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 5

Revision of top surgery

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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.

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

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"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

2 Months Post Op & Concerned About Needing a Revision

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It's usually suggested to wait 6 to 12 months depending on the reason for a #revision and it's still early in your healing. The ideal technique best for you is difficult to determine online by photos alone. 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 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. Your board-certified plastic surgeon will #confirm if you would actually benefit from a revision and the type best suited for your revision during an in-person evaluation.

FTM top surgery

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You are still swollen.  A revision should not be done until 6 months after surgery.  It looks like you are healing well and that you have a satisfactory result.  If you would like a revision in a few months Be sure to visit a board certified plastic surgeon who specializes in top surgery.

A revision can be done

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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.

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.