In regards to FTM top surgery, what would be some reasons a surgeon would opt for reduction rather than a full mastectomy?

*Given that the patient is healthy* I've just seen a couple doctors who opt for a reduction verses a full mastectomy and the results still look pretty great. I'm just curious as to the reasoning behind that since a reduction would still leave mammary glands behind. Although it still looks pretty good, that just doesn't seem like it would serve trans men or give the desired results. And how would that affect the chest's aesthetic with muscle development later on?

Doctor Answers 8

Breast Reduction Verses a Full Mastectomy for FTM Top Surgery

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#Mastectomy is usually the term used for addressing cancer disorders with the removal of the breast. However, such can be similar to #TOP surgery. TOP surgery generally converts a female breast to resemble a male's contoured chest. It 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.

FTM top surgery

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a breast Reduction and a FTM top surgery are two different procedures with different outcomes. Breast reduction reduces the size of the breast and top surgery removes all breast tissue to masculinize the chest.  Be sure that you choose a board certified plastic surgeon that specializes in FTM top surgery and works closely with the transgender community. 

FTM top surgery vs breast reduction

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A breast reduction will remove breast tissue in order to make the size of the breasts smaller.  In contrast, chest masculinization surgery will provide more masculine contours to the chest.

FTM Top Surgery

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Thanks for the post. It is really a very insightful question that you pose. I stress to my patients that this is not a breast reduction. This is chest masculinization. A masculine chest has very specific features that require certain techniques in the operating room. Just reducing the size of the breasts will not necessarily make it more masculine in appearance. You are absolutely correct that only performing a breast reduction will not give trans man the desired result he is seeking.

Dr. Dadvand

Find another surgeon

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Total lack of experience, lack of understanding of the community and the patient they are treating, lack of training skill and judgement.  This person should not be performing transsurgery.

Breast Reduction vs Mastectomy

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Thank you for your question. In my experience, most trans men want as tight and flat a chest as possible with as much definition to the pectoralis muscle as possible. This would not be able to be achieved with a breast reduction alone as there will still be a "pedicle" of breast tissue beneath the skin flaps that is necessary to keep the nipple areola complex alive. The reason to do the breast reduction method then becomes solely to maintain as much nipple sensitivity as possible for those trans men that postop maintenance of erotic sensation of the nipples is important. With the standard double incision top surgery with free nipple grafts, the contour will be superior, scar placement can be optimized into the inframammary crease only ( as opposed to the anchor configuration which is periareolar, vertical AND inframammary), and nipple placement can be achieved into a more masculine position further lateral on the pectoralis muscle. I hope this helps and best of luck with your transition!!

Russell Sassani, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 34 reviews

Reduction vs. mastectomy

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FtM mastectomy is a highly refined form of mastectomy since the end-appearance of the tissue removal assumes great importance. For example, in a cancer-related mastectomy the goal is to completely remove the cancer and as much surrounding breast tissue as possible without regard to the appearance of the breast. The breast reconstruction surgeon then is left with the challenge of recreating a breast, which often comes up short of expectations.
In contrast, the FtM mastectomy considers the male chest contouring as integral to the procedure. Breast removal preserves the proper amount of skin to cover the pectoral muscles and preserves a layer of fat/breast gland to give a smooth shape to the chest. This avoids a hollow or concave look to the chest. This layer is very important and should be balanced with the thickness of the fat layer next to the pectoral muscle on all sides. Because some breast tissue remains, lifelong surveillance for breast cancer is still recommended and some surgeons emphasize that fact by calling the procedure a breast reduction.

It is often semantics

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Reduction is a common term used to correct gynecomastia in men. Mastectomy is a "harsher" term implying removal of the female breast for cancer or other pathology. There is no discrimination here just an adjustment in terminology. I thought his out several years ago and it is really a subcutaneous mastectomy for Top FTM surgery.

You are correct that most of the breast tissue should be removed. One can never remove all of it but most is fine. The scar patterns and nipple relocation depends on the breast size and amount of skin present. Sometimes this can be performed through minimal incisions.

A good experienced surgeon who understands the breast and male chest should perform these procedures as the contour of the side of the chest is the difference between an improved female chest and a true male chest. Research and choose your surgeon wisely. He/she should be a board certified plastic surgeon who is experienced in breast reduction, reconstruction and gynecomastia surgery.

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.