Female-to-male (FTM) top surgery, also called gender mastectomy, involves direct excision of breast tissue with or without liposuction to create a masculine chest contour in transgender or gender-expansive patients. During the female-to-male (FTM) transition process, patients who are born female seek to alter a number of external features to better align their looks with their gender identity of male. The breasts are one of the most obviously feminine characteristics of the female form, and they can be a great source of discomfort in patients who do not identify as a woman. They may add unwanted contour and draw attention to the patient’s body, making it difficult for transitioning patients to live as a male. During chest reconstruction, more casually referred to in the transgender community as FTM top surgery, patients seek to alter the appearance of their feminine breasts to reveal more masculine pecs. While both men and women have two sets of pectoral muscles – the pectoralis major and the pectoralis minor – breast tissue covers this muscle group in women. Through the removal of breast and other tissue, the team of experts at Ann Arbor Plastic Surgery can successfully complete a FTM top surgery in transgender males.
Why Undergo FTM Top Surgery?
Some transgender patients opt to leave their genitalia unchanged while embarking upon a life as the opposite gender. Often, more obvious physical features of their born-gender take precedence in the transition process. In transgender men, these are the breasts. While supplemental testosterone may decrease the size of the breasts, a procedure is required to provide the best results. FTM top surgery is often one of the first of a series of masculinizing procedures.
Women are restricted by society and some laws in the ways in which they are allowed to reveal their chests. They don different undergarments and swim suits, and are typically not allowed to be topless in public. Unwanted breasts also cause an unnecessary hindrance in an otherwise male form. A chest reconstruction can provide a great deal of mental and physical relief in FTM top surgery patients.
How is Chest Reconstruction Performed in FTM Top Surgery Patients?
The goal of FTM top surgery is to create a masculine chest contour. A variety of incision patterns and techniques may be utilized, including peri-areolar, circumareolar, and double incision with free nipple grafting. The procedure is performed under general anesthesia and patients will typically go home the same day as an outpatient procedure. The day of the surgery, patients may be asked to use a pre-surgical soap on the body, with instructions to skip the use of body products. Prior to the procedure, the doctor uses a surgical marker to create a blueprint of the procedure on the patient’s body. The breasts appear different when the patient is in an upright position so they are marked this way, whereas during the surgery the patient will be laying down. The surgery typically takes about two hours to perform.
The particular technique used is dependent on a patient’s scar preference as well as breast size and anatomy. Depending on the size of the patient’s breasts, there are different ways to perform FTM top surgery. The double incision surgery (also referred to as elliptical incision) for larger breasts often require two access points. The breast tissue is excised from the top area of attachment to the chest wall and results in a lateral scar below each pec. Smaller breast sizes are often accessed through the nipple in a periareolar procedure, which will result in scarring located around the areola.
Under general anesthesia, your surgeon will perform the FTM top surgery in a fashion similar to mastectomies of cancer patients. During the procedure, he or she permanently removes breast tissue while conservatively eliminating fat, muscles, and extra skin. In some cases, the nipples are excised from their original location and repositioned on the chest. These changes result in a flat and possibly concave chest, where the pectoral muscles are more prominent than before. The doctor takes care to remove additional area fatty deposits that are specific to the female form, including liposuction of the chest around the pectoral muscles for better definition, as well as the sternum and underarms. Drains are placed to eliminate the buildup of fluid at and around the surgical site, and these will be removed by the surgeon’s guidance, which is typically 5-7 days postoperatively. A special garment may be worn for a period of time to protect the surgical site, aid in swelling, and promote great final results.
Insider Tips for FTM Top Surgery
- Ask your surgeon about his or her experience with the transgender population and WPATH standards of care.
- Discuss the planned technique and location of the scars you can expect following surgery.
- Your surgeon may require you to have a mammogram before surgery, depending upon your age and family history.
Candidates for Top Surgery
The surgeons at Ann Arbor Plastic Surgery follow the World Professional Association for Transgender Health (WPATH) standards of care for transgender individuals seeking surgery. Whether a patient is seeking to undergo FTM or MTF top surgery, many of the same criteria apply for Ann Arbor Plastic Surgery to accept patients for either procedure. Potential patients should be legal adults, aged 18 years or older, with a sufficiently documented history of gender dysphoria as relayed by trusted mental health professionals. Individuals seeking top surgery must be 18 years of age and have one letter of readiness for surgery by a mental health provider.
Patients younger than 18 may be surgical candidates if the patient, legal guardians, and mental health professional are in agreement that delaying surgery would induce patient harm. They must be in good health with no major medical or physical issues that would preclude a life- and figure-altering surgery. Those accepted as patients must also have realistic expectations of what plastic surgery can accomplish.
Preparing for FTM Breast Removal
Female-to-male subcutaneous mastectomy is often seen as a relief surgery by transgender and non-binary patients. The excess tissue has been compared to excess baggage that a person unwillingly carries around until the day of their surgery. While a patient may feel ready for the permanent changes a breast removal produces, there are steps that a person can take to better prepare for the procedure and recovery.
Plastic surgeons may operate on smokers on a case-by-case basis, though smokers will need to quit their habit for the two or more weeks prior to chest masculinization surgery and are encouraged to stop altogether. Smoking can impact many aspects of the surgery, from the provided medications to the final results of transgender male chest contouring.
A healthy diet and exercise are always recommended, especially in patients whose bodies are undergoing changes produced by medications and multiple surgeries. FTM surgery patients should refrain from drinking alcohol for two weeks before the surgery appointment since it may increase postsurgical bleeding and bruising. Medications like testosterone are typically suspended temporarily from the patient’s regular regimen for a few weeks prior to the surgery, and for a short period after.
More insurance companies are covering the cost of FTM top surgery than ever before. Gender reassignment surgeries (GRS) are recognized as medically necessary in many plans. State laws, insurance companies, and insurance plans will influence individual policies, so patients should be informed of these different variations. Transgender male patients should call their company to determine their coverage. In cases where patients are self-paid, there may be financial assistance plans and programs to help with the costs of this life-altering procedure.
Breast Reduction During FTM Top Surgery
In patients who may have smaller breasts due to a thin build, naturally lacking breast tissue, or effective male hormones, breast reduction surgery can be performed instead of total breast removal. Reserved for specific cases that meet necessary criteria, certain transgender men and non-binary patients may seek only a less pronounced chest. During reduction, some of the feminine traits of the breasts may remain, such as breast shape and projection.
Benefits of FTM Surgery
Transgender men and non-binary individuals are forever changed by top surgery. The prominent set of anatomical features serves a very specific function in women: to nourish their young with milk. Modern Western culture has sexualized the breasts, which are seen as aesthetically important to a woman’s body. After FTM top surgery, transgender men can enjoy this part of their physicality, which for some, has not been possible since before puberty. The breasts-turned-pecs can also help transgender men present more obviously as the gender to the world.
In patients who undergo removal of most of the breast tissue, the likelihood of breast cancer is significantly reduced. Though patients age forty and older should undergo a mammogram prior to the procedure, they will not be monitored in the same way as women. Patients with a genetic predisposition or risk factors like smoking should still get routine scans and physicals to examine the chest as their doctor recommends.
FAQs About FTM Top Surgery
What is the recovery process like after FTM top surgery?
Your surgeon will provide specific post-operative instructions depending on which procedure you are planning to undergo. In general, patients will need to avoid strenuous activities except for walking initially following surgery.
Patients may be advised to wear a chest binder to alleviate swelling for several weeks after surgery. If you undergo free nipple grafting as part of your procedure, you will have bolster dressings on your nipples for approximately five days after surgery, which will be removed in clinic. You may be discharged home with surgical drains in your breasts, which will be removed when the output decreases in the first one to two weeks after surgery. Generally, patients return to work within three to four weeks after surgery.
Why is FTM top surgery also called chest reconstruction?
During the female-to-male top surgery, the patient will have tissues surgically removed from the body, while other parts (like that of the areola and nipple) are constructed and sutured into a new position on the chest. Top surgery requires the surgeon to remove the breasts and make the pecs appear as natural as possible, which requires surgical reconstruction.
Is there a transgender male version of this procedure?
The opposite MTF top surgery involves a breast augmentation procedure, performed through implants. While chest reconstruction seeks to remove the breasts and create a flatter chest, the addition of implants will create the addition of breasts on the chest.
Can the FTM top surgery be customized?
The patient has the opportunity to make decisions about their procedure every step of the way. From incision placement, to implant material and location, this surgery can be completely tailored to suit a patient’s individual needs.
Meet the Experts at Ann Arbor Plastic Surgery
To learn more about the FTM surgery with the surgeons in Ann Arbor, MI, call today at (734) 913-5100, and the Jackson practice can be reached at (517) 789-9800 to schedule your consultation.