What type of top surgery do I have a chance at? (Photo)

Question

I was always a 36A, on the larger side of A, until this spring when I started birth control. Now I fill a B cup, and think I am a larger B. But this also doesn’t account for regular weight lifting and benching, etc. that comes with college sports. I don’t know how much pec muscle I’ve gained. From what I can tell I have good skin elasticity, but is it worth waiting until getting on T to make a decision? Ultimately I’d rather have Peri or keyhole if possible. I also have Grade 3 inverted nipples.

Jaime S. Schwartz, MD, FACS · Answer

Great question, and thank you for sharing your photos. In my practice, we require all transgender (and non-binary) clients who are considering a top surgery to have been on hormones for at least 18 months prior to their top surgery. The reason for this is that hormones alone may result in a decrease of breast tissue, increased body and facial hair, and other significant physical changes. The two major methods I use for this type of surgery are double incision mastectomy with nipple grafting and keyhole. Double incision mastectomy procedure is ideal for medium to large chested women. Keyhole (also known as peri-areolar) is ideal for a small chested woman, up to a b-sized chest, with good skin elasticity. 
    
Which method we choose for your 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. 
  
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 mastectomy, transgender top surgery, and aesthetic and restorative breast surgery. 
  
best of luck! 
  
Dr. Schwartz
  
Board Certified Plastic Surgeon
  
#RealSelf100Surgeon
  
#RealSelfCORESurgeon

Rukmini S. Rednam, MD, FACS · Answer

Hello izperry,Certainly the birth control can be a reasons why you have a larger cup size in addition to pectoral muscle mass.  Waiting 6-12 months after starting testosterone should show a decrease in breast size but the extent is not always predictable.The double incision approach often provides the most aesthetic male chest contour and allow repositioning of the areolas to a more masculine positioning. However using a keyhole or periareolar approach provides the option of retaining partial nipple sensation in some cases and vascularity but does require that some breast tissue remain to be successful.Make sure to seek out a board certified plastic surgery with experience in FTM top surgery who makes you feel comfortable and who can help you achieve your goals with transitioning journey.Best of Luck!Dr. Rednam

Harun Zekirovski, DO · Answer

I would definitely recommend starting testosterone first and waiting to see how your body changes. The hormones can potentially decrease the volume of your beasts and give you more surgical options. Right now, your volume may be too large for a periareolar procedure. My preferred procedure is the partial mastectomy with free nipple grafts. It places the scar in the most anatomical position and gives the best chest contour. The drawback is loss of nipple sensation. I recommend being on testosterone for at least a year and reevaluate the chest at that time. Good luck with your decision!

Jaime Caloca, Jr., MD · Answer

Hello and thank you for your photos. I recommend the double incision mastectomy that will enable us to remove all excess skin, fat and gland. The relocation of the areola and nipple complex to a masculine position is also an advantage of this procedure.

Babak Dadvand, MD · Answer

Hi,Thanks for the post and photos. With your current breast size double incision will need to be performed. Keyhole technique will leave you with excess skin in the lower part of the breasts. I recommend stopping the birth control and getting on testosterone. This may reduce your breast size to the point that you could be a candidate for keyhole surgery. Sincerely,Dr. Dadvand

Sheldon Lincenberg, MD · Answer

The keyhole approach will give you the best male contour and enhancement of the pectoral muscles. Good luck with your surgery.

Christopher J. Inglefield, MBBS, FRCS(Plast) · Answer

Hi there.  Thank you for your question and photos.  at your size now you would need a double incision procedure to achieve the optimum male chest shape.  Remember that the goals of surgery should be to remove all of the breast tissue to avoid the need to breast screening in the future and to create a natural male chest.  With regards to starting testosterone - you will lose some fullness of your breasts after 6 to 12 months, but may not be enough to make the periareola technique better.  Make sure you see a plastic surgeon who is experienced in FtM Top surgery to discuss all the options.  Good luck.

Karthik Ram, MRCS, DNB · Answer

Hello, thanks for sharing your pics.  Exercising doesnt change the breast size may be the birth control pills and weight gain has added volume. Testosterone definitely reduces the breast size and may take over 6 months of usage to attain results. Hopefully you can get away with periareolar mastectomy if the size comes down significantly.

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