If you’ve been exploring gender affirmation surgery, you might have come across many names for what’s often called “top” surgery. It can be confusing to tell whether they’re the same thing and to know which name you should use with your doctor. Naturally, you want to be sure that the surgery you’re thinking about is the one you’re asking for!
Let’s go through the names that you’ll see and talk about which ones are the same and which ones are different. Not only will this help you speak with your surgeon, but it’ll also help you become more knowledgeable about these procedures.
Many people have heard it called “FTM Top Surgery”. “FTM” stands for “Female to Male”, and it’s leftover from the days when transition surgery was called “gender reassignment” instead of “gender affirmation” or “gender-confirming” as it is today. You may also see:
- Chest reduction surgery
- Breast reduction surgery
- Subcutaneous mastectomy
- Transmasculine top surgery
- Male chest reconstruction or male chest contouring
- Cosmetic mastectomy
- Masculinizing chest surgery/chest masculinization surgery
- Transgender mastectomy
All of these are names for the same procedure: removing breast tissue and shaping the chest to create a less feminine and often more masculine-looking chest for transgender men or masculine-leaning nonbinary people. You can use the names you feel most comfortable with, and your doctor will understand what you mean.
What is FTM Top Surgery?
It’s important to understand that gender affirming top surgery for transmen is not entirely the same as breast reduction surgery for cisgender women who want smaller breasts. They’re similar in many ways, but you should find a surgeon who specializes in gender affirmation procedures and make sure that you see examples of their work with people whose bodies resemble yours.
This kind of specialist will have experience shaping a masculine-looking chest and talking through their patients’ expectations and experiences with dysphoria. They’ll make sure they understand what you want to look like, and will be able to tell you what’s possible for your body.
In the procedure, all of your visible breast tissue and excess skin will be removed through incisions. If you have small breasts, you might be able to have your nipple and nipple stalk preserved (so you still have sensation), but you might also have your nipples removed and grafted, or simply removed. Many people have them removed and get nipple tattoos to replace them.
The Types of Top Surgery
While there may be many names for top surgery that are pretty much the same, there are several techniques that your surgeon can choose from. These are different, so you’ll want to know what each one means:
- Double Incision: Good for medium to larger chests, this technique makes incisions at the top and bottom of the pectoral muscle. The nipple is usually removed and grafted back on. Liposuction may also be used to remove fat from the area.
- Buttonhole: Similar to double incision, except that instead of removing the nipple, the nipple is left intact (though may be re-sized) and is re-positioned through an opening cut into the new location on the chest. It preserves nipple sensation.
- Inverted-T: Also based on double incision, this also preserves the nipple-areola complex, but in this case by making a vertical incision to the nipple from the bottom pectoral incision which allows the surgeon to re-size and re-position the nipple while leaving the nipple stalk intact.
- Peri-Areolar: This technique is best for smaller chests. An incision is made around the nipple, and another concentric one is made a little farther away from the nipple. That ring of skin is removed, tissue is drawn out through the opening, and then the skin is re-attached to the nipple with a “drawstring” stitch.
- Keyhole: Also best for small chests, a single incision is made around the bottom of the nipple, leaving the nipple and its sensation intact, and liposuction is used to remove the fatty tissue.
At ACPS, we do double incision and peri-areolar. You’ll most likely talk about one of the other types with your surgeon when you discuss what to expect in the top surgery process.
If you’re wondering what type of masculine top surgery is right for you, please contact us to set up a consultation. We’re happy to answer all your questions and help you with your gender affirmation journey.
