This term can refer to any gender-related surgery dealing with a person’s chest, such as breast augmentation, enhancement and reduction surgeries, but is most often understood as a mastectomy due to the fact that mastectomy is the most accessible and sought after surgery for AFAB trans people pursuing surgery and the fact that breast augmentation is often denied by insurance for AMAB trans people making it harder to access and thus less talked about.
e.g. Violet was pursuing top surgery but her insurance was giving her trouble.
Further reading to gain expanded context:
Top Surgery | Healthline
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