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Gender Affirmation 101 – Event Recap

Gender Affirmation 101 – Event Recap

By Beverly Fischer on July 14, 2021

Gender Affirmation Back to Blog

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Recently, we were proud to present a webinar for people who are interested in FTM/FTX gender affirmation top surgery as part of their gender transition. The event was designed to give a thorough overview of the process from consultation through recovery, and to answer a lot of the most common questions about masculinizing top surgery.

We wanted to share with you some of the most important pieces of information that we covered in the webinar. If you’re just starting out on your gender affirmation journey, or actively researching providers to schedule your FTM/FTX top surgery, this is a great starting place.

The procedure, also known as “subcutaneous mastectomy”, is something that people may seek out as trans men or nonbinary people, and it can be an important part of their gender transition. It’s the removal of all glandular breast tissue and the creation of a more traditionally masculine flat chest. For many people, it’s a way to finally feel more at home in their body, relieving the dysphoria, depression, and anxiety they have suffered.

Dr. Fischer began her specialty in gender affirming FTM/FTX top surgery many years ago after her first such client, a trans man working with a national transgender organization, was so pleased with his results that he wrote an article talking about his great experience with us. At the time, Dr. Fischer was the only gender affirmation top surgery specialist on the East Coast, and she enthusiastically embraced the chance to meet the need for caring, compassionate, and skilled plastic surgeons who could make their patients feel safe, heard, and understood.

So what’s involved in the FTM/FTX top surgery process?

Consultation process

You’ll start your journey with a consultation appointment. We’ll ask you a series of questions, including:

  • What are your pronouns?
  • Do you have a family history of breast cancer and/or heart problems
  • Have you ever had any lumps? 
    • Do you have cysts or fibrocystic disease of the breasts?
  • What medications do you take?
  • Any allergies?
  • Are you on testosterone? If no, do you have plans to be? (note: you can have surgery either way!)

We’ll take some measurements to find out how to grade the size of your breasts (Dr. Fischer uses a grading scale of 1, 2a, 2b, 3, or 4 to determine your surgical needs) and recommend the type of procedure that’ll be best for you. We’ll go through the entire recovery process post-op including the timeline, look at some before and after photos, and answer any of your other questions including costs.


Procedure requirements

We follow the WPath (World Professional Association for Transgender Health) guidelines for gender affirmation surgery requirements. This means you’ll need a letter from a mental health professional (a therapist, social worker, psychiatrist, etc.) who can say that:

  • You have a support system 
  • You are mentally stable 
  • You understand the procedure is irreversible 
  • You are diagnosed with gender incongruence 
  • This is the next, medically necessary, step in your transition 

Additionally, we’ll need for you to collect some medical history from your Primary Care Physician and have some blood work done before you’re cleared for surgery.

Incision types

Dr. Fischer performs two types of FTM/FTX top surgery, and which one you’ll have depends on what grade your breasts are. They are:

  • Periareolar: This is where a small incision is made around the areola, allowing breast tissue to be removed in one piece. Scarring is minimal and less visible, and nipple sensation is preserved.
    • This is appropriate for breasts graded 1, 2a, and sometimes 2b– in other words, smaller, flatter breasts.
  • Double incision: This is where two horizontal incisions are made at the top and bottom of each breast, allowing tissue to be removed, with the incisions stitched together so that there’s one horizontal scar along the bottom of the pectoral muscle. There is a visible scar, and the nipple and areola must be repositioned as a graft.
    • This is the surgery for breasts graded 3 or 4 and sometimes for 2b– for larger breasts requiring more tissue removal.


When you’re recovering from FTM/FTX top surgery, you’ll need to allow about 6 weeks to get fully back to normal, although after week 4, you’ll be back to many of your regular activities.

Your first couple of weeks will be the most intense, although some people bounce back very quickly! However, you will spend that time having drains and a compression vest, checking for any signs of infection, not being able to shower, and not being able to lift much weight or exercise. It’s good to have help during this time and to plan on getting lots of rest.

By week 4, you’ll be able to decide how visible you want your scars to be, and to start using topical treatments like silicone gels, vitamin E, or cocoa butter if you want them to be less visible. After week 4, you’ll be able to start doing more of your normal activities and enjoying your “new” body!

FAQs for FTM/FTX Top Surgery

We get similar questions from many people, so here are a few of the most common:

  • How old do I have to be to get FTM/FTX top surgery? To get it without parental involvement, you must be 18. If you have your parents’ support, we’ve had patients as young as 12.
  • Do I need to be on testosterone? Absolutely not! You can be, of course, but it’s not a requirement.
  • Do I need to have been living as my true gender for any length of time? No, you don’t. That’s an outdated requirement.
  • Do I need to present a letter from my therapist? Yes, we do have to have that– or from another mental health professional.
  • Can I use my insurance to pay for it? We don’t accept insurance, but you may be able to submit the bill to your insurance provider. We’re happy to talk to you about CareCredit as a common financing option.

You can watch the recording of the webinar if you want to see the full presentation and hear the audience’s questions answered. If you think you’re ready to take the next step in your gender affirmation journey, contact us for a consultation and let us help you achieve the body you’ve been dreaming about.

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