Female to Male Top Surgery

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.

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.

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.

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.

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.