Will my Chest Flatten During HRT(FtM)?

Question

I'm a 22 y/o Trans Man about to start Hormone therapy. I have (luckily) a little under a AA cup breast-size, will the HRT flatten them completely or will I have to worry about chest surgery eventually?

Raffy Karamanoukian, MD, FACS · Answer

The treatment of FTM scars is different than normal scar revision and is a focus of our office. There are at least seven different priorities in FTM Top surgery revision, including:
Reduction of High Tension Scar Widening
Revision of Areolar scar width, size, position, and texture.Pigmentation correction for the scar and areola (especially if there is areolar/nipple hypo pigmentation)Textural improvement in scarsContour Correction of the scarContour Correction of the glandular part of the male breast pectorisPectoral footprint reestablishment (concavity or convexity)Hyperemia correction of the scarsOur office specializes in the management of Top Surgery corrections using a Hidef combination approach that minimizes scar visibility and maximizes the footprint of a male pec. This can be achieved with a combination of surgery, RF, laser therapy, intralesional injections, PRP, and scar modulation. Sometimes, liposuction or fat grafting is indicated. 
Best, 
Dr. Karamanoukian
Realself Hall of Fame

Jed H. Horowitz, MD, FACS · Answer

Top Surgery is the #reduction and masculinization of the breasts and chest for a person who wants a more #masculine chest.  This is often an individual who desires #gender reassignment. Breast tissue is #removed and the #nipple position is usually made smaller and then placed in a more masculine #anatomic #position.  Top surgery allows for a more #comfortable chest with improved psychosocial benefits. Clothing fits better, physical activity may be easier. The chest can also be made more masculine with fat #grafting or #implants to provide a more muscular and #sculpted #appearance. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.Hormone therapy for top surgery is not required unless you’re seeking coverage through #insurance. Many companies will require one year of HRT (Hormone replacement therapy). The #benefits of HRT for every patient, however, do include heavier #chest #muscles and more chest #hair; which can cover some incisions while you are healing. #HRT may be a strong consideration for most patients. WPATH (World Professional Association for Transgender Health) provides the best current standards of care for physicians to assist in the care of #transgender, #transsexual and #nonconforming patients. It's best to consult with your board-certified plastic surgeon about your concerns and to confirm if FTM Top is in your best interests.

Jaime S. Schwartz, MD, FACS · Answer

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 sensationGiven your size, decreasing estrogen may shrink things even moreThe 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

Gary Lawton, MD, FACS · Answer

In very small breasts, T may be enough.  You will just have to see if your new chest is adequately flat to meet your expectations.

Douglas M. Senderoff, MD, FACS · Answer

Its important that you consult with a board certified plastic surgeon that specializes in this procedure.  If done correctly you should not need a second surgery.  Especially if your breast are as small as AA.

Sheldon Lincenberg, MD · Answer

Now that 5 months has gone by, you should see the results of the HRT on your breasts. At this point there will not be much more shrinkage of the breasts from the hormone therapy alone. If the hormone therapy had some effects on your breast size, it may have altered your breasts enough to do a keyhole or comma technique, which result in smaller scars. I hope that it helped you.

Josef Hadeed, MD, FACS · Answer

If your breast size is very small then it is possible that hormone therapy can flatten them to give you a masculine contour.  If it does not, then it would be possible to undergo surgical revision.

Babak Dadvand, MD · Answer

Hi Corin,Thanks for the post. The effects of hormone therapy on the breast is to reduce the fat content while at the same time increase the size of the pectoralis muscle, especially in conjuction with a weight training program. This may be enough given your small breast size. If the chest doesn't get flat enough for your liking then chest surgery will be necessary. Typically in very small breasted men, an incision on the lower half of the areola is all you need to achieve a flatter look.Sincerely,Dr. Dadvand

Will my Chest Flatten During HRT(FtM)?

Answers (8)

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