Why I Chose Non-Flat Top Surgery — & How It Changed My Life

As I write this I am in recovery from the most expensive and intensive birthday present I’ve ever given myself: non-flat top surgery. 

Non-flat top surgery is commonly associated with a growing range of gender-affirming surgeries that don’t quite fit the binary understanding of gender. It sits somewhere between the more well-known procedures of standard flat top surgery (the removal of breast tissue to create a more 'masculinised' chest) and a breast reduction (which normally aims to produce a smaller, perkier but still recognisable breast). The purpose of non-flat top surgery will be a little different for everyone, both in intention and outcome. The results I’m aiming for are slightly larger than average, pec-type mounds where my breasts used to be.

Top surgery is still usually classified as an elective procedure or occasionally a cosmetic procedure, even though it can be a life-saving — or at the very least, life-altering — procedure for many who suffer from dysphoria, mental and physical ill health due to their chest.  

Non-flat top surgery varies from standard top surgery in that you aren’t necessarily removing all breast tissue or going totally flat. I wanted this because it gives the flexibility and freedom to bind and get that flat effect sometimes but also — to take inspiration from Shakira — provides breasts that are "small and humble so you don’t confuse them with mountains". I wanted them to be as small as I could go while keeping my nipples attached during surgery, which is more likely to retain higher sensitivity and just one of the customisable options available. 

I’ve been searching for this surgery from the moment puberty came barging in on my carefree, tomboy life. I was suddenly forced to be incredibly aware of how my ever expanding chest meant I was an object of fascination, desire and loathing, and no longer "one of the boys". This was just the start of how my breasts would impact the way I moved through the world. I’ve experienced ridicule, hypersexualisation and invasions of personal space and bodily autonomy over them. That's before I even touch on the physical pain and discomfort of having a large chest. 

Yet the idea of a totally flat chest never quite sat right with me, nor did a breast reduction.

Discovering Dr Sidhbh Gallagher, the Miami-based surgeon I ended up going with, was a revelation. I came across a post of hers about non-flat top surgery which the patient and the doctor had innovated together. Upon stumbling across this image I sat there, ugly crying for about 20 minutes out of relief that this thing that I’d imagined for so long was actually possible.

Making it happen wasn’t easy or cheap. The thought of going across the pond for a surgical procedure was pretty terrifying and added about $5,700 AUD (£3,000) to an already expensive undertaking. I was highly fortunate to be supported by my incredibly generous community, friends and family, who contributed about half the cost of the trip through crowdfunding, but even with that support behind me I was left with some difficult choices. I could try to contend with UK trans healthcare, potentially waiting up to five years just to jump through the hoops of a Gender Identity Clinic consultation. Even privately, I’d have to advocate for myself almost every step of the way, even for a recognised procedure, let alone something less well known. The alternative was taking a risk on the American healthcare system with its specific medical requirements, insurance, COVID and the prospect of virtual rather than in-person consultations and follow-ups. 

As a fat, Black woman I haven’t had the best experiences within the healthcare system. It was essential that I found a surgeon who was confident working on larger bodies and understood how Black/darker skin heals. I needed to be able to speak candidly about my concerns, both on the operating table and when healing. 

Ultimately, Dr G’s care and expertise confirmed that she was the right choice. She was backed up by frequent posts about surgery options and experiences on social media, a detailed list of non-binary surgical options on her website and a recently published book detailing them further. She even met the standards of Reddit's Top Surgery forum, who are definitely not afraid to let you know their honest opinions. When she started the consultation by asking me what my pronouns are, it only solidified my decision.  

Gender is a wild ride. I’ve spent a lot of time examining my own understanding of gender and identity and this has only intensified during lockdown. A lot of the gender social cues we’d usually confront on the daily thankfully didn’t translate to working online and not having to be out there in the world. If you’ve never done so, I’d highly recommend going on a gender journey of your own, even if the result is that you are cis. You get to know yourself just by asking what belongs to you and what belongs to society. What is a result of the world around you telling you that you have to be a certain way? 

I’ve always been unconventional, butch, masc, a stud, whatever you want to call it. I’m sitting pretty comfortably with the label of gender non-conforming at the moment, although that doesn’t necessarily fall into any specific identity categories and this gives me room to explore. I’m finding that I’m increasingly less interested in making other people comfortable by allowing them to package me up into easily digestible gender bites. 

But it also makes me incredibly weary. Navigating the world as a fat, dark-skinned, Black, butch woman presents a whole host of obstacles that I am used to circumventing daily but it is all I have ever known. I’m not sure what to expect as the perception of who I am shifts. When I’m perceived as male, as has happened occasionally since my surgery, I’m also perceived as a big Black man. I am under no illusion about the unfamiliar dangers that might arise because of that. Or what danger lurks when people then clock that I’m not. 

Ultimately I’m more in tune with my body than I have ever been. I was able to come to this procedure from a place of love and acceptance rather than the self-loathing or disassociation I have felt towards my body in the past. Instead of contesting my body I was able to look at it like an old pal to whom I was saying goodbye. We had our ups and our downs but we were always there for each other. Now, it’s time to start a fresh relationship with a body that I am able to craft and mould, to be precisely who I was always meant to be, even if that person is fluid and ever evolving.