FTM: I'm a bigger transman and I want a flat chest, what surgery do I need to achieve this? (Photo)

Excellent question. Thank you for sharing your photo. 
In my practice, we understand that transgender patients are on a journey to aligning their physical body with their gender identity, and that the journey can be a long and sometimes difficult one. Some transgender men may consider a top surgery to help them feel more like their authentic selves. FTM top surgery (breast reduction) can provide you with the masculine looking chest that better represents your gender identity, reduce body dysmorphia, and result in better overall body confidence. But ultimately the decision will be yours. 

During your initial consultation, we determine based on your individual goals and desired body shape how to tailor your top surgery specifically to you. 
The two major methods I use for FTM top surgery are double incision mastectomy with nipple grafting and keyhole. Keyhole (also known as peri-areolar) is ideal for small chested transgender men, up to a b-sized chest, with good skin elasticity. Double incision mastectomy procedure is ideal for medium to large chested transgender men, such as yourself. During this procedure, the skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. (The muscle itself is not touched.) The skin is pulled back and the breast tissue is then removed. In both techniques, additional liposuction may be performed to adjust the contour of the chest, and the areola complex can be resized and made smaller and more oval for a more masculine appearance. 
Which method we choose for your top surgery will depend on the size of your breasts. But, rest assured, no matter how much breast tissue there is to remove, there is a surgery for you. Our goal is to help you feel comfortable, happy, and confident in your own skin. 

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

Board Certified Plastic Surgeon

#RealSelf100Surgeon

#RealSelfCORESurgeon

Top Surgery is the #reduction and masculinization of the breasts and chest for a person who wants a more #masculine chest.  This is often an individual who desires #gender reassignment. Breast tissue is #removed and the #nipple position is usually made smaller and then placed in a more masculine #anatomic #position.  Top surgery allows for a more #comfortable chest with improved psychosocial benefits. Clothing fits better, physical activity may be easier. The chest can also be made more masculine with fat #grafting or #implants to provide a more muscular and #sculpted #appearance. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

Hi transman101,Thanks for the post and photo. Refer to the link provided for a more detailed explanation but generally speaking, larger breasts will require double incision with free nipple grafts. Sincerely,Dr. Dadvand

If you have a large breast size, you will likely require a mastectomy with nipple grafting in order to masculinize the chest. 

The most important factor to consider is your choice for a surgeon.Your plastic surgeon must be familiar with mastectomy for gender transition as well as very experienced with performing this procedure in the heavier man. You do not want to end up with an overly flat chest.

Best of luck with your transition.  It appears that you have a sizable amount of breast tissue and skin that would require mastectomy and free nipple grafts.  In this situation, the scar is placed along the ideal inferior (bottom) border of the pectorals muscle, and then hockey sticked up along the sides of the chest wall.  This prevents developing a standing cone at the sides of the chest wall.  Sometimes it is addressing the sides of the chest that can be the more tricky.  

Usually, if your breasts are large or ptotic (droopy), you would require a formal double incision operation, which is basically a double mastectomy and then nipple reconstruction with a free nipple graft.You should carefully research your options for the right plastic surgeon to do your surgery.For further info, check out my website which provides details about surgery for trans men.Elliot W. Jacobs, MD, FACSNew York City

 Definitive advice would require in person evaluation, or at least viewing photographs, but most patients in your situation (starting with DD cup breasts) benefit from mastectomy as well as free nipple grafting.  Seek consultation with board-certified plastic surgeons who can demonstrate lots of experience achieving the types of outcomes you would be pleased with.  Best wishes.