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, and involves reconstructing an individual’s chest 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 legislation at the state and federal levels can influence an individual’s access to medical care, there is no one-size-fits-all answer.
Eligibility for top surgery depends on several factors, including your age, location, ability to provide informed consent, overall health, individual surgeon’s policies, and insurance requirements. Laws governing gender-affirming care also vary by state and can change. Contact potential surgeons and your insurance provider directly to determine which requirements apply to you.
Additional factors such as general health, BMI, psychological readiness, and history of previous surgical 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, 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 procedure if you book with them, while others do not charge a consultation fee), the cost of the procedure, general anesthesia, the operating room fee (whether the procedure occurs in a hospital or an in-office operating room), biopsy/pathology (based on your surgeon’s preference), and all your post-operative appointments.
If your health insurance covers top surgery, it may substantially reduce your out-of-pocket cost. However, deductibles, copayments, coinsurance, network restrictions, exclusions, and prior-authorization requirements vary by plan. The complexities of health insurance coverage and procedure approval are best assessed directly with the health insurance company, as coverage varies even within plans from year to year.
In 2025, cash-pay top surgery at private practices in the United States generally cost between $6,000 and $16,000, although prices varied considerably by surgeon, location, surgical technique, and what was included in the quote. Insurance coverage may substantially reduce what you pay, but you may still be responsible for deductibles, copays, coinsurance, or services your plan does not cover. Depending on the practice, some or all of your estimated share may be collected before surgery.
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.
Some insurance plans and surgical practices require one or more letters from qualified healthcare or mental health professionals before approving top surgery. Other providers may use an informed-consent model without requiring a therapy letter. Requirements vary, so confirm them directly with both your insurance company and surgeon. 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. (see Sample Support Letter for Top Surgery Insurance Approval)
Seeking a letter writer with experience in this area is integral to the process of approval. The World Professional Association for Transgender Health (WPATH) publishes clinical guidance through its Standards of Care, currently Version 8 (SOC-8). However, WPATH does not determine the requirements of individual insurance plans or surgical practices. Insurers and providers establish their own documentation policies, which may or may not align fully with SOC-8.
If a letter is required, you may be able to work with a qualified professional who specializes in gender-affirming surgical assessments. You do not necessarily need to use your regular therapist, but you should confirm that the letter writer’s credentials and documentation will satisfy your surgeon’s and insurer’s requirements.
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 may require diligent planning and time to obtain.
Next page: types of top surgeries
