I Am a Ftm Transsexual Interested in Top Surgery but I Do Not Want my Nipples Changed?

Is it possible to have top surgery without having the nipples removed, revised, or graphed on? I enjoy the sensation in my nipples and do not want to lose that. Or would a breast reduction be a better option? Basically I want a flat chest with my original nipples.

Doctor Answers 7

FTM "Top Surgery" chest masculinization without nipple-grafting

Yes, it is definitely possible to leave the nipples attached (as in a breast reduction, only a more "extreme" form of the same), in order to retain at least some sensation, especially if you are starting at a C/D-cup or smaller with a relatively minimal "drooping" effect.  I agree that healing after full-thickness nipple grafting is often unpredictable, with high potential for partial nipple loss, thickened scars, pigmentation irregularities, etc., which is why this alternative "nipple-sparing" technique (with the incisions closed in an "anchor"-pattern) was developed and refined.

Denver Plastic Surgeon
5.0 out of 5 stars 16 reviews

725 Heritage Road
Golden, CO 80401

FTM breast removal

The male chest contouring procedures all have one characteristic in common and that is the removal of the breast tissue underneath the nipple. Because this tissue contains the sensory nerves that go to the nipple, there is a substantial likelihood that you will lose sensation of the nipples. Preservation of this tissue in a breast reduction procedure is what maintains the nipple sensation in approximately 92% of women. 

I hope that this info helps.

Sheldon Lincenberg, MD
Atlanta Plastic Surgeon
4.0 out of 5 stars 10 reviews

One Glenlake Parkway
Atlanta, GA 30328


I appreciate your question.
The 2 major methods are double incision mastectomy with nipple grafting and keyhole.
It depends on the size of your breasts as to which method would be best for you and the ability to maintain nipple sensation

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

best of luck!

Dr Schwartz

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 24 reviews

421 N Rodeo Dr
Beverly Hills, CA 90210

Nipple grafting

It is difficult to offer an opinion without the benefit of photographs.  In general, if your breast size is small then it would be possible to leave the nipple attached, but if your breast size is large then nipple grafting would be performed in conjunction with a double incision mastectomy and give you the best cosmetic results.  

Josef Hadeed, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 6 reviews

8929 Wilshire Blvd
Beverly Hills, CA 90211

FTM Top Surgery Options

Hi aCreativeBoi,

Thanks for the post. To truly answer your question it would have been helpful to have a photo. That being said, men with smaller breasts (A-small B cup) and fair to good skin tone do well with procedures where the nipples are not removed. Typically a combination of liposuction and excision of excess breast tissue through an incision along the bottom half of the areola is performed.  The results are very good. Men with larger breast, droopy breasts, and excess skin will not do well with this procedure and will need the double incision Top surgery.


Dr. Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 21 reviews

9201 W. Sunset Blvd.
Los Angeles, CA 90069

FTM without nipple graft

Yes, this is possible, but it will limit the amount of flattening that you can get.  I have preserved nipples and sensation in some of my FTM transgender patients.  It tends to work better in patients who are on the heavier side, in whom a small amount of residual fullness is in line with the rest of their body dimensions.  Even with keeping the nipples vascularized, there is still a risk of sensation change.  Most of my FTM patients do opt for nipple grafting, however, as the goal of the flattest chest usually takes precedent over nipple sensation.

Best Regards,

Dr Deboni

The information above should not be considered a substitute for consultation with a board-certified plastic surgeon to address individual medical needs. Your particular facts and circumstances will determine the plastic surgery treatment which is most appropriate for you.

Anthony Deboni, MD
Syracuse Plastic Surgeon
4.5 out of 5 stars 15 reviews

5898 Bridge Street
East Syracuse, NY 13057

Cannot have both

A breast reduction with preservation of the nerves to the nipple will not result in the flat chest you are looking for.  The double incision mastectomy requires nipple grafting to ensure the flatness of the chest.  So you cannot unfortunately have both.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
5.0 out of 5 stars 46 reviews

525 Oak Centre Drive
San Antonio, TX 78258

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.