2 months post op from FTM top surgery. Looking for revising advice. Can I get what I want? (Photo)

I went to a board certified plastic surgeon who did a "breast reduction with recontouring for masculinization". I had no idea it was going to leave me with the mammary glands and also thought much more tissue would be removed. I'd like my nipples higher up because they aren't lined up with my pecs but I don't want to do grafting. Is it possible to get everything removed and my nipples moved up without detaching them or do I have to basically do a double incision with nipple grafts?

Doctor Answers 3

A revision can be done

it is still early in your post operative course and you should wait almost a year to allow all tissues to heal and the " final " result determined. At that time you and your surgeon can evaluate and discuss options. Removing residual breast tissue, excess skin is relatively east. The nipple positions should be more appropriate after that. Minor adjustments may be suggested.

Birmingham Plastic Surgeon
4.9 out of 5 stars 18 reviews

Revision of top surgery

Revisions take many forms and shapes. In your case, a pretty good operation was done to begin with and your revision will be relatively minor in scope.
Better definition of the lower edge of the pectoral muscles can be obtained by simply raising the same incision and removing the residual bulge of breast tissue on both sides. Nipple position is not perfect and could be improved, but will require adding other scars. Improved pectoral size and bulk can be achieved with fat grafts into these muscles.

I hope that htis helps you to move forward.

Sheldon Lincenberg, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 22 reviews

2 months post op from FTM top surgery. Looking for revising advice.

"What you want" is a masculine chest and all of your breast tissue (99+% at least) removed. You already have the scars of a "double incision" though it looks as if your surgeon used a modified inframammary crease incision to "reduce" your breasts. It looks as if your areolas have incisions around them (reduced in size), but your papillae (actual nipples) are still large and feminine in appearance. Areola position on your chest wall is suboptimal, but you probably don't really want them "higher" (you can't have them "moved up" without grafting), but you may want your incisions closer to your areolas to better simulate a lower pec "edge." Proper NAC position for a male is lateral and near the inferior edge of the pecs, NOT central and "up."

I'll bet your surgeon "sold" you on the idea that leaving some of your own breast tissue and not grafting your nipples would "preserve sensation." Perhaps your surgeon is inexperienced in transgender surgery, or has some misguided (IMHO) ideas.

Properly performed, complete (99%, as some microscopic bits remain on the skin flaps) removal of breast tissue is carried out with transgender mastectomy ("top surgery"), and sensation is almost always absent as a result. Anchor skin patterns, too-large nipples or areolas, and NAC (nipple-areola complex) malposition are hallmarks of inexperienced transgender mastectomies, as this is NOT a female breast reduction  "with recontouring for masculinization." The words sound good, but the surgery as performed is inadequate.

Please click on the web reference link below for some of my patient examples that show what I believe is a better surgical plan of action. You already have the scars, so revision is always possible, but may be limited by those scars and their positions. Removal of the residual breast tissue is indeed possible; it is unfortunate this was not done at the initial operation--there is no reason to have left residual glandular tissue (except for a disc beneath the NACs if this had been keyhole mastectomies, which you obviously did not have). I am perplexed by your surgeon's technique. Sorry, but I share your dismay. Best wishes for improved results elsewhere. Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 238 reviews

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