Female-to-Male Top Surgery
(FTM) Body Affirming Surgery
Female to Male (FTM) Top Surgery is a surgical 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.
FTM Top Surgery is typically performed under 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 flatten and masculinize the chest.
FTM Top Surgery uses the following different techniques:
- Double Incision with Free Nipple Grafting
- Inverted T (Anchor)
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 positioning.
Periareolar: A periareolar procedure is ideal for those with minimal excess skin. This technique involves reducing the areola down to a more 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.
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.
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 by completely removing the nipple and areola. The surgeon then removes the breast tissue and excess skin, while resizing and placing the areolas as skin grafts in a more masculine position. With this procedure normal nipple sensation is lost, but overtime mild protective sensation may return.
Inverted T (Anchor): The Inverted T technique is ideal for patients hoping to maintain nipple sensitivity post-surgery. During the procedure, the tissue attached to the nipple and areola maintains its blood supply, also known as the pedicle. It runs from the nipple all the way to the lowest part of the breast and is left intact. 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 tell 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.
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 physicians before undergoing FTM top surgery, to ensure they have selected the best procedure for their needs.
Liposuction may also be used with any of the techniques, but is most often used when excess lateral chest fat deposition is present.
After surgery, a compression dressing is placed around the chest for 5-7 days to help reduce swelling and bruising, and to improve patient comfort during recovery. Dr. Rednam will change a patient’s dressings at their first postoperative appointment and will also discuss scar care and healing. At this time, patients begin using compression vests, which are easily hidden under clothes. In very rare cases, drainage tubes are placed when necessary.
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 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.