introduction

WHAT IS TOP SURGERY?

When a transgender individual aims to have their external appearance match their internal sense of self, generally a medical transition is a desired outcome. A medical transition can come in the form of hormone replacement therapy (HRT) and/or gender-affirming procedures, such as top surgery.

Top surgery is performed by a plastic surgeon, where an individual’s chest is reconstructed through a surgical gender-affirming procedure requiring advanced preparation, anesthesia, and post-operative care.

WHO CAN GET TOP SURGERY?

This is one of the most highly debated, and often politicized, topics in gender-affirming care. In a time where state legislation can influence an individual’s access to medical care, there is no one-size-fits-all answer.

Generally, if you are over the age of 19 and live in a state where there are not restrictions on gender-affirming care, you are a candidate for top surgery. Additional factors such as general health, age, BMI, psychological readiness, and history of previous surgery complications play a role in your eligibility for top surgery.

WHY TOP SURGERY?

Top surgery is desirable for individuals for personal, emotional, physical, and social reasons. Individuals suffering from gender dysphoria might not align to the image they see reflected in the mirror.

Binders and binding tape can be a temporary solution while wearing clothing, but what about when you are at the beach, pool, or during intimate moments? We deserve to feel at home in our physical bodies, with or without clothing on.

HOW MUCH DOES TOP SURGERY COST?

There are two major avenues that influence your eligibility, and ultimately the cost: out-of-pocket private practice or health insurance.

Out-of-pocket private practice is exactly as it sounds; you will be responsible for paying for, or sometimes financing, the total cost of the surgery without using insurance.

Generally, the total cost includes the plastic surgeon’s consult fee (some apply it to the cost of the proceed if you book with them, some don’t have a consult fee at all), the cost of the procedure, general anesthesia, the operating room fee (if in a hospital vs. in-office operating room), biopsy/pathology (based on your surgeons preference), and all your post-operative appointments.

Health insurance is generally a more cost-effective avenue that allows for the same costs as above to be applied to your eligible plan, based on their parameters for coverage. The complexities of health insurance coverage and procedure approval is best assessed directly with the health insurance company, as coverages range even within plans from year-to-year.

In 2025, the average total for top surgery in out-of-pocket private practices is estimated to cost between $6,000 and $16,000, with many procedures falling in the $8,500 to $11,500 range. Health insurance coverage can significantly lower the cost and, in some cases, delay when you are required to pay any uncovered portion of the procedure.

WHAT IF I WANT INSURANCE TO COVER MY TOP SURGERY?

Going through health insurance will generally require more hoops to jump through before approval. Informed consent requires providers to give you information on the benefits, risks, and potential alternatives. Informed consent means you are making a well-educated decision about your top surgery.

Most, if not all, insurance companies require a support letter, or multiple letters, from a licensed therapist or mental health provider. Insurance companies look for very specific information to be present in these letters and not all mental health providers have experience writing letters that will be accepted through insurance.

Seeking a letter-writer with experience in this area is integral to the process of approval. WPATH Standards of Care (SOC-8) is responsible for creating and outlining the letter requirements. There are mental health professionals who can work with you specifically to write you your letter; meaning you do not necessarily need to use your primary therapist if they are not experienced in writing support letters.

Additional documentation, such as a referral letter, might be required if your chosen provider is out-of-network. A referral letter can be obtained from your primary care provider in preparation for insurance coverage approval. Overall, both the support letter(s) and referral letter will require diligent planning and time to obtain.

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