Home|Blog | Top Surgery 101: What to Expect Before, During and After Female-to-Male/Female-to-Nonbinary Gender Affirming Chest Surgery
Top Surgery 101: What to Expect Before, During and After Female-to-Male/Female-to-Nonbinary Gender Affirming Chest Surgery
For transgender men and gender non-binary individuals seeking either female-to-male (FTM) or female-to-nonbinary (FTN) top surgery, this is absolutely a life-changing step in their gender affirming journey. Choosing to undergo this procedure is deeply personal so it is essential to feel informed, respected and supported every step of the way.
At the Arizona Center for Breast Surgery, we believe in offering compassionate, patient-centered care that addresses both the physical and emotional aspects of top surgery. This blog will walk you through the basics of what to expect before, during and after the procedure as well as the different surgical techniques available.
5 Min Read:
Table of Contents
- Understanding Your Surgical Options
- Planning for Surgery
- What to Expect During Recovery
- Nipple Placement, Scarring & Aesthetic Considerations
- Gender Affirming Top Surgery in Scottsdale, AZ
Understanding Your Surgical Options
Top surgery isn’t a one-size-fits-all procedure. Your body type, chest size, skin elasticity and personal goals will all influence which surgical technique your surgeon recommends. The four most commonly performed FTM/FTN top surgery techniques include:
1. Double Incision (With or Without Nipple Grafting)
This is the most common technique used for patients seeking top surgery for a variety of reasons. Though it is the treatment of choice for those with a medium to large chest or decreased skin elasticity it can also be employed for those individuals with smaller chests. It involves curvilinear or straight horizontal or oblique incisions made near the lower edge of the pectoralis muscle. Excess breast tissue, fat and skin are removed and the nipples are resized and repositioned as grafts to achieve either a more masculine or gender nonbinary appearance. The same procedure can be done without replacing the nipple-areola complexes back on for those with this preference.
Pros: Offers the most dramatic chest contouring and nipple placement control.
Considerations: Results in more visible scarring across the chest.
2. Keyhole Incision
Best suited for patients with small chest sizes and good skin elasticity, this technique involves a small incision along the lower half of the margin of the areola. It allows for the removal of breast tissue without removing or repositioning the nipple.
Pros: Minimal scarring and preservation of nipple sensation.
Considerations: Limited contouring capability; not suitable for medium to larger chests.
3. Periareolar (Circumareolar) Incision
Also called the “donut” technique, this method involves making a circular incision around the areola to remove tissue. It is appropriate for patients with smaller chest sizes without drooping.
Pros: Limited scarring and potential for good aesthetic results in appropriate candidates. Provides for some skin tightening when needed.
Considerations: Not suitable for medium to larger chests or those with skin laxity. Can result in undesirable distortion and scarring of the areolas when it is not used in an appropriate situation.
4. Gender Affirming Breast Reduction
This is employed in very select situations for gender nonbinary individuals who want to have very small breasts and do not want a totally flat chest. It is more commonly requested in those individuals who are gender fluid or androgynous. It can be done with or without replacing the nipple-areola complexes.
Pros: Meets the desire to have some breast tissue and projection, allowing for gender fluidity or an androgynous look.
Considerations: Longer overall scar length.
Planning for Surgery
Before undergoing top surgery, patients should expect a thorough consultation with their plastic surgeon. This includes a detailed discussion of your goals, medical history, chest anatomy and surgical options. Your surgeon will help determine the most appropriate technique and create a customized surgical plan.
You likely will be asked to provide documentation related to your gender identity from a qualified mental health professional depending on a variety of factors including your plastic surgeon, surgical facility and your insurance provider (if using insurance).
What to Expect During Recovery
Recovery time can vary depending on the surgical technique used, your overall health, compliance with postoperative care instructions and your physical requirements such as related to work, school and other activities. The following are some general milestones that will have individual variations and are also influenced by surgical technique employed:
- Initial surgical dressing are removed after 2 – 3 days
- Drains are in place for around 10 days to 2 weeks
- For the double incision free nipple graft technique, the nipple dressings are removed at around 2 weeks
- Scar gel or tapes are started at around 3 – 4 weeks
- Weight lifting restrictions are removed at 2 months
- There is complete removal of all activity restrictions by 3 months
- Full scar maturation takes t around 1 year
If you are seeking to return to work, the time frame would depend on several factors, especially your activity type and level. Returning to school can potentially be within 1 – 2 weeks.
Nipple Placement, Scarring & Aesthetic Considerations
A key component of gender affirming top surgery success is achieving a chest contour that aligns with your gender identity. This includes appropriate nipple-areola complex size and placement, chest symmetry, and scar shape and positioning. Dr. Steven Turkeltaub pays meticulous attention to these details, aiming to create a natural-looking result that complements your body type.
Scars are inevitable with most top surgery techniques, particularly with double incision methods. However, with proper scar care, including silicone treatments and sun protection, they can fade significantly over time and become relatively inconspicuous.
Gender Affirming Top Surgery in Scottsdale, AZ
With the proper support, top surgery can be a powerful, affirming step forward in your gender journey. Dr. Steven H. Turkeltaub is certified by the American Board of Plastic Surgery with years of experience in advanced breast and chest surgery. He is dedicated to helping each and every patient that he sees to feel comfortable, respected, heard and empowered.
If you’re considering FTM or FTN top surgery in Scottsdale or anywhere else in Arizona, contact the Arizona Center for Breast Surgery at (480) 451-3000 to schedule your private consultation. You can also reach us through our online form.