Female-to-male transition questions?

Alright. I am a young man trapped in a young woman's body, and I am likely going to start hormone therapy within the next month. Of course, I have the "breast problem". I currently have a 36 A breast size. Once I start hormones, is there any way to tell how much breast fat will transfer to the abdominal region? And how much surgery would be necessary in the future to get the remaining tissue out? The best estimate you can give would be very greatly appreciated.

Doctor Answers 8

FTM surgery

Amongst transitioning men, you are in an envious position because you are starting with small breasts. A photo of your chest would help to refine my answer, but in general you may be a good candidate for a short scar technique. This would be either the shaving technique designed originally in Brasil which leaves no scars, the periareolar technique with a scar around the areola, or the comma technique with a scar that  curves downward from the areola. 

I hope that your transition goes smoothly.

Atlanta Plastic Surgeon
4.7 out of 5 stars 26 reviews

Double incision mastectomy with nipple graft

Treatment with T may change the breasts to some degree, but the only way to achieve the look you are wanting is with double incision mastectomy with nipple graft.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 136 reviews

FTM Top Surgery and the Costs

Depending on the Top Surgery procedure and surgeon you choose, the #cost for your Top Surgery will vary. Typically, but not always, the #Keyhole and #Periareolar Top Surgery procedures are less expensive than the #Double Incision method, by as much as $2,000.00 USD. In general, the cost of FTM Top Surgery ranges from $3,500.00 - $9,000.00 USD. This may or may not include consultation fees. A down payment is usually #required to secure a surgery date. The amount of this down payment varies by surgeon but usually ranges between $500.00 - $2,000.00 and up to 50% of the total Top Surgery cost.

Often there are #hidden fees in addition to the surgeon's fees. Such as the Anesthesiologist's fee, potentially facility fees, pathology fees and other medical test fees. It is important to gather all the cost information for Top Surgery from all of the surgeons you consult with. Additionally, you will also incur post-operative costs such as a medical compression vest, medications, paper tape, gauze, scar care and more.
It's best to begin by seeking a plastic surgeon with #board #certification and experience in this type of procedure. You should feel comfortable with your surgeon and his or her office staff. They should be open-minded regarding gender surgery. It’s important for your surgeon to have an aesthetic eye for body contouring, you should be comfortable with the surgical facility that your doctor uses and it should be certified.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Top Surgery

I appreciate your question.
Given your size, you would probably do great with the keyhole procedure that limits the scar.
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

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 93 reviews

Female-to-male transition questions

Testosterone replacement therapy will not cause the transfer of fat to other areas of your body.  You have a smaller breast size, which makes the chest surgery easier.  The particular technique chosen will depend on the amount of breast tissue you have, the amount of excess skin, and the position of your areola.  A consultation with a board certified plastic surgeon who specializes in gender confirmation surgery can help you to understand what your options are.  

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

FTM Top Surgery

Hi Alix,

Thanks for the post. Testosterone therapy will not transfer fat from your breast to the abdomen or any other area. What it may do is reduce the fatty content in the breast and increase the size of the pectoralis muscle.  As mentioned by my colleagues, you do not need to be on hormone therapy before or after top surgery.  The surgical technique best suited for you will be based on how much fat and breast tissue you have, how much excess skin you have, how good the skin tone is, and the position and size of your nipples/areolas. 


Dr. Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 46 reviews

Female to male top surgery questions

The use of male hormones will change a number things, but is not likely to result in the "transfer" of fat from the breasts to the abdomen.   The male hormones will likely change your fat distribution and increase your muscle mass, but are not required prior to F-to-M top surgery.  The type of surgery required is highly dependent on your current breast size and shape.  You state that you're currently a 36A, which is favorable in terms of F-to-M top surgery.  As a general statement, the smaller the existing breasts, the more straightforward the surgery.  The surgery is designed not only to decrease the contents of the breast (fat and breast tissue), but also to address the skin envelope.   The position and size of the nipple also needs to be addressed in most cases.  The best way to answer your question is to arrange a consultation with a Board Certified Plastic Surgeon experienced with this type of surgery.  Best wishes.

Eric T. Emerson, MD, FACS
Charlotte Plastic Surgeon
4.7 out of 5 stars 28 reviews

Female to male transgender questions about top surgery.

Although you have small(er) breasts (36 A-cup), starting hormone therapy does not cause "transfer" of breast fat to any other area of your body. However, testosterone does cause some reduction of fatty tissues (breasts and elsewhere), strengthening of muscle and increase of muscle mass, hair growth, voice deepening, etc. You do not need to be on testosterone therapy to undergo "top surgery," but should have lived full time as a male for at least a year. Depending on the amount of breast tissue present at the time of transgender mastectomies, periareolar excision (scar only around the areola) of the breast tissue may be possible, though this would not be recommended if you have larger areolas, or large(r) amounts of breast tissue and skin that would require skin-reducing, areola-reducing, and nipple-reducing mastectomies.

For examples of each of these types of transgender mastectomies, click on the web reference link below. Seek ABPS-certified plastic surgeons who have performed transgender surgery for many years, as top surgery is not something that is taught as part of "standard" plastic surgical training, and requires experience with this subset of patients. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 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.