What Should You Know Before FTM Transgender Breast Surgery?

Female to male (FTM) top surgery is the most common gender-affirming procedure sought by those with gender dysphoria as well as by those individuals who just want to feel and look more masculine. This is truly a life-changing procedure that can provide emotional and intellectual relief and comfort, aligning one’s felt gender to one’s external anatomy.

The same is true for those individuals who identify as non-binary, transforming a feminine appearing chest to one that no longer is. Similar to FTM top surgery, this procedure provides physical alignment to one’s identified gender as well as major psychological benefits.

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Top surgery, medically known as a mastectomy, involves the removal of breast tissue along with the skin (when appropriate) and contouring procedures as needed in order to transform the chest to one that is not female in appearance. There are a few different techniques available that provide for individualized customization in order to obtain the desired results.

Let’s review some of the information and considerations as relates to this surgery.

Are You a Candidate?

Dr. Turkeltaub follows the guidelines provided by the World Professional Association for Transgender Health (WPATH). WPATH is dedicated to educating providers and ensuring that patients receive the safest and highest standard of care.

Before proceeding with FTM top surgery, you must provide at least one letter from a qualified mental health professional clearly substantiating your transgender status, supporting your desire to undergo the procedure and affirming that you are emotionally prepared for the physical transformation. If you are seeking insurance coverage, most insurance companies require two letters as well as that you are at least 18 years of age. Proceeding with top surgery for those with gender dysphoria and who are younger than age 18 will be made on an individual basis.

How Should You Prepare for Top Surgery?

For those individuals taking testosterone, it needs to be discontinued starting from one month prior to your surgery date until around two to three weeks postoperatively. The reason for this is to reduce the risk of postoperative bleeding which the testosterone has been associated with. Bleeding and the formation of a hematoma are already increased risks with top surgery.

If you smoke—cigarettes, marijuana, vaping, cigars, etc.—they must be stopped at least one month before surgery. The reason for this is that they will inhibit blood flow to the surgical sites which will increase the risk for such complications as skin necrosis (death) including the nipple-areola complex, delayed wound healing, greater scarring, and infection. Even just one cigarette can lead to these problems so if you cheat even once – your body may not be fooled and you can pay a high price for that indiscretion.

Alcohol can also increase the risk of bleeding so it should also be avoided starting from at least ten days prior to surgery until ten days after it. In addition, you should avoid drinking alcohol if you still are taking narcotic pain medication.

Prior to your top surgery, you will also be provided with explicit instructions and guidelines on a variety of items. If at any time you have questions, you are strongly encouraged to contact the office.

What Are Your Incision Options?

FTM top surgery involves the removal of breast tissue along with skin and fat as indicated. The procedure that would be best for you will be determined at the time of your consultation and is based on a variety of factors.

Double Incision

The double incision-free nipple graft approach is the most commonly employed technique. Generally, it is well suited for those who are a “C” cup or larger, those with poor skin elasticity as well as skin drooping. It entails the removal of both breast tissue and skin as well as the removal and repositioning of the nipple-areola complex as a full-thickness skin graft.

Keyhole

The keyhole technique is a common FTM top surgery option for those individuals with relatively small breasts, such as in the “A” and “B” cup range, and with good tissue elasticity. It utilizes an incision situated along the lower border of the areola. No skin is removed nor is the nipple-areola complex removed or repositioned.

Concentric Circle

The concentric circle approach is the keyhole incision technique to which has been added skin removal in order to address the excess skin. It entails placing two concentric incisions around the areola and resecting the intervening skin.

Liposuction

Although liposuction cannot be performed on its own as a top surgery technique, it can be a useful and needed addition to one of the above incision options. Liposuction will remove excess fat from the chest and help to sculpt a more masculine chest contour.

What Will Your Recovery Entail?

Pain

Most patients experience mild to moderate discomfort following their procedure that can last from a few days to a week or more. The initial surgical dressing and the later compression garment can help reduce discomfort. Analgesics prescribed are usually quite effective in addressing the discomfort.

Scarring

The specific technique used for your top surgery will directly affect the overall length and appearance of the scars. These will also be affected by individual factors including genetics, health, compliance, activities, sun exposure and diligence in the usage of scar mitigating agents after surgery.

Results

The general results from your top surgery are evident immediately but will become even more apparent and refined with time as swelling resolves and scars mature. It can take a year for you to appreciate the more long term results.

It is still essential that you practice self-breast examinations and receive regular breast screenings. This procedure does not eliminate the possibility of breast cancer.

Female to male (or non-binary) top surgery is truly a life-changing procedure and one that our patients have been unanimously happy with. The physical transformation is obvious, gender affirming and appreciated. Perhaps even more satisfying have been the profoundly positive effects on confidence, happiness, self-esteem, and overall sense of normality.

To learn more about FTM breast surgery, contact Dr. Turkeltaub at the Arizona Center for Breast Surgery by calling (480) 451-3000 or by filling out our online contact form.