'Top Surgery' Is Becoming More Common for Trans Teens

Breast removal—or "top surgery"—is an option being chosen by a small but growing number of transgender teens. Research has shown that top surgery has improved the lives of many transgender men, and while there has been less research on transgender adolescents, studies suggest that these teens also have dramatically reduced body distress and a higher overall quality of life after the surgery, the New York Times reports. The Times surveyed pediatric gender clinics across the country and 11 said they had performed a total of 203 procedures on minors last year, while nine other clinics declined to respond. Other forms of breast surgery were far more common among adolescents: more than 3,200 girls aged 13 to 19 had cosmetic breast implants in 2020 and almost 5,000 had breast reduction surgery, per the Times. Teens who have top surgery also usually take testosterone and change their pronouns.

Miami surgeon Dr. Sidhbh Gallagher says she performs one or two top surgeries on patients under 18 every month. They are usually at least 15, she says, but she has operated on two younger patients who were in "extreme distress about their chests," per the Times. Most states require parental consent for patients under 18, though Arizona and Alabama have banned all gender-related surgeries for patients under 18 and other GOP-led states plan to follow suit. "This is a very, very considered decision, and it’s a decision between parents, the individual seeking surgery, the surgeon and the multidisciplinary team, the mental health professional, the pediatrician," says Dr. Loren Schechter, director of gender-confirmation surgery at Rush University Medical Center, per the Chicago Tribune.

"It’s taken very, very seriously, and that includes the times at which we perform the intervention," Schechter says. Only a small number of teen patients have expressed regret about having the irreversible surgery, but Canadian researcher Dr. Kinnon MacKinnon—who is transgender and has had the surgery—says more research needs to be done on "detransitioning." "I know personally many, many, many trans men that have benefited and are happy with their medical transition and their top surgery. I would put myself in that category,” MacKinnon tells the Times. "But just as a researcher, I do feel like there are questions that are deserving of answers and have implications for clinical care." (More transgender stories.)