What is FTM Top Surgery
The goal of transmasculine top surgery is to remove the breast tissue (mastectomy) from both breasts and create a masculine appearance to the chest. Top surgery is performed as a single stage procedure. There are many techniques used to perform top surgery, and many factors should be taken into consideration when choosing which technique is best:
- Amount of breast tissue
- Amount of excess skin
- Desire for nipple sensation
A surgeon's cost for transmasculine top surgery may vary based on his or her experience as well as geographic location. Many plastic surgeons offer patient financing plans for transmasculine top surgery, so be sure to ask.
Transmasculine top surgery costs may include:
- Surgeon's fee
- Hospital or surgical facility costs
- Anesthesia fees
- Prescriptions for medication
- Post-surgery garments
- Medical tests and x-rays
When choosing a board-certified plastic surgeon for transmasculine top surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery.
Transmasculine top surgery is considered a reconstructive procedure and can be covered by health insurance. However, your coverage may only provide a small part of the total fee.
Transmasculine top surgery is a highly individualized procedure. You should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.
Transmasculine top surgery is a good option for you if:
- You have been diagnosed with persistent gender dysphoria
- You have been under the care of a mental health professional who can provide a letter of recommendation supporting your decision to undergo surgery
- You have been living as a member of your desired sex
- You are of the age to make consent
- You have a positive outlook and realistic expectations
- If significant medical or mental health concerns exist, they must be reasonably well-controlled
Following your transmasculine top surgery, gauze or bandages will be applied to your incisions. An elastic bandage or support bra will minimize swelling and support the reconstructed chest. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.
You will be given specific instructions that may include: How to care for your surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
- Where will I be taken after my surgery is complete?
- What medication will I be given or prescribed after surgery?
- Will I have dressings/bandages after surgery? When will they be removed?
- Will there be drains? For how long?
- When can I bathe or shower?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?
Healing will continue for several weeks as swelling decreases and the chest shape improves. Continue to follow your plastic surgeon’s instructions and attend follow-up visits as scheduled.
The final results of transmasculine top surgery can help alleviate the feelings of gender dysphoria that some individuals may experience.
The removal of the female breast tissue typically also removes some sensation in the chest. Over time, some sensation to the chest skin and nipples may return, and scar lines will improve, although they'll never disappear completely. There are trade-offs, but most transmen feel these are small compared to the large improvement in their quality of life and the ability to look and feel like a man.
Although the breast tissue is removed during the procedure, and growth of breast tissue is suppressed by testosterone therapy, the risk of developing breast cancer is not zero. Careful monitoring of breast health through self-exam is essential to your long-term health.
When you go home, if you experience shortness of breath, chest pains, or unusual heartbeats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.
Following your physician's instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
Transmasculine top surgery includes the following steps:
- Step 1 – Anesthesia
- Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
- Step 2 – Mastectomy to remove the breast tissue
- A mastectomy will remove the breast tissue present on your chest. Sometimes, excess skin will need to be removed as well.
- Step 3 – Creating a masculine shape
- After the breast tissue and any excess skin is removed, the remaining tissues must be repositioned to create a masculine contour to the chest.
- Step 4 – Repositioning the nipple and areola
- Sometimes the nipple and the areola need to be reduced and/or repositioned on the chest after the mastectomy is performed. The nipple and areola tend to be smaller and lie slightly more lateral and inferior on the male chest.
The decision to have top surgery is extremely personal. You'll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Many individuals view this procedure as a necessary step toward alleviating their gender dysphoria.
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications.
The possible risks of transmasculine top surgery include, but are not limited to, bleeding, infection, poor healing of incisions, hematoma, loss of nipple sensation, loss of the nipple and areola, and anesthesia risks.
During your transmasculine top surgery consultation be prepared to discuss:
- Your transition process
- Your surgical goals
- Medical conditions, drug allergies and medical treatments
- Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
- Previous surgeries
Your surgeon will also:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolae
- Take photographs
- Discuss your options and recommend a course of treatment
- Discuss likely outcomes of top surgery and any risks or potential complications
Be sure to ask your plastic surgeon questions. It’s very important to understand all aspects of your top surgery. To help, we have prepared a checklist of questions to ask your plastic surgeon that you can take with you to your consultation.
It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.
In preparing for transmasculine top surgery, you may be asked to:
- Get lab testing or a medical evaluation
- Provide a letter of recommendation from your therapist
- Take certain medications or adjust your current medications
- Stop smoking
- Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
Transmasculine top surgery is typically performed in a hospital or ambulatory surgery setting, and will likely use general anesthesia. Some follow-up procedures may be performed on an outpatient basis, and local anesthesia with sedation may be used. These decisions will be based on the requirements of your specific procedure and in consideration of your preferences and your doctor’s best judgment.
Words to know:
- Pigmented skin surrounding the nipple.
- Double-incision technique
- An incision is made in the breast fold, and a second incision is made on the breast skin. After the breast tissue and excess skin is removed, the upper incision is pulled down to the breast fold and the skin is closed. The nipple and areola are removed and then reattached with this technique.
- General anesthesia
- Drugs and/or gases used during an operation to relieve pain and alter consciousness.
- A surgical technique to reattach your nipple and areola.
- Blood pooling beneath the skin.
- Intravenous sedation
- Sedatives administered by injection into a vein to help you relax.
- Keyhole technique
- A small incision is made along the lower border of the areola, and excess breast tissue is removed through the incision. Skin cannot be removed with this technique.
- Local anesthesia
- A drug injected directly to the site of an incision during an operation to relieve pain.
- The removal of the whole breast.
- Periareolar technique
- An incision is made circumferentially around the areola, and a larger circular incision is made to remove excess skin. The remaining skin is then drawn in closer to the areola.
Use this checklist as a guide during your transmasculine top surgery consultation:
- Are you certified by the American Board of Plastic Surgery?
- Were you trained specifically in the field of plastic surgery?
- How many years of plastic surgery training have you had?
- Are you a member of the World Professional Association for Transgender Health?
- What specific training do you have in top surgery techniques?
- Do you have hospital privileges to perform this procedure? If so, at which hospitals?
- Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
- Am I a good candidate for this procedure?
- What will be expected of me to get the best results?
- Where and how will you perform my procedure?
- What surgical technique is recommended for me?
- How long of a recovery period can I expect, and what kind of help will I need during my recovery?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if I am dissatisfied with the outcome?
- Do you have before-and-after photos I can look at for this procedure and what results are reasonable for me?