Post FTM chest surgery, what are the options now to achieve a raised nipple?

hello samsmithsr Nipple Augmentation
For women who have very flat nipples, augmentation can enhance
projection. This is a simple procedure that can be performed with a
filler such as fat or an HA such as Juvéderm® or similar. Other implants
including cartilage or synthetic products can also be used. #areola #options

Dermal or cartilage grafting beneath your existing grafted areola can create a small papilla, though the vast majority of my F-M transmen have not requested this. I usually try to leave a slightly greater amount of papilla dermis on my skin graft centers to give some protrusion, though trying for too much leaves a higher potential for losing this part of the skin graft, as the tissue has to survive by osmotic imbibition for the first few days, and composite grafts have a higher dead tissue rate.Secondarily grafting bits of dermis or cartilage can provide the protrusion you desire, as long as you are not hoping for too much! Best wishes! Dr. Tholen

Hi,Thanks for the post. It is not unusual to at least some projection of the nipple after free grafting. Options to increase projection are fillers, grafts (either dermal, fat, cartilage). Flaps tend not to work because the areola is a free graft as well. Another option is 3D tattooing which gives the look of a nipple without the actual three dimensionality.Sincerely,Dr. Dadvand

Thanks for the question.  A photo would help with this, but there are many options out there.  One would be some fat transfer, where you liposuction fat from somewhere and inject some under the areola to prop it up.  The actual nipple could be augmented with fat, filler, or even cartilage depending on how much you wanted.  The nipple loses its ability to firm up and get erect after a free nipple graft so that function will likely never come back.  Talk with your surgeon to see what their recommendation is.  Good Luck"The above answer has been given without seeing this patient and cannot be substituted for actual in-person examination and medical advice; it is only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

There are a few options available that may help you obtain projection of your nipples following FTM breast surgery with free nipple grafts. These include using dermal fillers, cartilage grafts, fat injections, 3D tattooing (gives the effect without true 3 dimensionality) and flap techniques.Steven Turkeltaub, MDScottsdale, AZ

It may be possible to achieve more projection to the nipple by either dermal fillers, fat injections, or cartilage grafting. 

The erectile tissue of the nipple is generally removed during the Top surgery so that the nipple/areolar graft has greater success of survival. Most methods of restoring nipple height (injectable filler, cartilage graft, nipple flaps) have limited success. The appearance of nipple height can be achieved with 3D tattooing.

FTM masculinization surgery usually is done with bilateral mastectomies with free nipple grafts.  A free nipple graft involves removing the nipple and areola from its original position on the breast and moving it to a new area on the chest wall.  When this is done, the nipple/areola graft has to obtain a blood supply so that it can retain its color and the nipple can have some projection.  If the nipple has lost that because of the transfer, then a few things can be done to try to help give it back its volume.  Fillers (like a hyaluronic acid) may give some bulk to the area, but they are not permanent.  If, however, the fillers give the projection you desire, you can try a more permanent filler like your own fat.  Other materials, like cartilage, may be too stiff and may resorb with time.  There is, unfortunately, no great fix to this problem.  Talk to your plastic surgeon about your options.  Good luck!