Female-to-male transition questions?

Alright. I am a young man trapped in a young woman's body, and I am likely going to start hormone therapy within the next month. Of course, I have the "breast problem". I currently have a 36 A breast size. Once I start hormones, is there any way to tell how much breast fat will transfer to the abdominal region? And how much surgery would be necessary in the future to get the remaining tissue out? The best estimate you can give would be very greatly appreciated.

Doctor Answers 5

Double incision mastectomy with nipple graft

Treatment with T may change the breasts to some degree, but the only way to achieve the look you are wanting is with double incision mastectomy with nipple graft.

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Female-to-male transition questions

Testosterone replacement therapy will not cause the transfer of fat to other areas of your body.  You have a smaller breast size, which makes the chest surgery easier.  The particular technique chosen will depend on the amount of breast tissue you have, the amount of excess skin, and the position of your areola.  A consultation with a board certified plastic surgeon who specializes in gender confirmation surgery can help you to understand what your options are.  

Josef Hadeed, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 4 reviews

FTM Top Surgery

Hi Alix,

Thanks for the post. Testosterone therapy will not transfer fat from your breast to the abdomen or any other area. What it may do is reduce the fatty content in the breast and increase the size of the pectoralis muscle.  As mentioned by my colleagues, you do not need to be on hormone therapy before or after top surgery.  The surgical technique best suited for you will be based on how much fat and breast tissue you have, how much excess skin you have, how good the skin tone is, and the position and size of your nipples/areolas. 

Sincerely,

Dr. Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 16 reviews

Female to male top surgery questions

The use of male hormones will change a number things, but is not likely to result in the "transfer" of fat from the breasts to the abdomen.   The male hormones will likely change your fat distribution and increase your muscle mass, but are not required prior to F-to-M top surgery.  The type of surgery required is highly dependent on your current breast size and shape.  You state that you're currently a 36A, which is favorable in terms of F-to-M top surgery.  As a general statement, the smaller the existing breasts, the more straightforward the surgery.  The surgery is designed not only to decrease the contents of the breast (fat and breast tissue), but also to address the skin envelope.   The position and size of the nipple also needs to be addressed in most cases.  The best way to answer your question is to arrange a consultation with a Board Certified Plastic Surgeon experienced with this type of surgery.  Best wishes.

Eric T. Emerson, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 20 reviews

Female to male transgender questions about top surgery.

Although you have small(er) breasts (36 A-cup), starting hormone therapy does not cause "transfer" of breast fat to any other area of your body. However, testosterone does cause some reduction of fatty tissues (breasts and elsewhere), strengthening of muscle and increase of muscle mass, hair growth, voice deepening, etc. You do not need to be on testosterone therapy to undergo "top surgery," but should have lived full time as a male for at least a year. Depending on the amount of breast tissue present at the time of transgender mastectomies, periareolar excision (scar only around the areola) of the breast tissue may be possible, though this would not be recommended if you have larger areolas, or large(r) amounts of breast tissue and skin that would require skin-reducing, areola-reducing, and nipple-reducing mastectomies.

For examples of each of these types of transgender mastectomies, click on the web reference link below. Seek ABPS-certified plastic surgeons who have performed transgender surgery for many years, as top surgery is not something that is taught as part of "standard" plastic surgical training, and requires experience with this subset of patients. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 181 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.