Top surgery with or without hormone treatment?

Question

Hi, I'm an agender 18yo and I'd like to have a top surgery to 'remove' my breasts but I've never thought about hormone treatment (hormone replacement therapy?) beforehand (and I'm not sure I want/need it) Could you explain what hormonal treatment does and do you know the difference of a simple top surgery with this treatment beforehand and a top surgery without it? Like, what are the differences in the end? The results? Thank you

Jaime S. Schwartz, MD, FACS · Answer

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

Orna Fisher, MD · Answer

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.

Jed H. Horowitz, MD, FACS · Answer

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.

Babak Dadvand, MD · Answer

Hi The_alex,Thanks for the post. Most FTM patients who are transitioning start HRT to develop the secondary male traits, such as deeper voice, facial and body hair, as well as adding more bulk to their muscles. It also reduces the breast size to a variable degree. That being said, it is not mandatory to take HRT and definitely is not required to be on therapy to have TOP surgery. Sincerely,Dr. Dadvand

Emese Kalnoki, MD · Answer

Hello!  Testosterone therapy helps transgender men develop masculine features.  This includes more bulk in their muscles, deeper voices, a masculine hair pattern, and a more masculine physique.  The breasts also get smaller and more firm.  I prefer to do chest masculinization surgery on patients that have started testosterone because it gives a better aesthetic result.  The chest is usually more sculpted because the pectoralis muscle (chest muscle) is larger and more well defined.  Also, the hormone often helps to shrink the breast tissue and the removal is easier.  That being said, the surgery can be done if the patient is not on hormonal therapy.  The decision to start hormones is one that is up to you.  Hope this helps!

Sheldon Lincenberg, MD · Answer

The results of your top surgery are not affected by testosterone use. We do ask our patients to begin testosterone before surgery, nor do we ask our patients that take testosterone to stop their medication before surgery. Our endocrinologists agree with that approach.

Elliot W. Jacobs, MD · Answer

Top surgery to remove your breasts can actually be performed with or without hormonal treatment. Hormonal treatment (ie testosterone) will probably help to shrink your own breast tissue -- but it will not disappear.

Top surgery can be performed with minimal scar techniques if you are young and have an A or Bcup. If your breasts are larger or droopy, then you may require a double incision technique, which is a longer operation and has more scars.

Formore information, kindly refer to my website captioned below.

Good luck!

Elliot W.Jacobs, MD,FACS
New York City

Top surgery with or without hormone treatment?

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