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FTM Top Surgery: Which Incision Is Right for Your Body?

Gender Affirmation Procedure Surgical FTM Gender Transition Gender Reassignment Patient Information

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Gender affirmation surgery is one of the biggest decisions you’ll make in your life, but if it’s right for you, it can also be one of the greatest gifts you give yourself. Time and time again, we’ve seen life-changing benefits in our transgender patients who finally have the masculine chest that reflects their true gender. We’re proud to say that we’re one of the best facilities in the country for gender affirmation procedures, and Dr. Fischer is considered one of the best surgeons for top surgery, widely recommended by patients and peers alike.

Although chest reconstruction surgery to reduce or remove breast tissue is often referred to as female-to-male (FTM), surgeons are moving more and more away from that, because it implies gender change rather than affirming the patient’s true gender. More recently, it’s also called transgender mastectomy, masculinizing chest reconstruction, chest re-sculpting, or simply referred to by the catchall “top surgery”. Regardless of your gender, you can have the silhouette you’ve dreamed of, without binding.

It’s important to do plenty of research before you embark on your journey, not just to understand the risks and requirements of top surgery, but to learn about the different types available and find out which one is best for your body.

What Are the Types of Masculine Top Surgery?

There are a number of different techniques for performing top surgery or the more medically known term that removed breast tissue They vary according to where the incisions are made, whether the nipple and areola are reduced and/or re-positioned and how much sensation is preserved.

Two of the most common are periareolar and double-incision surgery, both of which we offer our patients. Others include keyhole, inverted-t, and minimal scar. Our top surgery techniques are ones that provide a good option for every breast size and shape. Keyhole surgery, for example, is only appropriate for a small percentage of patients who already have very small breasts.

Periareolar surgery creates an incision around the nipple and areola, and then another incision in a concentric circle a couple of inches away from the nipple. The skin between the incisions is removed, which allows the surgeon to do tissue removal. Finally, the chest skin is reconnected to the areola using a “drawstring” method. The areola may also be reduced in size, although usually the nipple stalk is left intact and preserves nipple sensation.

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Double incision surgery creates horizontal incisions at the top and bottom of the pectoral muscle to allow for tissue removal. The nipple stalk and nerves must be severed so that the nipple and areola can be repositioned and grafted into place, resulting in loss of sensation. The skin is reconnected at the bottom of the pectoral muscle, usually resulting in two horizontal scars.

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While you might be thinking that you have a clear preference for one type over the other, let’s talk about how to approach that decision.

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Which Type of Chest Re-Sculpting Suits Your Body?

The biggest factor that you’ll need to consider in choosing your top surgery is the size of your chest. Small to moderately-sized chests, particularly those with good elasticity, do very well with periareolar surgery. Larger-chested people usually require double incision, and people with moderately-sized chests but less elasticity in their skin may also do better with double incision.

If you fall into one of those gray areas where you might be able to go either way, the best thing to do is to schedule a consultation with your doctor to talk through your expectations, your body’s needs, and your surgical history (if you’ve had a breast reduction in the past, that could affect the options that are right for you). There’s no pressure to book your surgery with us or even to make a decision right away. We’re here to support you in your journey to become your best self!

Are There Differences Between Types of Top Surgery in Recovery?

Although double incision surgery is often a more dramatic chest re-sculpting, the recovery process for either type of top surgery is very similar. Both will have drains inserted with attached bulbs that collect excess blood and fluid and will need to be changed and emptied regularly.

In both cases, you’ll be wearing a chest compression vest for 3-6 weeks to help your chest tissue re-adhere to the chest wall, to minimize fluid build-up, and to reduce scarring. You’ll need about 2 weeks at home resting and limiting your arm movements (you can only shower after your drains are removed), but you should be able to start getting back into everyday life after that. In both cases, you won’t be able to do any heavy lifting, raise your arms over your head, or do heavy exercise or activity for about another 6-8 weeks. 

Where Should You Start if You’re Seeking Top Surgery?

You’re already off to a great start just by reading up on the types of masculine chest reconstruction available to you! Next, check out our article about the costs of top surgery so that you can begin figuring out your financing and other logistics, like time out of work. You can also read more about our procedures and what to expect on our FTM Gender Affirmation page. When you’re sure that top surgery is right for you, and that this is the right time to start planning it, contact us online or call us at 410-308-4700 for a consultation to let us help you from there.

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Dr. Beverly Fischer

Dr. Beverly A. Fischer, a leading female surgeon with over 20 years' experience, believes plastic surgery makes a profound difference in people’s lives.