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

Question

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?

Richard H. Tholen, MD, FACS · Answer

"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

Jed H. Horowitz, MD, FACS · Answer

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.

Michael S. Beckenstein, MD · Answer

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.

Babak Dadvand, MD · Answer

Hi,Thanks for the post. Two months is still early in the healing process. That being said, your case highlights what i tell my patients regarding the goals of this surgery. This is not breast reduction surgery. This is chest masculinization surgery. There are many things that differentiate a masculine chest from a feminine chest and size is only one of them. Contour, nipple size, areolar size, areolar location with respect to the pectoralis muscle are but a few others. Contouring your chest to remove the excess tissue in the lower part of the chest is relatively straightforward but i would still wait until you are at least 6 months post op. The areola position may be less straightforward to address unfortunately.Sincerely,Dr. Dadvand

Douglas M. Senderoff, MD, FACS · Answer

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.

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

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Answer: TOP Surgery Revision

Answer: TOP Surgery Revision

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Everything you need to know about Masculinizing Top Surgery

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

Answers (6)

Answer: TOP Surgery Revision

Answer: TOP Surgery Revision

Answer: FTM top surgery

Answer: FTM top surgery

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Recommended reading

Everything you need to know about Masculinizing Top Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.