I Am a Ftm Transsexual Interested in Top Surgery but I Do Not Want my Nipples Changed?

Is it possible to have top surgery without having the nipples removed, revised, or graphed on? I enjoy the sensation in my nipples and do not want to lose that. Or would a breast reduction be a better option? Basically I want a flat chest with my original nipples.

Doctor Answers 13

FTM "Top Surgery" chest masculinization without nipple-grafting

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Yes, it is definitely possible to leave the nipples attached (as in a breast reduction, only a more "extreme" form of the same), in order to retain at least some sensation, especially if you are starting at a C/D-cup or smaller with a relatively minimal "drooping" effect.  I agree that healing after full-thickness nipple grafting is often unpredictable, with high potential for partial nipple loss, thickened scars, pigmentation irregularities, etc., which is why this alternative "nipple-sparing" technique (with the incisions closed in an "anchor"-pattern) was developed and refined.

Transgender "top surgery" to preserve nipple sensation?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I agree with Dr. Lawton's answer. Properly-performed transgender mastectomies would remove 99% of your breast tissue, along with the sensory nerves to your nipples. To imply that some surgeons or techniques can preserve or "spare" sensation in reliable or "guaranteed" fashion is truly false, and frankly, disingenuous.

Breast reduction can preserve sensation in about 85% of patients, with more tissue removal reducing those odds. Breast reduction will NOT yield a "flat chest." Anchor-pattern breast reductions do NOT offer guaranteed sensory maintenance, and they do NOT yield a masculine-appearing chest (a "double whammy" IMHO).

Total mastectomies, nipple reduction, areola reduction, and reconstruction of the nipple/areola complexes as full-thickness skin grafts will give you the most masculine results, but will usually result in numb nipples permanently.

Some patients will recover some sensation in their grafted nipple/areola complexes, but this is neither normal nor erotic, but not totally numb either.

However, to state or imply that properly-performed transgender mastectomies COULD yield sensate nipples that retain erotic sensation (if only you were to find that particular surgeon) is plainly a lie designed to fool prospective patients into seeking that particular surgeon or "special" technique. Don't "fall" for this deplorable lapse of ethics. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

FTM Top Surgery While Not Altering the Nipples

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Yes, this is possible.  There are several methods used which depend upon the patient’s breast or chest #size before surgery. Considerations include the #laxity of skin, the #size of the #areola, the amount of #fat and recent weight #gain or weight #loss. The most common procedures which are described include the #periareola, #buttonhole, #double incision, and #anchor patterns. I often use #liposuction along with the double #incision for larger breasts, and, some variation for smaller breasts; depending upon the position of the areola. The female breast nipple and areola are often centered on the breast. However, the nipple and areola are lower and closer to the outside edge of the #pectoralis muscle in the male patient. Shaping the side of the chest may also be required and can be performed with #suctioning; along with contouring of the muscle, as noted above, to provide the best definition for the chest. 

Being each person varies, it’s important to be realistic about your goals and what is achievable. 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.

It's best to begin 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 116 reviews

In FTM top surgery can I keep my nipples how they are now?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You do not show any of your pictures in order to determine which operation you are a candidate for.  In general though, you cannot leave your nipples (areolas) surgically unchanged and still have an acceptable cosmetic outcome. Either FTM top surgery or breast reduction would both alter the nipple areolar complex  although in different ways.  Also of note, a breast reduction is not top surgery  many reasons.

A skin sparing nipple sparing mastectomy, as done for some cases of breast cancer, can be done if you are an A cup or small B. In that case, there is also still no way to guarantee sparing of the nerves for nipple sensation.  If you are a large B cup or larger  and you did this, your remaining breast skin would be deflated and unpredictably wrinkled and indented to your chest wall. 

I'm sorry, but there is no magic. Top surgery is done how it is for very specific reasons. If we could spare the nipples completely  and still have the desired cosmetic outcome, we would all do that.

Orna Fisher, MD
Palo Alto Plastic Surgeon
4.4 out of 5 stars 14 reviews

Preserving nipple sensation with FTM chest masculinization

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In general I agree with the other doctors that have posted.  I have a frank conversation with each patient as to what is realistically attainable.  Depending on the patients anatomy and amount of skin below the nipple a non cumbersome pedicle and be developed and sculpted to appear as pectoral muscle bulk.  For patients that do not derive significant pleasure from their nipples this is a wasted venture and adds complexity.  For those that strongly desire nipple sensation it can be very advantageous and no vertical scar is necessary.  Healing is quicker and more reliable than with free nipple grafts.  The technique has to be tweaked for the individual's body, chest wall and skin excess. Not all patients are reasonable candidates for sensate nipple FTM chest masculinization.  I hope this helps!

Rian A. Maercks M.D.

Nipple sparing top surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. In my experience, most trans men (like yourself) 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 and sensate. 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. Even with this technique there is no guarantee of maintenance of nipple sensation. With the standard double incision top surgery with free nipple grafts, the contour is usually superior, scar placement can be optimized into the inframammary crease only ( as opposed to the breast reduction 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

No promises!

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Any breast reduction technique whether the nipples are not relocated (rare) can alter sensation. No surgeon should promise the preservation of nipple sensation following breast surgery even if liposuction is the only approach used. You have to be willing to possibly diminish or lose sensation with Top surgery.

Michael S. Beckenstein, MD
Birmingham Plastic Surgeon
4.9 out of 5 stars 21 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I appreciate your question.
The 2 major methods are double incision mastectomy with nipple grafting and keyhole.
It depends on the size of your breasts as to which method would be best for you and the ability to maintain nipple sensation

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

FTM breast removal

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The male chest contouring procedures all have one characteristic in common and that is the removal of the breast tissue underneath the nipple. Because this tissue contains the sensory nerves that go to the nipple, there is a substantial likelihood that you will lose sensation of the nipples. Preservation of this tissue in a breast reduction procedure is what maintains the nipple sensation in approximately 92% of women. 

I hope that this info helps.

Sheldon Lincenberg, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 28 reviews

Nipple grafting

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It is difficult to offer an opinion without the benefit of photographs.  In general, if your breast size is small then it would be possible to leave the nipple attached, but if your breast size is large then nipple grafting would be performed in conjunction with a double incision mastectomy and give you the best cosmetic results.  

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