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Non-Binary: Top Surgery

Good - Better - You!

Medically reviewed by: Dr. med. Timo Spanholtz
Specialist in Plastic and Aesthetic Surgery | Medical Director

Your identity doesn't fit into any box? Your result doesn't have to either. We offer specialized Top Surgery for non-binary, agender and genderqueer people. Individual, respectful and free of norms.
Make an appointment with our experts

Top Surgery beyond the binary

For many people, the goal of gender-affirming surgery is clear: a masculine chest or a feminine breast. But for non-binary (enby) people, the goal often looks different.

Perhaps you want a completely flat torso, but without typically male attributes? Or a radical reduction that looks androgynous, but not "male"?

At the Praxisklinik am Rosengarten, we understand that gender is a spectrum. Our team won't force you into a mold. We listen, look at your reference images and plan a surgery that relieves dysphoria and creates euphoria – exactly the way you need it.

What options do I have as a non-binary person?

Surgically, we use techniques similar to those of a classic mastectomy, but we adapt the aesthetics to your wishes.

Completely flat (Flat Closure)

You want a flat chest wall, similar to a mastectomy, but perhaps typically male features such as chest hair or an overly pronounced muscle definition bother you? We can adjust the incision so that the result appears as neutral as possible
Flat Closure

(Image generated by AI)

Radical Reduction

Not everyone wants to be "flat". Some wish for a very small, hinted breast that can be easily bound (binder), but has an androgynous aesthetic when naked. Here we remove most of the tissue, but deliberately leave some volume. (Note: This is often a self-pay service, as health insurance companies usually only pay "all or nothing". We will advise you honestly on this.)
Radical Reduction

(Image generated by AI)

No nipples
(Nipple-less / Nullification)

A growing wish in the community is to forgo nipples entirely. The result is a smooth, uninterrupted aesthetic ("Blank Canvas"). This completely eliminates the risk of loss of sensitivity or asymmetries at the nipples and greatly facilitates the later tattooing of a large chest piece (tattoos).
Nipple-less / Nullification

(Image generated by AI)

Individual nipple placement

In a classic masculine surgery, the nipples are placed far to the outside and bottom. If you prefer a more neutral look, we can choose a more central or higher position – entirely according to your aesthetic preference.
Individual nipple placement

(Image generated by AI)

Meeting as equals

We know that going to the doctor is often associated with hurdles for non-binary people (wrong pronouns, lack of understanding).
  • Pronouns:
    Just tell us how you would like to be addressed (he/she/they/no pronoun/name). The entire team respects that.
  • No "Real Life Test" requirement from us:
    We don't judge how you dress or present yourself. For us, what counts is your level of distress and your desire for physical alignment.

Frequently asked questions about Non-Binary: Top Surgery

We are happy to answer your questions about the treatment here.

Does the clinic support me with the application for the health insurance?

Yes, we are happy to support you. For non-binary identities, the path to cost coverage is sometimes a bit more complex, as the insurance companies' guidelines are often still thought of in very binary terms. We help you to clearly present the medical necessity of your individual treatment and to prepare the necessary documents for the MD (Medical Service).

Will the health insurance pay if I am "only" non-binary?

The system is often still very binary (diagnosis "transsexualism"). Many patients formally use this diagnosis for the application, even if they identify as non-binary. We word our medical reports in such a way that they meet the insurance requirements, but take your individual wishes (e.g. radical reduction) into account.

How flexible is the choice of scar placement in non-binary surgeries?

Very flexible. Especially in the area of top surgery, there are various options – from horizontal to diagonal to connected scars or forgoing nipples. In the consultation, we discuss exactly which scar appearance you prefer and what is surgically feasible in order to realize your individual vision.

How do I find out which medical steps make sense for me?

A detailed medical consultation is the most important first step. It involves discussing personal goals, health prerequisites, risks, and realistic outcomes. The aim is an informed decision that contributes to your well-being in the long term.

What options does the clinic offer for non-binary patients?

We know that gender identity is a spectrum. That's why we don't offer "off-the-shelf" solutions. Whether you want a mastectomy without nipples, a breast augmentation to a very specific size, or a masculinization of your body contour without undergoing full hormone therapy – we adapt the surgical techniques to your individual goals.

What medical options are available for non-binary people?

Depending on individual wishes, various measures may be considered, for example:

  • Breast surgery (removal, reduction, or augmentation)

  • Body contouring

  • Hormone therapy (also low-dose)

  • Facial surgery

  • Genital surgical adjustments
    The selection depends on personal goals and medical prerequisites.

What if I'm unsure about what I want as a non-binary person?

That's okay. Bring pictures with you! Photos of desired results help us more than terms. We'll look together at what's feasible – whether completely flat, "nipple-less" (without nipples), or just a reduction.

What does "non-binary" mean?

Non-binary describes a gender identity that does not define itself exclusively as male or female. Non-binary people may locate themselves between, outside of, or independently from these categories. The identity is individual and can be expressed in different ways.

What does "individual body contouring" mean?

It means that we don't follow a fixed scheme. We look at which areas of your body cause you discomfort. Perhaps you only want to masculinize your waist, but keep the volume on your buttocks? Or do you wish for more feminine hips, but don't want breast augmentation? We combine liposuction and autologous fat transfer exactly as is right for your well-being.

Do you also offer "neutralization" instead of classic "alignment"?

Yes. Many non-binary people do not want a binary result (i.e. not "typically male" or "typically female"), but rather a neutralization of the characteristics that trigger dysphoria. This can be, for example, a breast reduction to a minimum that preserves some remaining softness, or liposuction on the hips that makes the body appear more linear.

Does health insurance cover gender-affirming treatments for non-binary people?

Whether the costs are covered depends on the individual medical indication and the decision of the respective health insurance provider. A non-binary identity does not exclude coverage of costs; however, the assessment is always carried out on a case-by-case basis.

Do non-binary people have to undergo medical treatments?

No. Medical treatment is not a prerequisite for a non-binary identity. Some people do not want any physical changes, while others choose individual gender-affirming measures. Every decision is individual and legitimate.

Can I undergo only individual steps of a gender-affirming treatment?

Yes. It is possible to carry out individual measures independently of one another – for example, a breast surgery without hormone therapy or without further procedures. There is no fixed treatment path.

Can I get a mastectomy if I am non-binary and not trans?

Yes, absolutely. A mastectomy (top surgery) is an important step toward reducing gender dysphoria, regardless of whether you define yourself as a trans* man or non-binary. Together, we will discuss which incision technique and which aesthetic (e.g., a completely flat chest or a more neutral contour) best suits how you feel about your body.

Is hormone therapy possible for non-binary people?

Yes. Non-binary people can – but do not have to – undergo hormone therapy. In some cases, a low-dose or individually adjusted hormone treatment is chosen. Specialist medical supervision is necessary in this process.

Are there special "non-binary" surgical methods?

There is no standardized "non-binary operation." Instead, existing surgical techniques are individually adapted to achieve a neutral, androgynous, or individually defined result. The planning is always personalized.

Do I need testosterone for the mastectomy or reduction?

No. Many non-binary people forgo hormones. Surgically, this is not a problem for the mastectomy or reduction.

Make an appointment

Get non-binding advice now on Non-Binary and individual solutions. We will clarify all open questions and talk about your desired change.

Completely without pressure, completely non-binding and above all as equals and without prejudice!