What is FTM Surgery?

black and white photo of a person's face

Thousands of Americans live with the belief that their gender identity differs from their identified sex. This means that these individuals believe that the sex they were assigned at birth is incorrect. People who wish to live life as a sex other than what they were assigned at birth are identified as transgender individuals. Some transgender people live this way by making small changes to their appearance, as well as, identifying as their desired sex in their everyday lives. Others, however, choose to alter their physical appearance in other ways. Hormone therapy and transgender transition surgery are two ways in which someone can alter their physical appearance to make a more permanent transition.

Female to Male (FTM) Top Surgery is a surgical procedure designed to help patients feel more comfortable in their skin and to help them match who they are on the inside with who they show to the world from the outside. Surgery uses a variety of techniques to craft a masculine and defined chest for patients, by reducing the size of the breasts or removing them completely.

Procedure

FTM surgery involves removing the breast tissue in order to flatten and masculinize the chest. There are several different techniques used in order to achieve this outcome. The different techniques Dr. Rednam uses for FTM top surgery are:

Periareolar: The ideal candidate for this procedure will have minimal excess skin and breast tissue. She reduces the areola down to a more masculine size, then excises 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, she removes the remaining breast tissue. The surgeon then uses internal stitches to connect the outer circle incision to the inner one, closing the incision and reducing the areola size.
Keyhole: This procedure works best for those with naturally small chests. The surgeon will create a small incision along the bottom of the areola and remove the breast tissue with a combination of liposuction and direct excision.
Double Incision with Free Nipple Grafting: This procedure is performed by creating an incision underneath the breast and by completely removing the nipple and areola. The surgeon removes the breast tissue and excess skin, resizes the nipples, then reattaches the nipples as skin grafts in a more masculine position. Normal nipple sensation will be lost with this technique, although over time, some sensation may return. This is the most popular technique due to its very natural looking result and ability to remove the most breast and skin.
Inverted T (Anchor): For those patients concerned about nipple sensitivity, this procedure may be a good choice. A pedicle, or island, of breast tissue is preserved which the nipple and areola sit upon which allows both nerve and blood supply preservation which in most cases preserves nipple sensitivity. It runs from the nipple all the way to the lowest part of the breast and is left intact. It is impossible to know if the nipple sensitivity has been hampered until after surgery and healing is complete. Once the pedicle is created, the remaining skin and excess breast tissue are excised and the skin is re-draped for closure. Dr. Rednam takes many factors into consideration when deciding which technique is right for her patient. She will discuss her patient and evaluate the skin quality and excess, the amount of breast tissue present, the desire for nipple sensation post-surgery, and patient preference.

Recovery

Patients are expected to wear a compression dressing for 5-7 days following top surgery if the double incision technique is used. In all other cases, the patient can shower 48hrs after surgery. This helps reduce swelling and bruising, as well as, keep the patient comfortable during recovery. Dr. Rednam will discuss all post-operative instructions with the patient, including scar care and healing. She will change the dressing at the first post-op appointment and discuss post-operative compression which is necessary for 4-6 weeks after surgery. There are very rare instances when drainage tubes are placed.

Some patients experience bruising, but not all. There will be some swelling. However, this is more prominent when liposuction is performed, as well. Most patients see a decrease in swelling around 3-4 weeks post-surgery, 80-90% decrease in swelling after 6-9 months, and completely gone at the one year mark. Patients generally find that the need for pain regulation subsides after the first 2-3 weeks following surgery. Patients can expect to return to their office jobs in 2-3 weeks. However, those who work in heavy labor or active positions will need to wait closer to 4-6 weeks after surgery to return to work. Light exercise can resume after 2 weeks, and more impactful exercise should wait until 6 weeks post-op.

Outcome

Each technique provides its own benefits and drawbacks regarding scarring, nipple sensation, and complication rates. It is important for patients to consult thoroughly with their surgeon before undergoing female to male surgery to ensure they have selected the best procedure for their needs.