Does Anybody Here Perform Breast REMOVAL Surgery (FTM)?

Doctor Answers 11

FTM "top surgery" for chest masculinization

Many plastic surgeons are also fully-trained general surgeons who had complete training in mastectomy for cancer, and therefore feel qualified to perform traditional mastectomies on transgender patients. Very few, however, have experience with specifics of  transgender mastectomies, nipple/areola reduction, and proper nipple placement for convincing chest masculinization, as shown in several examples if you search this site and others like

For example, inverted-T, anchor, or Wise-pattern mastectomies are not only unnecessary (even for large or pendulous breasts), they are decidedly feminine incision choices, especially when better choices exist to create a much more masculine chest.

Nipple design and placement is another common area of poor choice, as failure to recognize that the masculine nipple/areola complex is small (21-22mm in diameter), with a small, virtually non-protruding papilla, and is low and lateral in position (not higher and central, like female breasts). Take a look at any male model with his shirt off to confirm these "normal" anatomic landmarks, and then look at some of the photographic results some surgeons post. Scary.

Then there are the mastectomy flaps themselves, often thinner than the surrounding subcutaneous fatty layer, giving a dented, scooped, or shark-bite appearance to the chest. This is not necessary, and finding the exact breast gland-fatty layer interface is a surgical art unto itself, and critical to proper flap thickness, as well as complete (99+%) breast tissue removal. Leaving 10-20% of the female glandular breast tissue achieves what goal?

Too many patients request "keyhole" mastectomies (and too many improperly-motivated surgeons are eager to capitalize on these requests), which are suitable only for transmen with the smallest breasts. Otherwise, wrinkled, Shar-pei like skin remains, and is disfiguring as well are requiring more surgery to correct this deformity. Another related mistake is to try to maintain nipple/areola complexes on vascularized pedicles, which not only creates too-large areolas, too-protruding nipples, and malpositioned results, but also fails to retain sensation, which is another common "sales pitch." If the breast tissue is completely removed (which it should be), the sensory nerves to the nipples will be removed as well, and has nothing to do with "saving sensation" other than incomplete breast tissue removal. Free nipple grafts are necessary for optimum size, shape, configuration, and position, and will by necessity be numb. But with results that are masculine, not pseudo-feminine breast reduction.

I have been performing transgender surgery (non-genital) for over 2 1/2 decades, and have learned many of these things the "hard way," since I too was a fully-trained and American Board of Surgery-certified general surgeon before I completed plastic surgical fellowship and certification by the American Board of Plastic Surgery, both at the Mayo Clinic. In my 7 years there, I never saw or operated on one identified transgender patient--that came in my first year or two once I started in private practice in 1987.

The surgical results I saw then (and still unfortunately see frequently now) appalled me. Since then I have strived to study the normal male anatomy as a surgical goal, and how to best achieve it surgically for my FTM patients. I see one or two transgender patients each clinic day, and operate on one or two per week, so I have obtained a fair amount of experience from which to derive my observations and comments above. Many transmen will appreciate that these are accurate statements by their own astute observation of my and other surgeons' work.

Let me state with all humility that my work is not "perfect" either, and I have learned "the hard way" how to make my results consistently better. What you see in my own patient results over many years (click on the web reference link below for several examples--a few good, a few less than ideal, and truly a spectrum of my work) is how consistently striving for better outcomes for my transgender patients has influenced my work, and hopefully these words will do the same for a few of my colleagues and patients seeking superior outcomes. They ARE achievable. Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
5.0 out of 5 stars 196 reviews

Top Surgery

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

Breast removal surgery

Breast removal surgery for FTM gender confirmation lets the underlying male contours of the pectoral muscles display themselves. You should look for a board certified plastic surgeon who does this procedure regularly.

Sheldon Lincenberg, MD
Atlanta Plastic Surgeon
4.0 out of 5 stars 11 reviews

You might also like...

FTM Top Surgery

Hello! We perform Gender confirmation surgery in our practice. We actually perform several a week. 

Russell Sassani, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 21 reviews

Breast removal surgery

It is best to consult with a board certified plastic surgeon who specializes in gender confirmation surgery.  There are nuances of female to male breast surgery that differs from a standard mastectomy in females.  

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

FTM Top Surgery


Thanks for the post. Although many plastic surgeons perform breast surgery, not many plastic surgeons perform FTM top surgery routinely. This surgery is not an extreme breast reduction. There are certain attributes of a male chest that make it look masculine. That is the goal of FTM Top surgery, not just to remove the breasts, but to make the chest look more masculine.


Dr. Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 27 reviews

Best Plastic Surgeon for Transgender Breast Surgery

I am sure you will find many board certified plastic surgeons that to transgender surgery. The key is to find the most qualified. See the below link for suggestions.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 76 reviews

FTM surgery

Yes, this is a surgery which many plastic surgeons perform.  It is important to seek out a surgeon which has experience and sensitivity in addressing the needs of transgender patients.  Make sure you seek out a board certified plastic surgeon with significant breast and transgender FTM experience.  Best of luck.

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.


There are board certified plastic surgeons that specialize in double incision mastectomy for transgender patients.   

Yes, Female to Male Chest Surgery - Bay Area Aesthetic Surgery

Yes, I perform breast removal surgery. In some instances female to male chest surgery can be performed with retention of nipple sensation.  Other instances a free nipple graft needs to be used.  I will be more than happy to assist you to gain an aesthetic identity.

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.