Top Surgery in Asheville, NC

Halvorson Plastic Surgery is committed to providing a safe and welcoming environment for patients seeking gender-affirming top surgery. We are honored that the Asheville community put their trust in us when we started offering top surgery in 2019. Hearing our patients’ stories, listening to their struggles with family, life, and healthcare access, and witnessing what top surgery does for their mental health has made this part of our practice mission-driven.

Because of our genuinely caring staff, surgical results, and success with insurance coverage, our top surgery volume continues to grow, and we are now drawing patients from throughout the Southeastern U.S. Dr. Halvorson is a member of WPATH and follows their guidelines for clinical care.

What Is Top Surgery?

Top surgery refers to a variety of procedures that can help you achieve a physical appearance of your chest that conforms with your gender or sense of self. Although certain procedures and approaches have gained widespread popularity in recent years, our goal is to develop a unique surgical plan built around you.


A gender-affirming surgical option for transgender men and nonbinary/genderqueer people assigned female at birth (AFAB), mastectomy involves the removal of breast tissue to create a flatter, more traditionally masculine chest appearance. Patients can choose whether or not to keep their nipples, modify them, or get a 3D nipple areola tattoo by Violit at Zen Ink in the River Arts District in Asheville (there are others outside of Asheville as well).

Dr. Halvorson performs a variety of mastectomy procedures, including:

  •  Double incision with a scar at the inframammary fold
  • Double incision with a straighter scar along the lower pectoral border
  • Keyhole (periareolar)
  • Nipple-sparing with a variety of scar options

There is no one-size-fits-all approach to FTM top surgery, and what works for one person might not be the best fit for your unique chest shape and size. To help you find the right procedure for your transition, we’ll work together to develop a plan that takes your unique anatomy and preferences into account.

Breast Augmentation

A gender-affirming surgical option for transgender women and nonbinary or genderqueer people assigned male at birth (AMAB), breast augmentation is performed using implants (silicone or saline) to enhance the size and shape of the breasts. This procedure helps create a more traditionally feminine chest appearance, contributing to a patient’s overall gender identity and self-confidence.

Non-Binary Top Surgery (aka FTX top surgery)

Various procedures are performed for non-binary and gender non-conforming patients to help them achieve their desired chest appearance. These may or may not fall into the category of FTM or MTF, as defining top surgery with two categories reinforces a binary concept of gender.  These may include:

  • Breast reduction (with or without nipple preservation)
  • Subtotal or total mastectomy
  • Nipple/areola removal

The Halvorson Plastic Surgery Process

First and foremost, we will treat you as we do all our patients — with respect and compassion in a comfortable and safe environment. We do not take for granted that our patients have entrusted us to help transform their lives physically and emotionally, and we are honored to be part of this process.

Your initial point of contact with the practice, whether by phone, email, or website inquiry, will be the beginning of relationship between you and our team. Whenever you contact our office, you will reach a human being who knows you and/or how to address your concerns.  We treat our patients like family.

Whether you’re navigating insurance requirements or recovering from surgery, our dedicated team will be there to support you.  We do not have a phone tree, and you can easily reach Dr Halvorson after hours.

What to expect before surgery

Before you step foot in the office, our patient coordinator and/or insurance specialist will communicate with you and answer any questions you have.  For patients going through insurance, we often work with them to secure appropriate support letters at this stage, to expedite scheduling surgery.

The first time you visit, you will meet with one of our nurses to review your medical history and go over any initial questions you might have.  This is immediately followed by a consultation with Dr. Halvorson, where you will discuss your goals and preferences, review surgical options, look over before & after photos from previous patients (FTM, MTF, FTX), and develop a treatment plan.

Our staff will provide you with your insurance company’s specific policy for top surgery coverage and summarize their requirements, if applicable. Once insurance requirements are met, your surgery will be scheduled (usually 2-3 months). A preoperative appointment will occur within 30 days of surgery to finalize the surgical plan, answer your questions, review our drain/pain management protocols, and provide any prescribed medications. Preoperative photos will be taken for medical documentation and insurance purposes only.

You will also receive a folder with all of this information printed out, including after-hours phone numbers to reach Dr. Halvorson if you have any questions or concerns.

Requirements for surgery: You must have someone to bring you to surgery, drive you home (taxi/Uber/Lyft etc not allowed), and spend at least the first night with you after surgery.  These do not necessarily need to be the same person, although that is ideal.  It is also helpful to have someone who can assist with dressing changes, bathing/dressing, etc for about 1 week.  For patients who do not have someone to help, or who need supplemental assistance, Anam Cara offers full spectrum gender-affirming surgery doula services.

What to expect after surgery

Top surgery recovery varies with the specific procedure, but most patients can expect to experience some bruising, swelling, and temporary limitations in mobility that will improve with time. However, pain is typically well-tolerated using our multi-modal pain management protocol, which minimizes narcotic use yet ensures a more rapid and comfortable recovery.

Depending on your top surgery procedure, you will have particular post-op aftercare and instructions, including:

  • For most mastectomy procedures, one drain is placed on each side.
  • If you have a free nipple graft, a bolster dressing is placed over the graft.
  • You may have surgical glue or hypoallergenic tape on your incisions.
  • A compression garment will be supplied to you, although we also recommend getting a few extras.
  • You may shower two days after surgery.
  • We recommend compression 24/7 for the first two weeks, during the day for the following two weeks, and then as needed.
  • We recommend not lifting your arms more than 90 degrees or over your head for two weeks, then you can resume a full range of motion.
  • We recommend no heavy lifting (>10 lbs) for four weeks.
  • Drains and bolster dressings are usually removed at your first post-op appointment, around 1 week after surgery.
  • If you have free nipple grafts, once the bolster dressing is removed, apply ointment and a large bandaid after showering for four weeks, then moisturize as needed.

One month post-op, Dr. Halvorson will assess your progress and provide guidance on scar care, compression, and activity restrictions as you heal. He may also recommend scar massage and/or silicone tape/gel at that time to improve scar appearance. Final results typically aren’t seen until at least 3-6 months, with scars continuing to mature for 1-2 years.

Preparing for Your Top Surgery Consultation

During your initial consultation, you’ll have the opportunity to discuss your goals, concerns, and preferences with Dr. Halvorson. While we currently only offer top surgery to patients who are 18 years of age, we are happy to see younger patients in consultation.

To make the most of your appointment, consider bringing a friend or family member for support, a list of questions, and photos of results you like. Be prepared to discuss your medical history, hormone therapy (if applicable), and any previous surgeries. For FTM/FTX top surgery, there is no requirement for patients to be on hormonal therapy.  For MTF top surgery, most insurance companies require that patients be on hormonal therapy for at least 1 year (this is not a requirement outside of insurance).  Studies have shown that it is not necessary for patients to stop hormonal therapy before or after top surgery – it is safe to continue these medications before and after surgery.

Please let us know if you have any requests for us to make the experience more comfortable for you.  We do have large mirrors in our consultation rooms, and we are happy to work with you to avoid them.

For patients 40 years of age and older, we strongly recommend getting a mammogram prior to mastectomy or breast reduction surgery.

Physical therapy and top surgery: Most patients recover well on their own, however there are those who want to optimize their outcome and healing potential by working with a physical therapist after surgery, and possibly even before surgery.  A physical therapist can help with muscle strengthening, mobility, scar management, and lymphedema treatment.  We work with several physical therapy offices in the Asheville area that are trans-friendly: Unified Therapies, Thrive Therapeutics , and Physio.

Insurance and Financing Options

Halvorson Plastic Surgery is one of very few practices in the region offering top surgery as a self-pay option and through insurance. Why? Because we believe the transgender community is underserved, poorly served, and top surgery is an unmet need.

We know that navigating insurance coverage for top surgery can be complex, which is why our experienced insurance coordinator will work with you to help you understand your coverage and meet any requirements, such as letters of support from your primary care physician and/or mental health provider. We accept most Aetna, BCBS, Cigna, and Medicare plans, although we do not accept United or Medicaid.

For patients without insurance or who wish to have surgery outside of insurance, we offer self-pay options and financing plans to help make your gender-affirming surgery more accessible.

Out-of-pocket costs for top surgery range from $8-10K, with liposuction adding $4-8K, depending on how many areas are involved.

Choosing the Right Surgeon for Your Top Surgery

When selecting a plastic surgeon for your top surgery, choosing someone with experience and expertise in gender-affirming procedures is essential.

Dr. Halvorson is a nationally recognized and double board-certified expert in plastic surgery of the breast and brings over 15 years of experience in complex breast reconstruction to the table when performing top surgery. As a member of the World Professional Association of Transgender Health’s (WPATH), Dr Halvorson follows the highest standards of care for transgender and gender diverse people, based on expert medical consensus.

Always seeking to improve results, he continues to refine his techniques based on educational conferences, discussions with national top surgery experts, and reviewing published clinical research.

Schedule Your Top Surgery Consultation

Top surgery is an outpatient surgery that Dr. Halvorson performs at the Asheville Surgery Center (a Mission facility) or the Outpatient Surgery Center of Asheville (an independent ambulatory surgery center). Patients who have surgery outside of insurance will typically do so at our on-site AAAASF accredited ambulatory surgery center (The Plastic Surgery Center).  With our board-certified MD anesthesiologist and highly experienced nursing staff, our practice is able to provide you with the care you need in a highly personalized and, above all else, safe environment.

Schedule your consultation with Dr. Halvorson today to begin your journey toward a more authentic and confident you. If you have any comments or feedback on this website page, we would love to hear from you.  Please fill out this form which will generate an email directly to Dr. Halvorson.