Female to Male Top Surgery
At a Glance
- Recovery: 1- 8 Weeks
- Anesthesia: General
- In-Op Length: 1.5 - 5 hours
Female to Male (FTM) Top Surgery is the most common gender reassignment procedure for transgender men and is also performed on many non-binary individuals. This gender confirmation surgery removes the breast tissue (Subcutaneous Mastectomy) and creates a masculine chest through chest contouring.
Top surgery can treat gender dysphoria or distress experienced as a result of a difference between self-affirmed gender and gender assigned at birth. It can also help someone to live more comfortably and function properly, both socially and psychologically.
There are four different types of FTM Top Surgery:
Periareolar top surgery, also known as peri or circumareolar, is generally performed on people with smaller breasts (A or B cup) with minimal excess skin. This is a nipple-sparing procedure, which means the nipple remains attached during the entire surgery, allowing patients to retain most, if not all, of their nipple sensation. During a periareolar procedure, the areola is reduced in size, a donut-shaped piece of skin is removed from the breast as well as the rest of the breast tissue, and the outer circle incision is connected to the inner circle. This technique results in less scarring than other techniques, however, 40 to 60% of patients require revisions to achieve their desired results. It is usually an outpatient surgery taking 3 to 5 hours.
Keyhole top surgery can be performed on very few people. Candidates must have very small chests and tight chest skin since no excess skin is removed. While nipple sensation is preserved and very little scarring occurs, this procedure does not allow for nipple repositioning. During this procedure, a small incision is made along the bottom of the areola and breast tissue is removed using liposuction and direct excision. This is typically an outpatient procedure taking 1.5 to 3 hours.
Double Incision with Free Nipple Grafting
Double incision top with nipple grafting, also known as a bilateral mastectomy with nipple grafts, is the most common type of FTM top surgery and is typically performed on people with larger chests and bodies. Since the nipple must be removed and reattached, this procedure often results in decreased nipple sensation. More significant scarring is also likely to occur. During this procedure, one incision is made under the breast and another is made higher up on the chest, creating a single final scar aesthetically located under the pectoralis muscle. The majority of the breast tissue and excess skin is removed, and the areola is removed, resized, and grafted back on in a more masculine position. This is usually an outpatient surgery taking 3 to 4 hours.
Inverted T (Anchor)
The Inverted T or anchor technique allows patients to maintain some nipple sensation. During this procedure, the pedicle (the tissue attached to the nipple and areola that extends to the lower breast) is left intact, in hopes that the nerves and sensation will remain intact. However, it is impossible to guarantee a certain amount of preserved sensitivity. The remaining skin and excess breast tissue are then removed and the skin is redraped for closure.
Which procedure is best for you?
Your ideal procedure depends on your original breast size and your goals. If you have small breasts, you may be able to have a periareolar or Keyhole top surgery. Most people require a double incision with free nipple grafting, but if you want to maintain nipple sensation, you may be a candidate for an Inverted T procedure.
There are many ways you can prepare for your surgery to create the best possible outcome:
- Avoid alcohol the week before your surgery.
- Stop smoking three weeks prior to surgery. Smoking causes complications with healing.
- Discuss medications you are currently taking with your surgeon. You may need to discontinue use.
- Wear comfortable, loose-fitting clothing with a front zipper or button closure.
- Day 1 and 2: you will likely experience discomfort from the compression binder and the anesthesia wearing off.
- The first week after surgery: you will need to sleep on your back with your torso elevated.
- 6 or 7 days after surgery: you will have a post-operative appointment where sutures and drains will be removed if necessary. The dressing will come off, and you will get to see your chest.
- 2 to 3 weeks after surgery: you will continue to wear your compression garment except when showering. Your swelling will generally decrease within this time frame, although for some it can take up to 6 months. You should be careful not to lift your hands above your head, as it can increase scarring.
- 4 weeks after surgery: most people can return to normal activities.
- Several weeks after surgery: your chest will remain in a compression wrap. Avoid lifting more than 10 to 15 pounds.
- 6 to 8 weeks: you can generally resume physical exercise.
Regardless of surgical technique, some breast tissue will likely remain. Some patients may need revision to achieve their desired results. However, research has shown that most transgender men are satisfied with their results. If you are interested in learning more about the four different types of FTM Top Surgery Dr. Kayastha offers, please give our office a call at 518-674-9060 or fill out the contact form on our website.