Top surgery with or without hormone treatment?

Excellent question.
In my practice, I require 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. Keep in mind, the decrease in estrogen will shrink your breasts, but ultimately you may still need surgery to achieve your desired results.   

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. In both techniques, additional liposuction may be performed to adjust the contour of the chest.  

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

Hi, while testosterone treatment does not necessarily greatly shrink breast tissue, it is helpful for general shape due to its effect on fat, muscle mass, and hair growth. Testosterone causes masculinization of features, so it is beneficial if that is the goal you are trying to achieve in your gender affirmation journey. 
That being said, plastic surgeons who do this work are guided by the world organization recommendations. As such, most will require you to be on testosterone as part of your transition prior to having a permanent surgical modification to your body. A great deal depends on your particular circumstances which are discussed in detail at your consultation. 
You must see a board-certified plastic surgeon experienced in these procedures for a specific evaluation of what is appropriate for your particular situation. 

Hormone therapy for top surgery is not required unless you’re seeking coverage through #insurance. Many companies will require one year of HRT (Hormone replacement therapy). The #benefits of HRT for every patient, however, do include heavier #chest #muscles and more chest #hair; which can cover some incisions while you are healing. #HRT may be a strong consideration for most patients. WPATH (World Professional Association for Transgender Health) provides the best current standards of care for physicians to assist in the care of #transgender, #transsexual and #nonconforming patients.