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Similarities and Differences Between FTM and FTN Top Surgery
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Female-to-male (FTM) and female-to-nonbinary (FTN) top surgery is a category of gender-affirming procedures that allows trans men and gender nonbinary individuals to achieve a chest appearance that best aligns with their gender identity. There is not just one procedure that can accomplish this.
There are a few procedures that are identical for both FTM and FTN top surgery. Customization can provide for some differentiation of the ultimate appearance, such as in nipple-areola (also referred to as just “nipple”) size and location. A few procedures are used exclusively in FTN top surgery based on patient desires.
In this blog, we’ll explore the similarities and some differences between the most common procedures selected for FTM and FTN. This is an overview and not a comprehensive exposé on the subject.
Understanding Goals of FTM and FTN Top Surgery
FTM and FTN top surgery are procedures designed to address gender dysphoria and create a chest that is more aligned with an individual’s sense of gender. Hence, they are gender-affirming procedures. However, the goals may be the same or different between the two gender groups.
Virtually all trans men are seeking a flat, masculinized chest with or without nipples. The vast majority of gender nonbinary individuals are also seeking a flat chest with or without nipples. However, for many of the latter, the size and location of the nipple-areola complexes may differ, though the basic procedure is the same.
Common Surgical Techniques for FTM and FTN Top Surgery
- Double Incision Mastectomy
- Most appropriate procedure for individuals with larger chests or with loss of skin elasticity.
- Can also be used in those with smaller breasts, depending on goals.
- Involves incisions across each side of the chest that provide for the removal of breast tissue and excess skin—and nipples when not desired.
- When nipples are desired, they are resized and repositioned through grafting to align with one’s gender ideal.
- Periareolar (Concentric Circle) Surgery
- Suitable for individuals with smaller chests and good skin elasticity.
- Uses an incision that goes around the areola, allowing for the removal of both breast tissue and a donut of skin in order to resize the areola.
- The nipple areola complex retains its blood supply, providing for a more predictable appearance.
- Involves minimal scarring around the areola, which is often barely discernable.
- Keyhole Technique
- Suitable for individuals with smaller chests and good skin elasticity.
- Uses an incision that goes around the lower half of the areola.
- Does not allow for direct reduction in size of the areola.
- The nipple areola complex retains its blood supply, providing for a more predictable appearance.
- Involves minimal scarring around the areola, which is often barely discernable.
Techniques Used Exclusively for FTN Top Surgery
Not all gender nonbinary individuals are seeking a flat chest. Some just want their breasts to be a lot smaller and do not desire a totally flat appearance. Others who are gender fluid or androgynous want some breast volume to allow them to have flexibility in appearance and have a chest that is more aligned with their sense of gender.
- Breast Reduction
- Removes some, but not all, of the breast tissue to create a reduced yet not completely flat chest.
- Most commonly sought sizes are an “A” or “B” cup.
- Some will even desire a “C” cup size, which meets their gender ideal.
- Considerations for preserving sensation versus free nipple graft.
- Customized and Miscellaneous Techniques
- May involve elements of a mastectomy and liposuction to achieve a nonbinary chest appearance.
- Allows for more personalized results to meet gender ideal, such as contouring without a fully flat chest.
Key Elements of FTM and FTN Top Surgery
The real differences between female-to-male and female-to-nonbinary top surgery are largely individual preferences, which should guide the surgeon and their technique.
| Feature | FTM Top Surgery | FTN Top Surgery |
| Goal | Masculine chest contour | Masculine chest contour
Androgynous or other nonbinary chest contour |
| Tissue Removal | “Complete” removal of breast tissue | “Complete” removal of breast tissue
Partial removal or reduction of tissue |
| Nipple Alterations | Usually resized to masculine size and repositioned to more masculine location when possible | Usually reduced in size either to a more masculine appearance or one that is less feminine
May be placed in a masculine location when possible, remain in present location or anywhere in between |
| Nipple Preservation | Nipple-areola complex preserved in vast majority of procedures | More likely to opt not to have nipples preserved as compared to FTM though a majority do want them replaced |
| Nipple Sensation | Rarely a concern | Uncommonly an issue that can affect procedure selected |
| Techniques Used | Double incision mastectomy with free nipple graft
Double incision mastectomy without nipples Periareolar (Concentric circle) Keyhole |
Double incision mastectomy with free nipple graft
Double incision mastectomy without nipples Periareolar (Concentric circle) Keyhole Breast reduction |
Recovery and Post-Surgical Care
Recovery from both FTM and FTN top surgeries are identical when the same procedures are performed. The specific procedure and personal characteristics will affect the postoperative course, restrictions and results.
The Choice Is Yours: FTM or FTN Top Surgery in Phoenix, AZ
Dr. Steven H. Turkeltaub is board certified by the American Board of Plastic Surgery. He has been providing plastic surgery services to his patients in Scottsdale, Phoenix and the rest of Arizona for 38 years.
If you are ready to pursue your gender-affirming top surgery and want to know what this all entails, including your options, you can schedule a very informative and thorough consultation with Dr. Turkeltaub either by calling us at (480) 451-3000 or by filling out our online contact form.