What is my best surgical FTM top surgery approach? (Photos)

Hello, I am pre testosterone and worried about the scaring provided I am able to get top surgery. I'm looking for something that will give minimal scarring, and the most natural looking chest. I've done some research and am interested in the peri-areolar / circumareolar technique and was wondering if I would be an alright candidate for it. (I am also anticipating my chest to change/morph a bit once I start taking testosterone and working out more)

Doctor Answers 6

Best Surgical FTM Top Surgery Approach

There are several methods used which depend upon the patient’s breast or chest #size before surgery. Considerations include the #laxity of skin, the #size of the #areola, the amount of #fat and recent weight #gain or weight #loss. The most common procedures which are described include the #periareola, #buttonhole, #double incision, and #anchor patterns. I often use #liposuction along with the double #incision for larger breasts, and, some variation for smaller breasts; depending upon the position of the areola. The female breast nipple and areola are often centered on the breast. However, the nipple and areola are lower and closer to the outside edge of the #pectoralis muscle in the male patient. Shaping the side of the chest may also be required and can be performed with #suctioning; along with contouring of the muscle, as noted above, to provide the best definition for the chest. Being each person varies, it’s important to be realistic about your goals and what is achievable. 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.

Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

FTM top surgery

A peri areola approach would not be the appropriate method for you.  A double incision is best.  However, if it makes you feel more comfortable you could stage the procedure. In other wards, do the peri areola approach, heal for 3-6 months and then tighten up whatever skin hasn't contracted.  Ultimately, if you chose the peri areola approach, you will most likely need additional surgery. 

Douglas M. Senderoff, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 32 reviews

FTM top surgery

Although there are many techniques for top surgery, it does have to be individualized to each person.  A double incision method will remove all excess skin and give a masculine contour to the chest.  

Josef Hadeed, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Candidate for peri-areolar technique

Honestly, at your current breast size, I don't think the periareolar method would do a very good job at making the masculine contour you want.  Although it has more scarring, the double-incision method would be more effective.

Thomas Fiala, MD
Orlando Plastic Surgeon
4.9 out of 5 stars 79 reviews

Best approach

Your breasts are of sufficient size that some skin will need to be removed. You do not have breast sag, so a double incision approach will leave scars that are high on your chest. A better approach is to use the comma technique, also called a lollipop technique.

Mastectomy for transgender men is a procedure that eliminates the breast by removing excess skin and most of the breast tissue. I utilize 5 different procedures and the procedure that is best for you will depend on your body size, your breast size, and the family history of breast cancer. We will make that determination during your consultation. This is a 3 hour outpatient procedure with a 14 day recovery off work, longer if you have a physical–type job. I recommend 4 weeks away from heavy pushing, pulling or lifting.  

We follow the standards of care for transgender healthcare established by WPATH. For gender confirmation surgery (non-genital), a single report from an experienced therapist is necessary. Our patient must be comfortable with the male lifestyle and have a recommendation from a Psychologist or similar licensed professional, demonstrating his commitment to the permanent physical alteration of his body with documented therapy. We also require a letter documenting hormone therapy if hormones are taken.

Sheldon Lincenberg, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 26 reviews

Best Procedure For Chest Masculinization

Hello and Thank you for your questions. I agree that less visible scars is a priority. In your specific case, the option of removing only excess breast gland and fat may result in loose excess skin. We would have to be very conservative and you may not end up with a completely flat chest. 

Skin removal procedure such as the double incision mastectomy, however, have the advantage of being able to remove ALL breast gland and fat, but also removing all excess skin. Your chest would be completely flat. The areolas and nipples are also reduced (areola diameter can cause a feminine aspect if it is not reduced). 

I hope that this answers your questions. 

Jaime Caloca, Jr., MD
Mexico Plastic Surgeon
5.0 out of 5 stars 8 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.