Top Surgery: Female to Male Mastectomy

What does the term “top surgery” refer to?
Top surgery enhances the appearance of the chest, giving transgender men a more masculine aesthetic. This operation is a form of gender-affirming surgery specifically designed for those transitioning from female to male (FTM).

What occurs during FTM top surgery?
There are numerous choices available for female-to-male top surgery. Procedures may encompass:

Performing a bilateral mastectomy to remove both of your breasts.
Removing surplus skin in the vicinity of your breasts.
Adjusting the position of your nipple and the pigmented skin surrounding it.
Implementing additional modifications to provide a smooth and unenhanced breast area.
FTM top surgery is primarily intended for those who identify as transgender men who wish to undergo a surgical procedure to alter their chest appearance.
A significant number of individuals seeking FTM top surgery experience gender dysphoria. This refers to the state of distress that arises when an individual’s biological sex assigned at birth does not align with their own sense of gender identity. Top surgery can effectively reduce this dysphoria.

Surgery can additionally mitigate difficulties arising from the utilization of compression garments for binding purposes. These form-fitting clothing can result in skin irritation, respiratory difficulties, pain, and potentially fractured ribs.

Which specialty of surgeon is responsible for conducting this procedure?
An optimal selection would be a plastic and reconstructive surgeon who holds board certification and specializes in gender-affirming surgeries. Seeking treatment from a seasoned practitioner maximizes the likelihood of a successful surgical outcome.

Details of the procedure
What precedes FTM top surgery?
In order to have female-to-male top surgery, you must satisfy the standards established by the World Professional Association for Transgender Health (WPATH). A mental health evaluation will be conducted to ascertain your comprehension of the operation and its ramifications on your life.

It is probable that you will require testosterone hormone therapy to verify your gender. The complete manifestation of the desired outcomes may require a duration of up to one year, encompassing the relocation of adipose tissue from the chest region and the augmentation of shoulder width.

What alternatives do I have?
Multiple options exist for FTM top surgery:

Double-incision top surgery involving the use of nipple transplants.
This is the prevailing choice. It encompasses:

The procedure involves the removal and reduction of both the nipples and areolas.
Performing extensive surgical cuts to gain access to and extract your breasts.
Conducting liposuction procedure to eliminate surplus adipose tissue.
Excising surplus skin, if required.
Using specialized sutures to prevent the formation of skin puckering, often known as dog ears, near the incision.
Reattaching the optimum mammary papillae and pigmented areas to your thorax.
Periareolar mastectomy
This choice is designed for persons with more petite chests. It could encompass:

Performing a single circular cut along the perimeter of your areola.
Creating a broader circular cut surrounding the initial one.
Excising mammary tissue and conducting liposuction.
The process involves resizing and reattaching the areola by carefully aligning and suturing the borders of the larger incision.
Keyhole top surgery refers to a surgical procedure that involves the removal of breast tissue through a small incision made around the areola.
If you possess a diminutive chest and taut skin, you may meet the criteria for this surgery. It encompasses:

Performing a surgical cut along the lower portion of your areola, leaving it partially connected.
Excising mammary tissue and conducting liposuction.
Adjusting the size of your nipple if needed.
What other gender-affirming surgical procedures are accessible for transgender men?
You might consider pursuing:

Facial masculinization enhances the appearance of your face to make it more manly. It offers choices like elongating your forehead or enhancing the angularity of your jaw.
Phalloplasty is a surgical procedure that constructs a penis of average size. This method involves utilizing grafts of dermal tissue from different regions of your body.
Metoidioplasty yields a reduction in penile size. This technique involves the administration of hormones to stimulate the growth and enlargement of your clitoris. Surgeons utilize this tissue to fabricate a penis.
Pros and Cons
What advantages can FTM top surgery offer?
One of the primary advantages is alleviation of gender dysphoria. Attaining a level, masculine appearance of the chest is beneficial for numerous transgender individuals as it enhances their self-perception and aids in reducing gender dysphoria.

Additional advantages vary based on the specific type of top surgery:

Double-incision top surgery with nipple transplant involves making two incisions on the chest to remove breast tissue and create a masculine chest contour. Nipple grafting is performed to relocate the nipples to a more appropriate position on the chest.
Improved alignment of the nipple.
Reduced likelihood of drooping.
Periareolar top surgery refers to a surgical procedure that involves making an incision around the areola to remove breast tissue and create a more masculine chest appearance.
Potential retention of nipple sensitivity.
After the healing process, incision scars are barely discernible.
Keyhole top surgery refers to a surgical procedure that involves the removal of breast tissue through a small incision made around the areola.
Potential retention of nipple sensitivity.
Negligible scarring.
What are the possible problems associated with female-to-male (FTM) top surgery?
The occurrence of complications is contingent upon the specific nature of the surgery and may encompass the following:

Urgent and manageable problems such as hemorrhaging and susceptibility to infection.
Dog ears refer to a tiny protrusion of adipose tissue and skin that extends beyond the incision site.
Diminished tactile perception in the nipple area.
Formation of permanent fibrous tissue as a result of injury or damage.
Accumulation of adipose tissue over a period of time necessitating further liposuction.
Asymmetrical nipples or other surgical imperfections that require corrective surgery.
Rehabilitation and Prospects

What is the postoperative experience of FTM top surgery?
Following the surgical procedure, it will be necessary for you to:

Utilize compression bandages on your chest to inhibit the accumulation of fluid.
Adopt a supine sleeping position.
Administer analgesics to alleviate discomfort and mitigate the occurrence of constipation.
Engage in restful activities, such as taking time off from work for a little duration and refraining from lifting or stretching momentarily.
Ensure regular replacement of the compression bandages.

What is the postoperative experience following FTM top surgery?
The prognosis following FTM top surgery is highly favorable. The process of pain and scar reduction may last several months. Following recuperation, the majority of individuals experience an enhanced perception of themselves and an elevated standard of living.

When to Seek Medical Consultation
What is the recommended timeframe for contacting my healthcare physician following FTM top surgery?
It is important to schedule follow-up consultations to monitor your progress in recovering. Promptly reach out to your healthcare professional if you encounter any of the following:

Stained bandages saturated with blood, indicating an excessive amount of bleeding.
These are infections that result in a rise in body temperature or the presence of a yellowish fluid coming out of the surgical wounds.
Intractable pain unresponsive to pharmacological interventions.
Indications of blood clots, such as atypical enlargement in your groin or lower thigh.
Experiencing emesis and inability to retain fluids.