FTM and MTF Transgender Breast Surgery

FTM and MTF Transgender Breast Surgery

Feeling that the body you were born with does not match the innate sense of your true gender can be far more than stressful and anxiety provoking. With transgender identity, also known as gender nonconformity, your body is either male or female but your mental being is telling you that you are really of the opposite sex or something else far different. You think, behave, dress and interact with others accordingly which is in conflict to your anatomic reality.

For many individuals, this results in gender dysphoria which can lead to negative, destructive manifestations such as anxiety, depression, eating disorders, self-harm, substance abuse, anti-social behavior and suicide. Counseling, psychological and psychiatric sessions can be very effective in helping people constructively address and deal with both the gender identity issues and the associated negative behaviors as well as facilitate their transitioning.

Advancements in the field of transgender plastic surgery and greater availability of these services have made it far easier for interested individuals to undergo gender transition leading to results that are very real, natural and quite satisfying. Here at the Arizona Center for Aesthetic Plastic Surgery, board-certified plastic surgeon Dr. Steven H. Turkeltaub specializes in transgender breast (top) surgery that includes both female-to-male (FTM) and male-to-female (MTF) aesthetic procedures, helping his patients transition more completely.* Like we do for all of our patients, you are treated in a very professional, caring, helpful and supportive fashion throughout your entire contact with us.

During your consultation with Dr. Turkeltaub, he will seek to understand your unique goals and desires, and based on your anatomy will customize a treatment plan to help you achieve that life-changing transformation. However, before you can undergo the selected breast procedure, we do require written documentation by qualified mental health professionals of their assessment of your gender dysphoria including that you have met all criteria necessary to have the surgery and that they recommend that you can proceed with it. We do follow guidelines from the World Professional Association for Transgender Health (WPATH) Standards of Care.

*We do not offer genital reconstruction or plastic surgery transitioning procedures involving other areas.

Female–to-Male (FTM) Transgender Breast Surgery

Changing the female chest anatomy to a masculinized form in Female-to-Male transgender breast surgery involves the complete removal of breast tissue along with excess skin, nipple and areola modifications including changing of position and contouring of the chest wall as needed. This is most often accomplished either with a nipple sparing mastectomy (“keyhole”) or a subcutaneous mastectomy with a free nipple graft (“double incision”). Liposuction can also be used to further enhance the outcome. Other ancillary procedures, such as a peri-areolar mastopexy, may need to be done in addition in order to obtain the best results.

As with any surgical procedures, there are attendant risks that will be discussed at your consultation. With his extensive experience and meticulous technique, Dr. Turkeltaub will do whatever he can to prevent or minimize the chance of these issues occurring.

Female–to-Male (FTM) Transgender Breast Surgery Techniques

There are several different procedures and variations that can be considered in FTM breast surgery. Ultimately, a variety of factors including the initial breast size, presence and degree of drooping and skin laxity, size and location of the areola and chest wall contour will determine the best surgical course of action. All of these are typically performed under general anesthesia as an outpatient.

The following are the major options for FTM breast transformation:

  1. Nipple sparing mastectomy (“Keyhole”) – With this technique, a mastectomy (removal of the breast tissue) is performed through an incision involving the lower half of the areola, making the ultimate scar fairly inconspicuous. This is a good choice when the breasts are relatively small and there is good skin tone. If the areolas are large, they can be reduced at the same time by extending the incision around the whole areola and removing a donut of skin.
  2. Nipple sparing mastectomy with a periareolar mastopexy (“Concentric Circle”) – This is a variation of the previous technique and is used when there is also some excess skin present or noticeable skin laxity. It adds a circumareolar (periareolar) mastopexy which involves the excision of a ring of skin around the entire circumference of the areola in order to address the general skin laxity.
  3. Subcutaneous mastectomy with a free nipple graft (“Double incision”) – This technique is excellent for larger breasts, ones with substantial skin excess and when drooping is present. It involves a complete mastectomy in combination with the removal of a large ellipse of skin using an incision near the crease at the bottom of the breast. The nipple-areola complexes are removed and then replaced back in an appropriate location on the new breast as full thickness skin grafts.
  4. Inverted “T” – This is the same configuration as that performed for most breast reduction procedures, involving an incision around the areola then down to and along the crease at the lower part of the breast. With this technique, the nipple-areola complexes are usually removed and repositioned as full thickness skin grafts—like with the previous technique. This approach is not commonly used.

At the time of your consultation, the most realistic option(s) for your particular situation will be thoroughly discussed.

Female–to-Male (FTM) Transgender Breast Surgery Recovery

Following surgery, you will have a circumferential dressing on for a few days and then be placed in an elastic, snug, form-fitting garment. Drains, which are placed at the time of surgery, are usually removed in the office at one to two weeks.

You can expect discomfort to be mild to moderate and it is usually well controlled with oral analgesics. Most patients can return to school or a non-strenuous job within several days to a week. Very vigorous activities, heavy lifting, sports and straining need to be avoided for around four weeks after surgery though this is variable depending on the procedure and individual circumstances.

The transformational results of your FTM breast surgery can be seen immediately. However, it can take up to a year for you to see what the final results will be, as the swelling abates and the scars fade.

Male-to-Female (MTF) Transgender Breast Augmentation

The male-to-female transgender breast surgery is nearly the same as that a of regular breast augmentation. This involves the insertion of breast implants through a preselected incision that are placed in a “pocket” created either in front of or behind the pectoralis major muscle. A very gentle, careful, atraumatic technique is employed so as to help you obtain the desired results while also minimizing any postoperative discomfort.

Surgery is performed under general anesthesia which is administered by an anesthesiologist.

Breast Implant Choices

Dr. Turkeltaub offers you a vast number of breast implant options that can help you obtain the results that you desire. All these will be discussed thoroughly with you during your consultation. These choices involve implant size, shape (round versus anatomical), fill material (silicone versus saline), silicone gel cohesiveness/firmness and profile (relates to width versus projection ratio and can be moderate, high and ultra-high).

To learn more about these options, please visit our Breast Implants page.

MTF Breast Surgery Incision Options

As with a standard breast augmentation, those considering male to female breast augmentation surgery theoretically have three different options for incision placement through which the breast implants can be inserted. These are:

  1. Inframammary – The incision is made in the inframammary fold, the crease along the bottom of the breast. This approach allows for the most amount of flexibility, precision, control and visualization during surgery which can lead to superior and more predictable results. It is the most popular choice and the one that Dr. Turkeltaub usually recommends.
  2. Transaxillary – This incision is located in the armpit, the advantage of which is that it is not situated and seen on the breast. There are significant limitations and compromises with this approach including when considering larger silicone implants.
  3. Periareolar – Situated along the margin of the lower half of the areola, this incision often is very inconspicuous. However, it has many restrictions and disadvantages including limitations on its length especially when often dealing with relatively small areolas in the MTF transition population. Consequently, this makes it extremely difficult to impossible to insert silicone implants of any substantial size.

Implant Placement Location

Breast implants for the MTF breast augmentation can be placed either in front of the pectoralis chest wall muscle (pre-pectoral or submammary) or behind it (subpectoral or submammary). There are advantages and disadvantages of each approach so which one would be best for you will be thoroughly discussed at the time of your consultation.

Male-to-Female (MTF) Transgender Breast Augmentation Recovery

Following surgery, you will be placed in a soft but snug, contoured circumferential dressing that is removed in a few days. It is then replaced with a form-fitting bra which is worn day and night for one to two weeks. Thereafter, recommendations will be made based on your particular situation.

You will have a moderate amount of swelling, firmness and tightness for at least the first several days after which these symptoms will then slowly diminish. It can take six months to a year for the swelling to fully abate, the firmness to maximally improve and for you to be able to appreciate the long-term appearance of your breasts.

Working out, heavy lifting, sports and other vigorous activities must be avoided for three to four weeks following surgery. Most patients are able to return back to school and to non-strenuous jobs in about five to seven days.

The impact of your MTF breast augmentation on your appearance can be excitingly positive and transformative and can dramatically improve your happiness, confidence, self-esteem, social interactions and life in general.

Are You Interested in FTM or MTF Breast Surgery?

If you are seriously considering Female-to-Male or Male-to-Female breast surgery as an important part of your transitioning, Dr. Turkeltaub would be very happy to assist you in making this a reality. You can contact our practice either by phone at 480-451-3000 or online to schedule your consultation.

Dr. Turkeltaub’s offices in Scottsdale and Glendale are conveniently located near the following: