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What is FTM top surgery?

Top surgery for transgender men and nonbinary people removes breast or chest tissue. It can be one step in treating gender dysphoria, helping transgender men physically transition to their affirmed gender. Alternatively, it may be the only surgical step in an FTM physical transition.

If your chest size is naturally small, you might be eligible for nipple-sparing subcutaneous mastectomy, which spares your skin, nipple, and areola. However, if you have a larger chest, you might need to have your nipples and areolas taken off, resized, and placed back into position.

Are there different types of top surgery?

There are several FTM top surgery options, such as:

Double-incision top surgery with nipple grafts

The most common surgical option, double-incision top surgery with nipple grafts, includes:

  • Removing your nipples and areolas
  • Decreasing the size of your nipples and areolas
  • Making long incisions to access and remove your breasts
  • Performing liposuction to remove excess fat
  • Removing excess skin, if necessary
  • Preventing skin puckering near the incision with special stitches
  • Reattaching the optimized nipples and areolas to your chest

Periareolar top surgery

Best for patients with smaller chests, the procedure may involve:

  • Making an incision along the bottom half of your areola so it’s semi-attached
  • Removing breast tissue and performing liposuction
  • Resizing your nipple if necessary

Am I a good candidate for female-to-male (FTM) top surgery?

Before having top surgery, most surgeons and insurance companies require you to obtain a letter of support from a mental health provider competent in transgender health. They will determine whether you meet the World Professional Association of Transgender Health (WPATH) standards of care.

These criteria include that you must:

  • Have persistent and well-documented gender dysphoria
  • Be able to make a fully informed decision and consent to treatment
  • Have reached the legal age to make health care decisions, which is eighteen in the United States
  • Be successfully managing significant medical or mental health concerns

It is important to note that masculinizing surgeries are commonly deferred until adulthood. And while hormone therapy isn't required before FTM top surgery, waiting for the chest muscle growth associated with testosterone therapy may provide the best surgical result. If you've been taking testosterone therapy, you'll have blood tests to ensure your testosterone level is in your target range before surgery.

Your healthcare provider will also evaluate your health to screen for or address medical conditions that might affect or rule out treatment. Such an evaluation might include the following:

  • A review of your personal and family medical history
  • A physical exam
  • Age- and sex-appropriate screenings
  • Identification and management of tobacco use and drug and alcohol abuse
  • Testing for HIV and other sexually transmitted infections, along with treatment, if necessary

FTM top surgery procedure

Top surgery in Auburn, WA, uses specialized surgical techniques to contour and reduce the chest wall while positioning the nipples and areola and minimizing scarring.

Remember that some chest tissue will likely remain regardless of the surgical technique. As such, Dr. Tseng will discuss continuing routine breast cancer screening. Additionally, if you carry genetic mutations that increase your risk of breast cancer, you might choose to have your nipples and areolas wholly removed.

After top surgery, you might need additional surgery or cosmetic procedures, such as tattooing, to:

  • Correct scarring
  • Contour the chest contour
  • Right nipple and areola placement

To reiterate, if your chest size is small, you might be able to have surgery that spares your skin, nipple, and areola. This procedure:

  • Minimizes scarring
  • Has a faster healing time
  • Preserves sensation in the nipples

However, suppose you have significant chest tissue. In that case, FTM top surgery may resize your nipples and areolas before placing them in a position that creates the appearance of a more masculine chest. This method can cause additional scarring and loss of sensation to the nipple; non-erotic feelings may take months or years to return.

Recovery and results for female-to-male (FTM) top surgery

After top surgery, your chest will remain in a compression wrap for several weeks to prevent fluid from pooling. You may also have small plastic tubes where Dr. Tseng removed your chest tissue to drain any fluids accumulated after surgery. You must sleep with your torso elevated for the first week after surgery and avoid lifting more than fifteen pounds for several weeks.

Some other FTM top surgery recovery requirements include the following:

  • Sleep on your back
  • Take medications as prescribed to relieve pain and prevent constipation
  • Rest, which includes staying home from work for a short period and temporarily avoiding lifting or reaching
  • Change the compression bandages regularly

The outlook after FTM top surgery is excellent. While it can take a few months for the pain and scars to fade, you’ll likely have an improved self-image and quality of life after recovering. Your chest will be flatter and have a more traditionally masculine appearance, which can be a powerful treatment for gender dysphoria.

Mark H. Tseng, M.D.
Mark H. Tseng, M.D.

Why choose Tseng Aesthetics for female-to-male (FTM) top surgery?

For some transgender men and nonbinary people, top surgery is vital to their sense of self. You deserve to love what you see in the mirror.

Residents of Kirkland, WA, Auburn, WA and nearby communities trust the skills and expertise of Dr. Mark Tseng, whose philosophy includes restoring and maintaining your natural beauty. Respect, agreement, and integrity are the cornerstones of his 17 years in practice. As such, Dr. Tseng is among the most experienced and dedicated plastic surgeons practicing in the greater Seattle area.

Mark H. Tseng, M.D.
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