MASCULINIZING CHEAST SURGERY

Masculinizing Chest Surgery (Top Surgery): Surgical Options

Top surgery is a procedure to change the contour and appearance of your chest so that it more closely matches your gender identity. In many cases, this means creating a more masculine-appearing chest.

People who desire top surgery are not required to identify as male or transgender. Some people with nonbinary gender identities choose to have top surgery.

We follow the World Professional Association for Transgender Health (WPATH) guidelines for surgery.

During surgery your surgeon will:

  • Remove skin, as well as glandular and fatty tissue, and adjust the shape of the chest.
  • Reduce the size of the dark area around the nipple (areola) to a size that is more typical for people assigned as male at birth.

How your surgeon performs surgery will depend on your chest size, age, skin elasticity, and surgical goals.

Deciding to Have Surgery

There are many things to consider when thinking about top surgery. Your surgeon will talk to you about:

  • Which surgery options are available and recommended for you.
  • Timing of surgery.
  • How long it will take you to recover. Most people will be away from work for about 2 to 4 weeks.
  • Goals and expectations about your surgical outcome and how your chest will look and feel.

In California, you do not need surgery to change your gender marker legally on identification documents.

Reasons people have top surgery

  • Increase physical and emotional comfort.
  • Reduce distress related to the body.
  • Feel more affirmed in their gender.
  • Feel a greater sense of ease and safety in public spaces.
  • Increase sexual function or fulfillment.

Physical and Mental Health

Most people who wish to can have top surgery. However, surgery may not be safe if you have certain health conditions. We will work with you to stabilize any health conditions that would put you at higher risk for complications during surgery. Some examples of health conditions that need to be monitored and stabilized before surgery include:

  • Obesity (BMI greater than 30)
  • Nicotine use, including cigarette smoking, nicotine patches, and e-cigarettes (vaping)
  • Diabetes
  • High blood pressure

Together, you and your surgeon will determine the best surgical approach for you based on your:

  • Medical history and overall health
  • Age
  • Body type
  • Surgical goals

Types of Top Surgery

There are several ways to achieve a more masculine-appearing chest. Your surgeon will discuss the best options for you. The type of surgery will typically depend on the amount of chest tissue that needs to be removed and your surgical goals.

Periareolar (keyhole) surgery is an option if you have a small to moderate chest size (A to small B cup). We will:

  • Make an incision under the areola, leaving the nipple attached to a small section of tissue.
  • Remove the skin, and glandular and fatty tissue with liposuction or excision.
  • Trim the dark area around the nipple (areola) to a smaller size.
  • Trim excess chest skin and then reattach the remaining skin to the areola.

Circumareolar surgery is an option if you have a moderate chest size (B cup). We will:

  • Make an incision all the way around the areola, leaving the nipple attached to a small section of tissue.
  • Remove the skin, and glandular and fatty tissue with liposuction or excision.
  • Trim the dark area around the nipple (areola) to a smaller size.
  • Trim excess chest skin and then reattach the remaining skin to the areola.

Double incision mastectomy is often the best option for medium to large chests. We will:

  • Make 2 incisions – one above and one below the pectoral muscle.
  • Remove the skin, and glandular and fatty tissue.
  • Use liposuction to remove extra fat and shape the chest. This is not always necessary.
  • Remove the nipples. Sometimes your surgeon will leave the nipple attached to a small section of tissue to preserve nipple sensation.
  • Trim the areola to a smaller size.
  • Reattach the nipples with stitches.
  • Close larger incisions and put in drains if needed.

Risks

There are risks with any surgery. Top surgery has specific risks. They include:

  • Bleeding
  • Infection
  • Hematoma (blood clots)
  • Seroma (fluid collection)
  • Delayed wound healing
  • Loss of sensation in certain areas
  • Problems with anesthesia
  • Possible need for surgical revisions

There may also be some scarring. Scars usually fade over time. You can help reduce them them by following the discharge instructions provided by your surgeon. Some people develop thick red scars (keloids) that are permanent.

Even people in the best physical health who follow all instructions can develop complications. Your surgical team will work closely with you if a complication develops and provide you with the appropriate aftercare and follow-up.

FTM Top Surgery Procedures

Types of Subcutaneous Mastectomy for Trans Men

Double Incision Top Surgery

The best choice for medium and larger chested trans men. Horizontal incisions along the bottom contour of the chest muscles are made, and the nipple and areola are removed, then resized and grafted back on. Sensation in the nipple and areola is usually compromised, if not completely numbed.

Peri-Areolar Top Surgery

A very good option for trans men with A to B-sized chests and good skin elasticity. Concentric incisions are made around the areola, and breast tissue is removed. The skin is brought together like a drawstring purse and connected to the outer edge of the downsized areola, similar to a drawstring purse. which may be downsized. The nipple stalk is usually left intact which helps retain sensation.