almost 100 percent wound complication rate as the BMI approaches 40. "The upper limit of a normal BMI is around 26. In overweight patients, a BMI of 30 would be a number to shoot for before a breast reduction surgery is done.

What BMI is too high for plastic surgery? ›

A good surgery candidate will have a BMI of 30 or below. While some surgeons will operate on patients with a BMI as high as 35-39, you're less likely to be suitable for surgery if you are overweight or in the BMI range of 30 or above.

Do you still have feeling in your nipples after top surgery? ›

The degree of sensation after surgery is usually similar to the sensation of the upper chest before surgery. Thus, sensation is still present, but is diminished from the sensation in the nipples that is usually present before surgery.

Is top surgery risky? ›

The possible risks of transmasculine top surgery include, but are not limited to, bleeding, infection, poor healing of incisions, hematoma, loss of nipple sensation, loss of the nipple and areola, and anesthesia risks.

How painful is top surgery recovery? ›

It's encouraged that pain medication is used when needed, but patients typically find that pain during recovery is very minimal and subsides after a couple of days. Apart from some pain, patients will experience slight discomfort from the swelling and bruising of the chest, but this can be managed with ice packs.

What in the brain causes gender dysphoria? ›

Structure of the GD Brain

Looking at the volume of the cortex using voxel-based morphometry, Simon et al found that females and male-to-female gender dysphoric individuals had a smaller grey matter volume in their left somatosensory and primary motor cortices in comparison to cisgender male controls.

Can gender dysphoria permanent? ›

If gender dysphoria persists during puberty, it is very likely permanent.

Is gender dysphoria very rare? ›

A diagnosis of gender dysphoria in childhood is rare. Most children who seem confused about their gender identity when young will not continue to feel the same way beyond puberty. Role playing is not unusual in young children.

How long is the average top surgery recovery? ›

Recovery time for top surgery varies from person to person. People who get FTM or FTN top surgery generally return to work or school about two weeks after surgery. Those who get MTF or MTN top surgery can typically get back to work or school after one week.

How many hours is top surgery? ›

This type of surgery usually takes around one to two hours. In some cases, it may be performed in less than an hour.

What happens if you get pregnant after top surgery? ›

You can get pregnant after chest reconstruction top surgery, although you will not be able to chest/breastfeed unless you only had a reduction. Having chest reconstruction top surgery otherwise has no effect on your fertility and reproductive capacity.

What are the drains after top surgery? ›

What are drains? Drains remove and collect blood, pus or other excess fluids that can collect inside your chest after Top Surgery. If fluids are given a chance to build up, complications and/or infection can set in and healing can be delayed. Excess fluid in a post-surgical site can also cause pain and swelling.

What is keyhole top surgery? ›

Keyhole uses a semi-circular incision at the base of the areola, while peri-areolar uses a circular incision around the areola. These both create very good male contours with minimal scarring and good nipple sensation. These surgeries are also frequently less expensive than double incision.

Can you tattoo over top surgery scars? ›

Surgery scars are usually precise incisions that leave minimal scarring. These scars are best worked into the edges of a tattoo to minimize their appearance. But you can also tattoo right over them, as is commonly done with mastectomy scars — as long as they're healed first.

Is top surgery recovery hard? ›

Most patients do not have much trouble with chest reconstruction top surgery recovery. When you wake up from surgery, it is normal to experience some discomfort, swelling, and bruising. Your chest will be wrapped in gauze dressings and a compression binder for support.

Does top surgery cut muscle? ›

We remove breast tissue and excess skin to create a masculine-looking chest. Top surgery is more than simply removing tissue. It includes careful contouring of muscle and nipple to create a pleasing, natural-looking chest.

Which TikTok famous doctor was banned from performing surgery? ›

TikTok Famous Plastic Surgeon's Medical License Suspended Over Video. Plastic surgeon, Dr. Katherine Roxanne Grawe, better known as Dr.

Does top surgery hurt FTM? ›

You may feel some pain for the first couple of days—especially when you move around or cough—and some discomfort for a week or more. Your surgeon will prescribe medication to lessen the pain. The bandages will be removed a week or two after surgery during your first postoperative visit.

What is the goal of top surgery? ›

The general goal of top surgery is to flatten the chest and remove tissue. Another goal of the surgery is to make the chest look and feel closer to the way you want.

Can I sue if I wake up during surgery? ›

Your anesthesia awareness case could fall under the malpractice umbrella of anesthesia errors. If you can prove that your awareness was caused by negligence, you could recover compensation from the hospital or doctor responsible for your psychological damages, including pain and suffering.

What does propofol feel like? ›

Patients sedated with propofol rarely complain of feeling "drugged" and more often remark that they feel as if they had a great nap. While fentanyl and other opioid-type drugs may cause nausea, particularly at higher doses, this is rare with propofol.

Do they take the breathing tube out before you wake up? ›

The breathing tube is removed at the end of the procedure as you start to awaken. Someone from the anesthesia care team monitors you while you sleep. This anesthesia team member adjusts your medicines, breathing, temperature, fluids and blood pressure as needed.

What doctor was suspended for sexting during surgery? ›

Arthur K. Zilberstein, for allegedly sexting dozens of times a day during surgeries. A Seattle anesthesiologist who allegedly sent sexually explicit texts dozens of times a day while he was supervising C-sections and other surgeries has had his medical license suspended immediately.

Who is the lady with excessive plastic surgery? ›

Jocelyn Wildenstein (née Jocelyne Périsset; born August 5, 1940) is a Swiss socialite known for her extensive cosmetic surgery, resulting in her catlike appearance; her 1999 high-profile divorce from billionaire art dealer and businessman Alec Wildenstein; and her extravagant lifestyle and subsequent bankruptcy filing.

What happened to Dr Aronov? ›

Daniel Aronov has reportedly been barred from performing cosmetic surgery. Aronov had 13 million followers on TikTok before his account disappeared. The ban follows an investigation into the practices of a clinic run by Dr. Daniel Lanzer.

Do nipples have sensation after top surgery? ›

After surgery, you can expect your nipples to be sensitive to touch and temperature. You may also experience some numbness or tingling. These sensations will usually go away within a few weeks to months. As for appearance, your nipples will be more proportional and may be slightly asymmetrical at first.

Do nipples work after top surgery? ›

During the surgery, the nipple remains intact; however the position of it is determined by the position on your breast. Its positioning cannot be changed or altered by the procedure. Because of this, it offers a better chance at preserving nipple and areola sensation, however this cannot be guaranteed.

Do you have to lose weight for top surgery? ›

Surgery is safest when the BMI is between 24-36. I recommend that you have your surgery when your body is at the weight you plan on maintaining for the foreseeable future. If you gain or lose a lot of weight after surgery, the way your chest looks will change also, and not always for the better.

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