Female to Male Top Surgery

Preparing for FTM Top Surgery

FTM top surgery is a significant step in the transition process for many trans men and non-binary individuals who wish to achieve a chest that aligns with their gender identity. To ensure the best possible outcomes, candidates for this surgery are guided through a comprehensive preparation process, which may include:

• Psychological Assessment: Engaging with mental health professionals who have experience with gender diversity is vital. This step involves evaluations to confirm emotional readiness for the surgery and to discuss realistic expectations of the outcomes. It’s an opportunity to address any questions or concerns and to ensure psychological support throughout the transition process.
• Hormone Therapy: While not always a prerequisite, hormone therapy with testosterone is common among individuals planning FTM top surgery. This therapy can promote physical changes that further align the body with one’s gender identity, such as increased muscle mass and the redistribution of body fat. The decision to start hormone therapy and its duration should be made in consultation with healthcare professionals specialized in transgender care.
• Experience Living in the Affirmed Gender: Many healthcare providers recommend that candidates live in their affirmed gender role for a certain period before undergoing top surgery. This experience helps confirm the individual’s commitment to their gender identity and ensures a stable and consistent sense of self throughout the transition.
• Physical Health Evaluation: A thorough medical assessment is conducted to evaluate the candidate’s overall health and readiness for surgery. This includes assessing any factors that might affect surgery or recovery, such as chronic health conditions or the use of medications that could influence surgical outcomes.
• Informed Consent: Understanding the details of the surgery, including the potential risks, benefits, and recovery process, is crucial. Candidates are provided with all necessary information to make an informed decision about proceeding with FTM top surgery. This consent process ensures that all individuals have a clear understanding of what the surgery entails and are making an autonomous decision about their bodies and their identities.

Preparing for FTM top surgery is a journey that involves careful consideration and planning.Dr. Rednam and her team are dedicated to providing support and guidance every step of the way, ensuring each patient feels confident and secure in their decision to pursue this life-affirming procedure.

FTM Top Surgery Techniques and Incisions

FTM top surgery uses the following different techniques:

• Periareolar
• Keyhole
• Double Incision with Free Nipple Grafting
• Inverted T (Anchor)

Periareolar: A periareolar procedure is ideal for those with minimal excess skin. This technique involves reducing the areola down to a more ideal masculine size, then excising an outer donut-like shape of skin from the breast. Once this circular superficial layer of skin (epidermis and a small portion of dermis) is removed, the surgeon makes an incision through this layer of tissue to remove the rest of the breast tissue. Once the breast tissue is removed, the surgeon uses a purse string stitch to connect the outer circle incision to the inner circle, reducing the size of the areola and slightly changing its position.

Double Incision: As the most popular form of FTM top surgery, the double incision technique is performed by creating an incision underneath the breast, and bringing it together with an incision higher up on the chest, creating a single final scar aesthetically placed under the natural position of the pectoralis muscle. In this procedure the surgeon removes the majority of the breast tissue and excess skin, while resizing and placing the areolas as skin grafts in a more masculine position. The nipple and areola are completely separated or “freed” with this procedure before replacement. With this procedure normal nipple sensation is lost, but over time mild protective sensation may return.

Keyhole: The keyhole procedure is ideal for those who are naturally small chested. With this technique, the surgeon creates a small incision along the bottom of the areola and removes the breast tissue with liposuction and direct excision. This involves little to no movement of the nipple areolar complex.

Inverted T (Anchor): The Inverted T technique is ideal for patients hoping to maintain some nipple sensitivity post-surgery. During the procedure, the pedicle (the tissue attached to the nipple and areola and extending to the lowest part of the breast) is left intact and maintains its blood supply. The hope when performing the surgery this way is that the nerves attached to the pedicle remain intact as well, thus preserving the sensitivity of the nipples. However, it is impossible to determine the amount of sensitivity preserved until after the procedure is finished and full healing is complete. Once the pedicle is created, the remaining skin and excess breast tissue is excised and the skin is redraped for closure.

Liposuction may also be used with any of the techniques, but is most often used when excess lateral chest or axillary fat deposition is present.