What's my Best Surgical Option for Gynecomastia/FTM Top Surgery? (photo)

Hello, I previously posted a question about laser liposuction and trying to figure out if it was possible to have surgery with a desired result using that method. I lost weight with the intentions of reducing the size of my chest and was successful going from what I think was a DD to maybe a C cup. I'm looking for something that will give minimal scarring, and little down time. Also, what common problems I might run into given my size and shape?

Doctor Answers 6

Double incision mastectomy

The best choice for FTM transition in this case would be double incision mastectomy with nipple graft.  You need to find a board certified plastic surgeon that specializes in the treatment of transgender patients to get the best results.

Have a question? Ask a doctor

Gynecomastia/Female to Male top surgery technique

Based on your photographs you need a procedure that addresses the skin envelope, the breast (or glandular tissue), and the nipple.  When assessing F to M patients (and those with gynecomastia) each of these elements needs to be evaluated and treated at the time of surgery.  Your goal is to achieve a male appearing breast with minimal to no extra skin and breast tissue with a nipple of appropriate size in the appropriate position.  While your goal is also to minimize scar, there is no way to address the skin excess and nipple size and position without a concomitant scar.   There is a therefore a trade-off between scar and breast shape.  A procedure using liposuction alone (laser or otherwise) would simply leave you with an empty, sagging breast with large nipples in the wrong place.  While liposuction alone can give reasonably good results even in some medium sized F to M patients, the presence of significant ptosis (sagging) eliminates this possible option.  You can still achieve a good result, but will have a bit more scarring than with the liposuction only approach.

Healing from this type of surgery should be reasonably quick.  Most patients would be able to return to work and most activities within 2 weeks.  Drains would remain in place, in most cases, for 5-10 days.  Patients are up and moving around almost immediately after surgery.   Revisions (usually dogears) are not that uncommon in this type of surgery and are generally done--at the earliest--about 6 months after the initial procedure.  Most revisions can be done under local anesthesia in an office setting.  Best of luck.

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

Top surgery with your anatomy will require skin-reducing mastectomies and nipple areola grafts.

Thanks for including photos, as they are critical in giving you advice specific to your anatomy. Keyhole (periareolar) incisions leave nearly imperceptible scars, so of course every trans patient would prefer essentially "invisible" scar mastectomies.

However, to create the most natural, normal male chest appearance requires the areolas be much smaller than your present areola size, the nipples themselves to be much smaller and less protruding, not to mention having the glandular tissue removed in a way that creates a masculine pec area without loose hanging skin.

Even after weight loss, your breasts still have excess skin and significant ptosis (droop), which would be retained if only the gland were removed via keyhole incision, whether this was done with lasers or any other method. So you therefore require skin-reducing mastectomies, nipple reduction, areolar reduction, and placement of your appropriately-sized nipple areola complexes as full thickness skin grafts in the normal masculine position (lower and more lateral than central and higher female nipple position).

This is a common F-M transgender operation that I have performed for over two decades, and would require about 4 hours of (outpatient) surgery, drains for a week to 10 days, skin graft dressings and care while the grafts become durable for about 3 weeks, and reduced strenuous activity for 3-4 weeks. Scars usually fade nicely after 6-12 months, and if situated correctly, simulate a natural Inferior pec line reasonably well. Someone your size may require touch-up surgery to minimize dog-ears laterally, but this is individual, and can usually be done (if needed) under a small local anesthesia office procedure.

For examples of some of my top surgery results, both skin-reducing and keyhole, click on the web reference link below. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 171 reviews

What's my Best Surgical Option for Gynecomastia/FTM Top Surgery? (photo)

The best option for female to male chest surgery in your case would be bilateral mastectomies with a free nipple graft.  The scar would consist of an incision along the length of the inframammary fold and a scar around the nipple areolar complex.  They typically heal very well.  Other options would be a keyhole incision technique, but would leave too much fulness post operatively leaving the appearance of a breast reduction rather than a flat chest more consistent with a male chest. 

TOP Surgery

You need mastectomy with Free Nipple grafts.  This will give you the best result.  You can have an (inframammary) breast incision. I would not recommend the inverted T incision.  

Ben Childers, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 6 reviews

Gynecomastia/FTM Top Surgery

I perform many gyneocomastia and FTM top surgeries. You have too much skin to give adequate contour with minimal scars, so you need bilateral mastectomies.  I excise breast skin and replace the nipple-areola as a graft. I do not perform a keyhole technique, because I believe the required scars are worse and the contour of the chest is inferior.  You would have drains for about six days but the procedure has only mild pain. You can exercise in a month.

Gary J. Alter, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 9 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.