Female to Male Top Surgery

Female to male (FTM) top surgery is a gender-affirming surgery procedure designed to help patients feel more comfortable in their skin and to help them align who they are on the inside with their outer selves that they show to the world. FTM top surgery uses a variety of techniques to craft a defined masculine chest for patients, by reducing the size of the breasts or removing them completely.

At the Houston-area plastic surgery practice of Dr. Rukmini Rednam, we have been honored to help a number of individuals who are born male in a female body or identify as non binary align their outer appearance with their true identities. We understand that the decision to undergo FTM top surgery is an emotional one and is not made lightly, and we’ve seen firsthand the positive impact top surgery has on patients’ sexual confidence, mental health, and overall Trusetd Source Checkbox Trusted Source Assessing Quality of Life and Patient-REported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study Poudrier G, Nolan IT, Cook TE, et al Go to Source well-being.

silhouette of a male body in black and white

What is FTM Top Surgery?

Female-to-male top surgery, sometimes referred to as chest reconstruction, chest masculinization, FTM top surgery, or FTM top surgery, is a gender-affirming surgery procedure performed on transgender men or non-binary persons who desire a more masculine chest. During this procedure, the breasts are removed or reduced, and sometimes the nipples and/or areola are repositioned, resized, or both. For patients with gender dysphoria, where the outward appearance of their body does not match their self-perception, FTM top surgery is a crucial part of stepping into their true identity.

Who is a Good Candidate for FTM Top Surgery?

Candidates for FTM chest surgery are those who identify as transgender men or non-binary individuals seeking to align their physical appearance with their gender identity by removing breast tissue. This procedure is often pursued by individuals experiencing gender Trusetd Source Checkbox Trusted Source Gender Dysphoria Mayo Clinic Go to Source dysphoria , which is the distress or discomfort felt due to a mismatch between one’s gender identity and their assigned sex at birth.

It’s important to recognize the diversity of experiences within the transgender community; not everyone who identifies as trans or non-binary will choose to undergo top surgery. The decision to proceed with FTM top surgery is influenced by a range of factors, including but not limited to the individual’s specific gender identity, their physical health, their mental and emotional readiness for surgery, and the strength of their support network.

The journey towards aligning one’s physical body with their gender identity is deeply personal and unique to each individual. Opting for FTM top surgery is a significant step for many in this journey, requiring thoughtful consideration and consultation with healthcare providers experienced in transgender healthcare. Dr. Rednam is honored to support her patients through this transformative process, helping them to live more comfortably and authentically in their bodies.

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.

The FTM Top Surgery Procedure

FTM top surgery is typically performed under total IV or general anesthesia. Depending on the technique selected, Dr. Rednam will complete the surgery accordingly, though the same general outcome is to be expected: removal of the breast tissue in order to contour and masculinize the chest.

There are many techniques for FTM chest surgery, allowing Dr. Rednam to customize the procedure and results for each patient. In general, the steps in FTM top surgery are:


Excess breast tissue will be removed. In some cases, this is done through liposuction.In addition to the removal of excess breast tissue, a mastectomy involves the removal of excess skin as well as changes to the nipple and areola.

Resizing the Areola

The areolae, or the colored area surrounding the nipples, may be Trusetd Source Checkbox Trusted Source What are the steps of transmasculine top surgery? American Society of Plastic Surgeons Go to Source reduced or adjusted to better match a more masculine chest.

Repositioning the Nipple

The size of the nipples may be decreased and the nipples are often repositioned for a more masculine appearance.

Removing the Nipple and Areola

Some FTM patients choose to have their nipples and areolae removed so that the result is a totally smooth, flat chest. Some patients may choose to have nipples and areolae created through 3D tattoo at a later date.

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.

Which FTM Procedure is Right For Me?

There is no single “best” procedure for FTM top surgery. The technique chosen for each surgery depends upon patient skin quality and excess, the amount of breast tissue present, the desire for nipple sensation post-surgery, as well as patient preference. However, the double incision technique typically provides the most ideal chest contour and allows for the reduction of the nipple areolar complex. This technique also gives better masculine anatomical nipple areolar positioning.

Each technique provides its own benefits and drawbacks regarding scarring, nipple sensation, and complication rates. Your FTM surgery consultation with Dr. Rednam is your opportunity to learn about all of your options and honestly evaluate your goals for top surgery so that you can decide together which procedure is right for you.

"Everything I've Wanted to See" | Chey's Gender Affirming Surgery

FTM Top Surgery Recovery

After surgery, a compression dressing or garment is placed around the chest for 5-7 days to help reduce swelling and bruising, and to improve patient comfort during recovery. For all surgeries except double incision surgery, patients may remove this dressing and shower after 48 hours. Dr. Rednam will change a patient’s dressings at their first postoperative appointment and will also discuss scar care and healing. Patients will continue to use compression vests, which are easily hidden under clothes, for 4-6 weeks after surgery. In very rare cases, drainage tubes are placed when necessary but generally are not needed.

While some patients experience bruising, this is not true for all. Swelling can be expected in all cases, and is much more prominent if liposuction of the chest area was necessary. Most patients see a decrease in swelling around 3-4 weeks post-surgery, and an 80-90% decrease in swelling after 6-9 months, with the remaining swelling gone after about one year. Pain varies from patient to patient, but for many minimal pain regulation is required after the first 2-3 weeks after surgery.

During recovery, patients working office jobs can return to work 2-3 weeks after surgery, whereas those in a heavy labor/active position typically must wait around 4-6 weeks. Lower body exercise may be resumed at 2 weeks recovery, and impact exercise such as running or weights, can be resumed at 6 weeks.

Dr. Rednam will meet with you for regular follow-up visits to monitor your healing, answer any questions you have, and offer continued support.

Frequently Asked Questions About FTM Top Surgery

FAQs About FTM Top Surgery

Dr. Rednam is a highly experienced plastic and reconstructive surgeon with an excellent safety record. Still, patients should be aware that there are risks associated with any surgical procedure. Risks of FTM chest reconstruction may include:

  • Bleeding
  • Infection
  • Changes in nipple sensation
  • Blood clots
  • Trusetd Source Checkbox Trusted Source What are the risks of transmasculine top surgery? American Society of Plastic Surgeons Go to Source Suboptimal scarring

The age of medical consent in Texas as well as across the United States is 18. There is no upper age limit for top surgery.

Navigating the landscape of insurance coverage for FTM top surgery can be complex, yet there is growing recognition of the importance of transgender healthcare services. Many insurance providers have begun to offer coverage for gender-affirming surgeries, including FTM top surgery, reflecting a broader understanding of the essential nature of these procedures for individuals transitioning.

Coverage for transgender health procedures including FTM top surgery varies significantly among insurance providers and is often subject to specific eligibility criteria, including but not limited to a diagnosis of gender dysphoria, letters of support from doctors and/or mental health providers, and specific criteria for the plastic surgeon.

Dr. Rukmini Rednam

Female to Male Top Surgery in Houston: Explore Your Options

If you were born male in a female body, top surgery can help you affirm your identity and improve your self-confidence by endowing you with a more masculine appearance that reflects who you are on the inside. As a Board-Certified Plastic & Reconstructive Surgeon, Dr. Rukmini Rednam draws on her extensive technical expertise and aesthetic artistry to help each of her patients achieve the body in which they feel most “themselves.” She and her team have created an environment where patients are treated with compassion and sensitivity, and look forward to guiding you through this important transition. To learn more about your FTM top surgery options as well as other gender-affirming procedures, please contact us to schedule a confidential consultation with Dr. Rednam.

1 Poudrier G, Nolan IT, Cook TE, et al. Assessing Quality of Life and Patient-REported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study. Plast Reconstr Surg. 2019 Jan;143(1):272-279. doi: 10.1097/PRS.0000000000005113. Accessed April 10, 2020.

2 Mayo Clinic. Gender Dysphoria. Available: https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/diagnosis-treatment/drc-20475262. Accessed February 13, 2024.

3 American Society of Plastic Surgeons. What are the steps of transmasculine top surgery? Available: https://www.plasticsurgery.org/reconstructive-procedures/transmasculine-top-surgery/procedure. Accessed February 13, 2024.

4 American Society of Plastic Surgeons. What are the risks of transmasculine top surgery? Available: https://www.plasticsurgery.org/reconstructive-procedures/transmasculine-top-surgery/safety. Accessed February 13, 2024.

Dr. Rukmini Rednam has either authored or reviewed and approved this content.

Page Updated: