Chest Construction & Reduction

Chest construction and reduction are gender-affirming, upper body surgeries that remove unwanted chest (breast) tissue.

Chest construction is a term that refers to both chest reduction surgery (procedure to reduce the amount of chest tissue) and full bilateral mastectomy (removal and sculpting of chest tissue to create a shape that is typically considered to be more masculine). These surgeries are done by a plastic surgeon. The goal is creating a smaller and/or flat chest.


Different techniques may be needed to contour (or shape) the chest during gender-affirming chest construction surgery. Resection (cutting of tissue with a scalpel) is a common surgical technique used during chest construction. Liposuction (removal of tissue through suction) is another technique that is sometimes used. The techniques used will depend on your surgeon's preference and your anatomy.

If a surgeon decides to use liposuction to contour your chest during your procedure, this would be included in the chest construction fee and therefore covered by MSP. If liposuction is done for any reason other than contouring (for example, to remove tissue in the underarm area) this would not be covered by MSP. Some surgeons will offer to do liposuction to areas beyond of the chest area (for example, in the underarm area) for a fee. If you are interested in this option, you can discuss this with your surgeon during your surgical consult. 

Chest Construction Surgery Guide

The information below can be found in our new Chest Construction Surgery Guide and Workbook which are meant to help people understand and navigate the surgical journey. Everyone's experience is different, but these resources can be helpful during the surgical journey for individuals, their families, and care providers.

Referral & Consult

Referral & consultation process

1Complete surgical care planning

To get started, you will need one surgical recommendation, which is made after surgical care planning. This can be done by a clinician who meets the qualifications and competencies outlined in the WPATH Standards of Care 8- this may include your primary care provider or a clinical counsellor. Part of the surgical care planning process includes assessing whether you meet the WPATH criteria required for this surgery and whether you are ready for surgery. After you have completed your care planning and have received a surgical recommendation, your primary care provider will refer you either to the Trans Care BC central waitlist for upper surgery or to a plastic surgeon of your choice. Additional information or consultation with specialists may be required at the discretion of the surgeon.

2Review referral options

Visit the surgery referral page for steps required in the referral options for chest construction.

3Speak to your surgeon

You may want to speak to your surgeon about:

  • The different surgical techniques available
  • The advantages and disadvantages of each technique
  • What your options are if you are not satisfied with the appearance of your chest
  • Whether they have before-and-after photographs of their own patients, including those of both successful and unsuccessful outcomes
  • The risks and possible complications of the various techniques
  • The surgeon's own complication rates for each procedure

The procedure

There are many different techniques that can be used for chest construction. The technique used depends on factors like cup size and skin elasticity, as well as the size and position of your nipples. The three most common techniques are described below. Your surgeon will recommend a technique suited to your body shape and goals.

This technique may be recommended for those with an A cup size and lots of chest skin elasticity.

  1. A small incision is made along the bottom of the areola.
  2. Chest tissue is removed via a liposuction needle through the incision.
  3. The incision is closed. The nipple is usually not resized or repositioned.

This technique results in a small scar on the lower part of the areola and nipples with sensation.

This procedure reduces one's chest tissue (cup size) as part of one's surgical gender affirmation. The main difference between chest reduction and bilateral mastectomy is the amount of tissue and skin removed during the procedure. With chest reduction, some chest tissue (subcutaneous tissue, glandular tissue and skin) remains and the chest appears smaller (but not flat). People may choose this option for several reasons (including but not limited to):

  • Smaller chest aligns more congruently with their gender
  • Smaller chest may feel more congruent with one's body shape and size (compared to a flat chest)
  • More glandular tissue remains in place, which may facilitate future milk production and chestfeeding, particularly if nipples are not resized or repositioned.

Each person's body and needs are different and therefore the surgical technique used for reduction may vary. Similarly, whether nipple grafting (removal, re-shaping and re-position or left off based on patient-preference) is done varies as well. 

This technique may be recommended for those with a B cup size or a C cup size and moderate to lots of chest skin elasticity.

  1. An incision is made all around the outside of the areola.
  2. A second circular incision is made a few centimetres away from the first.
  3. The doughnut shaped skin between the two incisions is removed.
  4. Breast tissue is then removed with a scalpel, or with a combination of scalpel and liposuction.
  5. Some trimming of the nipple areola complex may be done but the blood and nerve supply remain intact.
  6. The skin is sutured together around the areola.
  7. Drains (long thin tubing) may be placed in the chest to help drain off excess blood and fluid so that it will not build up under the skin.

This technique results in scarring that goes around the nipple-areola complex and nipples with sensation. There may be some puckering around the incision.

This technique is only recommended for people with a C cup size and reduced skin elasticity, or a D cup size.

  1. Large incisions are made horizontally across the chest, usually beneath the nipple.
  2. The skin is peeled back. Chest tissue is removed with a scalpel.
  3. Excess chest skin is trimmed.
  4. Incisions are closed, leaving two scars below the pectoral muscle lines.
  5. The nipple-areola complex is removed completely, trimmed to a smaller size and grafted to the chest in a higher position.
  6. Two drains (long thin tubing) are placed along each incision to allow blood and fluid to escape.

This technique results in prominent scars. (You may be able to grow chest hair to cover the scars or building your pectoral muscles may make the scars less noticeable. Some people choose to get tattoos over their scars.) There may be possible changes to the pigment or the areola. The sensory changes include complete loss of sensation in the nipples.

Preparing for surgery

While you wait for your referral to be processed, you should keep your personal information updated with all of your health care providers, including any change of name or contact information. This will ensure your health care professionals can reach you to schedule consultation and surgery appointments.

You may also want to visit the Preparing for Surgery page to help you create a plan for success after surgery.


All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and artery blockages. These complications can, in extreme cases, result in death. It's important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise, and respond to them appropriately. They will also inform you about what you can do to minimize your risks.

Some complications are particularly associated with chest construction. Below are a list of some possible complications of this surgery. Please note - this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

An abscess is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.

When the skin tissue isn't the expected shape. Major contour irregularities can be corrected through liposuction. This is necessary in about 5 to 25% of cases, depending on the surgeon and the technique.‎


‎This is possible with the keyhole and periareolar surgeries and an expected result of double incision surgery (in which the nipple-areola complex is removed completely and re-grafted to the chest).

When blood collects in the surgical site, causing pain, swelling and redness. It is the most common complication. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.

‎When the shape or location of nipple on one side looks different from the nipple on the other side. Some asymmetry is common; very noticeable asymmetry can be corrected through a surgical revision.

When the nipple, or part of it, falls off. If this happens within hours after surgery, saving the nipple may be possible; otherwise, the nipple may need to be replaced or reconstructed. This complication is rare.‎

Scarring is to be expected; the degree varies by technique. Severe scarring may require surgical revision. You can take steps to prevent severe scarring by following your surgeon's advice about getting rest, avoiding the sun, doing massage exercises and using ointments.


‎When clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon. Big seromas may need to be removed through surgery.

After Surgery

Post-operative care

You will probably be sent home the day of your surgery. You will likely receive painkillers and antibiotics to reduce the chance of infection.

You will wear a compression vest around your chest for a period of about 1 month. You'll also have surgical dressings and Steri-strips along the incision lines. Your surgeon will give you instructions about when to remove the dressings and when it is okay to shower. The Steri-strips are usually left in place and will fall off on their own.

During the healing process your body will want to generate lots of fluid around the surgical site. To prevent this fluid from building up in your chest, it needs to be drained. The surgeon will insert drains for this purpose, and you will be taught how to monitor and empty them. The drains will be removed by the surgeon during a clinic visit 3 to 7 days following surgery.

It is normal for the incisions on your chest to be red, but this redness should not extend to more than 1 to 2 cm from the incision (if they extend beyond this, seek medical attention). It is also normal to see or feel the knot from the stitches at the end of the incision. These knots can be annoying, but they are nothing to worry about. If they work their way to the surface (which would usually happen around 3 weeks) they can be clipped free by a health care provider. Bruising and swelling is expected and is not a cause for concern unless there is an unusually large amount of swelling on one side.


The number of check-ups needed varies from person to person. Your surgeon will likely ask you to come in for a check-up around one week after your surgery, and again at 4 to 6 weeks. You can also see your primary care provider about any concerns in the post-operative period. When you visit your surgeon or primary care provider, they should check your surgical sites to make sure there are no infections or wound healing problems. They will ask questions about pain, bleeding, bowel movements, fever and how you are feeling physically and emotionally.

Recovery time

Recovery time varies from person to person, so always follow the advice of your own surgeon. Many people feel comfortable within two weeks following chest construction, but you'll need plenty of rest during those weeks. Expect to limit your arm movement for the first 2 to 3 weeks. It is common to return to your daily activities gradually over the 4 to 6 weeks following your surgery. Some activities, such as driving, heavy lifting, exercise, sex and soaking in hot tubs, may be restricted in the post-operative period. Your surgeon will give you advice about when it is okay to resume these activities.

Surgical revision

Chest construction revisions are relatively uncommon and it's important for you to know that revisions may not be covered by MSP even when requested by your surgeon.

MSP will only pay for revisions that are considered functional, for example scar tissue that causes ongoing pain or restricts movement. MSP generally does not cover revisions related to the appearance of your chest. If you have questions about this or concerns about your healing please bring these up with your surgeon at your post-operative visits. 

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