Considering surgery

What is chest construction?

Chest construction A gender-affirming, upper surgery that removes breast tissue and sculpts remaining tissue into a shape that is typically considered to be more masculine. (sometimes called top surgery Refers to some gender-affirming above-the-waist surgeries, including chest surgeries and breast surgeries. ) is a gender-affirming surgery that removes or reduces breast tissue and skin to make a flatter chest. It may involve changing the size or position of the nipples. If you’re considering chest construction surgery, you can choose between the following two options:

1. Chest surgery (bilateral mastectomy A surgical procedure to remove one or both breasts. with contouring) — Removal and sculpting of chest tissue to create a flatter and more sculpted chest
2. Chest reduction surgery — A procedure to minimize the amount of chest tissue present

Visit Understanding the Procedure for detailed information on the procedure, your options and the potential risks.

Making a decision about surgery

A wide range of people choose to have gender-affirming surgery, including people who are transgender, Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) and non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. . While having surgery does not make anyone more or less trans, it can help some people feel more comfortable in their body.

Download the workbook

In addition to the information below, our Chest Construction Workbook contains strategies to help you on your decision-making path.

Questions to ask yourself

As you consider whether surgery is right for you, it may be helpful to start by asking yourself the following questions:

• Are you okay with having visible scars?
• Is sensation important to you?
• How many operations are you prepared to have?
• What level of risk are you willing to accept?
• Do you have any health issues that may restrict your options?
• What can you afford to do (in terms of aftercare costs, time off work, etc.)?

Setting realistic expectations

Like with any other surgical intervention, there are risks associated with chest construction. Many people are very happy with the outcomes of their surgery, but some also experience complications or results that don’t meet their expectations. Being prepared for the limitations of what surgery can achieve and the possibility of disappointment are part of ensuring you have realistic expectations. 

Limitations of chest construction

• Scarring may be more prominent than expected.
• There may be contour issues such as skin puckering, bulging or indenting. 
• Your chest, nipples or areolas may be asymmetrical in size, shape or position. 
• The size or appearance of the areolas may not meet expectations.
• You may experience changes in sensation, including areas of complete numbness.

We recommend familiarizing yourself with the complications associated with chest construction.

When to have surgery

Timing is also an important consideration for surgery. You may be heading off to school, starting a new job or have other important life events. Commitments like these make it difficult to accommodate the down time needed to recover from surgery. Picking the right time for surgery is as important to your recovery as any other pre or postop activity your primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. recommends. 

This guide is meant to help you decide

There are many emotional, spiritual, physical, social and financial considerations that may impact your decision to have surgery. This guide was prepared to help you understand the costs, the procedure, the risks and the recovery associated with chest construction.

Surgical costs — who pays for these?

Public funding

The B.C. Medical Services Plan (MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. ) will pay for the cost of the chest construction surgery.

If a surgeon decides to use liposuction A surgical technique for removing fat from under the skin by suction. 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. 

Private pay option

Some people choose to have their chest construction surgery done outside B.C.’s public system. The reasons that someone may choose private-pay surgery include:

• Not having health care coverage
• Wanting to undergo surgery outside of B.C.
• Reduced wait times

If you choose that option, you would be required to pay for all of the costs, including the surgery itself, which typically costs $6,000 to $10,000. In some cases, your employer’s extended health benefits may provide some coverage. This varies significantly, though, so be sure to confirm with your health insurance provider.

Please note: There are no private pay options for chest construction within B.C. This is because this surgery is a MSP-funded benefit. Options for private pay include surgeons in other provinces or surgeons outside Canada. 

Other surgery-related costs

While MSP pays for most of the costs associated with your chest construction surgery, there are other costs you should consider, including:

• Time off from work — You will need time off for both your surgery and recovery period. Recovery times are unique to each person, but it usually takes 2–6 weeks (or more in the case of complications) for most people to return to work. If your work is physically demanding, you may need more time. 
• Medical supplies & other post-surgery items — These include wound care supplies, supportive garments and medications. You can find a full list of recommended post-surgery items in the Chest Construction Workbook.
• Travel and accommodation — If you don’t live near a surgical centre, you will need to cover the costs of travel. You may want to arrive a day ahead of your surgery and may need to stay for several days after. Ensure that you budget for accommodations, meals and parking.
• Costs for your support person — If someone is coming with you to help with your care before and after surgery, you may need to account for their travel and accommodation costs as well.

Financial support available

There may be some financial help available depending on your employer and your income bracket. 

• Paid leave — Speak with your employer or Human Resources department about any short-term disability, sick leave or vacation time you can use during your time off. 
• Extended benefits —  If you have one, check your extended benefits program to see what is covered.
• Disability assistance — If you are on provincial disability assistance, you can contact the Ministry of Social Development and Poverty Reduction to discuss funding for travel, support garments and other medically necessary Treatments, procedures or services that health care professionals determine are essential for diagnosing or treating a medical condition based on established medical guidelines and individual patient needs. supplies. Your primary care provider can write you a letter of support to access these funds.
• EI Sickness Benefits — EI Sickness Benefits can be an option for individuals who are working and meet the eligibility criteria.
• First Nations Health Authority (FNHA) Benefits Program — Individuals who are Indigenous, have status and live in B.C. are able to access FNHA benefits. These benefits can provide coverage for gender-affirming resources and postoperative supplies, like compression vests.
• Fundraising — Consider organizing online or in-person fundraisers.

There are also several programs in place that may help you cover transportation costs including:

• Hope Air — A Canadian charity that arranges free flights for low-income Canadians who must fly to get health care.
• Travel Assistance Program (TAP) — If travel costs are a barrier for you, you may qualify for this program. You can apply for the program through your primary care provider. Visit the TAP website to learn about the application process.
• First Nations Health Authority (FNHA) Medical Transportation Benefit — FNHA benefits can also cover the costs of travel, accommodation and meals when you need to travel for medically necessary care (including chest construction and revision A follow-up procedure or adjustment to a previous surgical operation or treatment to correct or improve its outcome. surgeries).