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 5

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.

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 5 reviews

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.

Sincerely,

Dr. Dadvand

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

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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.

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.

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.