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Female to Male (FTM)

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Female to Male Top Surgery in Houston

Female to male (FTM) top surgery is a surgical breast 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 masculine and defined 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 well-being.1

FTM Top 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.

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.

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.

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.

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.

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, please contact us to schedule a confidential consultation with Dr. Rednam.


References
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.

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

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