What are the usual requirements for top surgery?  Do you have to be on T, present as male for a set number of years, have therapy papers, etc. or can I just walk in with money and have it done?  (Informed consent?)  US/UK, wherever.

And I have a second question.  I'm an A so I'm a candidate for peri.  I've heard that if you want peri you shouldn't bind because that makes the tissue lose its elasticity.  I've been eyeing Underworks binders for some time now, but if my surgery results will be better if I don't bind, I'm not sure I want to.  Since I'm small I get a decent binding effect from sports bras, so not having a proper binder isn't a huge problem.  Suggestions?

I only have my experience with Dr. Brownstein in the U.S. so far (though I haven't had the surgery yet, it's still upcoming). You don't have to be on T prior to top surgery, nor do you have to live as a guy for a year. I know that sometimes he'll allow informed consent but he prefers a note from a therapist. Other surgeons I looked into tend to want a therapy note (some even want two). Since each surgeon has different criteria to meet, it's worth looking into what they require while you research whom you want to go to.

It may be a good idea to be on T first though because T influences your chest shape and so you might get better results if the surgeon knows how your pecs are going to lie. I know that's the case for DI, where surgeons try to place the bottom incision along the crease of the pecs - not sure about peri but it might make a difference. Remember that top surgery is chest reconstruction, not just a basic mastectomy.

Thanks for the info!  Glad to know that some doctors are willing to do it on consent.

Kyril, that's a good point, and I hadn't even thought of that.  The reason I asked about pre-T though is because I'm not sure I'll "fully" transition with T.  It's too early to say for sure, but at this point I think getting these things off my chest would be enough to fix my dysphoria.  I already have elevated T levels so my voice is Ok, and I'd prefer to be androgynous than especially "manly" anyway.

Any suggestions about binding?  I don't know how much difference it makes, but I haven't been binding in case the difference is significant.  I haven't been able to find much info on top surgery other than the basics of what it is.  Even with the doctors' names I've heard here it's hard to find an FtM section on any surgery websites. 

If sports bras are working for you, there's no reason to use anything harsher. Binding sucks and it's true that it can break down tissue by reducing blood flow. If you want peri - and remember that DI is an option even if you're a candidate for peri, and a lot of guys prefer the shape of the results, despite the scarring - but if you want peri, you really don't want to damage your skin in that area.

For now, if you want slightly better effect than a sports bra can give you without the risk of tissue damage, consider the Underworks Cotton Concealer. Make sure you get it a size smaller than your measurements indicate. You can wear it alone (compression slightly less than a sports bra, but more even throughout your torso and doesn't produce that line across your back) or over a sports bra (significantly more compression).

Thanks... 

I've got to ask now though, how much does it take to start damaging the tissue?  What if I bought a proper binder and only wore it about once a week?  Would I be able to wear it often enough for it to be worth it?

once a week should be ok

I have been wearing binders for 9 months now. everyday, and there has been a significant tissue breakdown, my chest is much saggier

Thanks, Elijah!

Originally I got excited at the prospect of them getting saggier/easier to flatten, but I'm so small I think I could get really good results with peri.  Otherwise I'd be crushing them to oblivion as we speak.