What's my Best Surgical Option for Gynecomastia/FTM Top Surgery? (photo)

Hello, I previously posted a question about laser liposuction and trying to figure out if it was possible to have surgery with a desired result using that method. I lost weight with the intentions of reducing the size of my chest and was successful going from what I think was a DD to maybe a C cup. I'm looking for something that will give minimal scarring, and little down time. Also, what common problems I might run into given my size and shape?

Doctor Answers 16

Top surgery with your anatomy will require skin-reducing mastectomies and nipple areola grafts.

Thanks for including photos, as they are critical in giving you advice specific to your anatomy. Keyhole (periareolar) incisions leave nearly imperceptible scars, so of course every trans patient would prefer essentially "invisible" scar mastectomies.

However, to create the most natural, normal male chest appearance requires the areolas be much smaller than your present areola size, the nipples themselves to be much smaller and less protruding, not to mention having the glandular tissue removed in a way that creates a masculine pec area without loose hanging skin.

Even after weight loss, your breasts still have excess skin and significant ptosis (droop), which would be retained if only the gland were removed via keyhole incision, whether this was done with lasers or any other method. So you therefore require skin-reducing mastectomies, nipple reduction, areolar reduction, and placement of your appropriately-sized nipple areola complexes as full thickness skin grafts in the normal masculine position (lower and more lateral than central and higher female nipple position).

This is a common F-M transgender operation that I have performed for over two decades, and would require about 4 hours of (outpatient) surgery, drains for a week to 10 days, skin graft dressings and care while the grafts become durable for about 3 weeks, and reduced strenuous activity for 3-4 weeks. Scars usually fade nicely after 6-12 months, and if situated correctly, simulate a natural Inferior pec line reasonably well. Someone your size may require touch-up surgery to minimize dog-ears laterally, but this is individual, and can usually be done (if needed) under a small local anesthesia office procedure.

For examples of some of my top surgery results, both skin-reducing and keyhole, click on the web reference link below. Best wishes! Dr. Tholen

Top surgery with your anatomy will require skin-reducing mastectomies and nipple areola grafts.

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Thanks for including photos, as they are critical in giving you advice specific to your anatomy. Keyhole (periareolar) incisions leave nearly imperceptible scars, so of course every trans patient would prefer essentially "invisible" scar mastectomies.

However, to create the most natural, normal male chest appearance requires the areolas be much smaller than your present areola size, the nipples themselves to be much smaller and less protruding, not to mention having the glandular tissue removed in a way that creates a masculine pec area without loose hanging skin.

Even after weight loss, your breasts still have excess skin and significant ptosis (droop), which would be retained if only the gland were removed via keyhole incision, whether this was done with lasers or any other method. So you therefore require skin-reducing mastectomies, nipple reduction, areolar reduction, and placement of your appropriately-sized nipple areola complexes as full thickness skin grafts in the normal masculine position (lower and more lateral than central and higher female nipple position).

This is a common F-M transgender operation that I have performed for over two decades, and would require about 4 hours of (outpatient) surgery, drains for a week to 10 days, skin graft dressings and care while the grafts become durable for about 3 weeks, and reduced strenuous activity for 3-4 weeks. Scars usually fade nicely after 6-12 months, and if situated correctly, simulate a natural Inferior pec line reasonably well. Someone your size may require touch-up surgery to minimize dog-ears laterally, but this is individual, and can usually be done (if needed) under a small local anesthesia office procedure.

For examples of some of my top surgery results, both skin-reducing and keyhole, click on the web reference link below. Best wishes! Dr. Tholen

What's my Best Surgical Option for Gynecomastia/FTM Top Surgery?

Looking at your photos, you would best be served with a more traditional Top surgery procedure that can address not only your breast tissue, but also the placement and size of your areolas.  This would be with a double incision mastectomy with free nipple graft.  Although this does have the scar along your chest wall, it is hidden in the shadow of the pectoralis muscle.  Your masculine hair growth can also help with hiding the scar.  

Unfortunately, a more minimal scar procedure like a keyhole incision around the areola is only useful for patient's that don't have too much breast tissue, have widened areolas on the chest wall, and don't have any sagging of the breasts.  The difference between a male chest and female chest is more than just size.  A male chest usually has a smaller areolar diameter (about 2.5cm) that is more widely spaced on the chest.  Also, the nipple is lower on the male breast as compared to a female's - it is usually located where the pectoralis major muscle meets the inframammary fold.  So, for most FTM Top surgeries, I recommend a double incision mastectomy with nipple graft.  This procedure addresses both the size of the breast and position of the nipples. 

What's my Best Surgical Option for Gynecomastia/FTM Top Surgery?

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Looking at your photos, you would best be served with a more traditional Top surgery procedure that can address not only your breast tissue, but also the placement and size of your areolas.  This would be with a double incision mastectomy with free nipple graft.  Although this does have the scar along your chest wall, it is hidden in the shadow of the pectoralis muscle.  Your masculine hair growth can also help with hiding the scar.  

Unfortunately, a more minimal scar procedure like a keyhole incision around the areola is only useful for patient's that don't have too much breast tissue, have widened areolas on the chest wall, and don't have any sagging of the breasts.  The difference between a male chest and female chest is more than just size.  A male chest usually has a smaller areolar diameter (about 2.5cm) that is more widely spaced on the chest.  Also, the nipple is lower on the male breast as compared to a female's - it is usually located where the pectoralis major muscle meets the inframammary fold.  So, for most FTM Top surgeries, I recommend a double incision mastectomy with nipple graft.  This procedure addresses both the size of the breast and position of the nipples. 

Best Technique Options for FTM Top Surgery

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.
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.

Best Technique Options for FTM Top Surgery

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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.
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.

FTM top surgery

For FTM patients with larger breasts, the "double incision" is really the best option.  Anything else simply won't give you a masculine chest contour, and will likely either leave you with extra skin, residual breast tissue, or both.  Although the double incision leaves a scar, the trade-off is a much better contour and the freedom to do away with a binder.  In order to get a qualified, expert opinion on your surgical options and expectations visit a plastic surgeon certified by the American Board of Plastic Surgery. Best of luck,
Keith M. Blechman, MD
New York, NY

FTM top surgery

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For FTM patients with larger breasts, the "double incision" is really the best option.  Anything else simply won't give you a masculine chest contour, and will likely either leave you with extra skin, residual breast tissue, or both.  Although the double incision leaves a scar, the trade-off is a much better contour and the freedom to do away with a binder.  In order to get a qualified, expert opinion on your surgical options and expectations visit a plastic surgeon certified by the American Board of Plastic Surgery. Best of luck,
Keith M. Blechman, MD
New York, NY

Mastectomy with nipple graft

In this case I would most likely suggest a mastectomy with nipple graft.  It should result in a this scar across the unser side of each breast and an incision around the aereola. Its discrete and effective way to give you the results you deesire. Its very important that you find a board certified plastic surgeon in your area that specializes in this procedure.  

Mastectomy with nipple graft

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In this case I would most likely suggest a mastectomy with nipple graft.  It should result in a this scar across the unser side of each breast and an incision around the aereola. Its discrete and effective way to give you the results you deesire. Its very important that you find a board certified plastic surgeon in your area that specializes in this procedure.  

Top Surgery

I appreciate your question.
Given your size, you would probably need double incision mastectomy and nipple/areola grafting.
Our office is set up to handle a lot of patients that travel in for surgery for our expertise.
We can help set up recovery facilities, hotels and make the experience wonderful for you.
Because of this you may even come by yourself.

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

Top Surgery

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I appreciate your question.
Given your size, you would probably need double incision mastectomy and nipple/areola grafting.
Our office is set up to handle a lot of patients that travel in for surgery for our expertise.
We can help set up recovery facilities, hotels and make the experience wonderful for you.
Because of this you may even come by yourself.

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

Double Mastectomy with Free Nipple Graft Technique

The procedure of choice is definitely a Mastectomy with the free nipple graft technique. I suggest that you consult an experienced surgeon in this type of surgery. Results can be very satisfying and permanent. 

Double Mastectomy with Free Nipple Graft Technique

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The procedure of choice is definitely a Mastectomy with the free nipple graft technique. I suggest that you consult an experienced surgeon in this type of surgery. Results can be very satisfying and permanent. 

Top surgery

By this time, I hope that you have completed your surgery and that your results are pleasing to you. My answer to your question is for current and future patients considering this surgery.

Whenever there are drooping breasts, the chest contouring will require removal of the extra skin and repositioning of the nipples up to where they should be at the lower edge of the pectoral muscles. To accomplish this, there will be sizable scars on the chest, although the scars are a fair trade-off for the greatly improved contour.

Top surgery

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By this time, I hope that you have completed your surgery and that your results are pleasing to you. My answer to your question is for current and future patients considering this surgery.

Whenever there are drooping breasts, the chest contouring will require removal of the extra skin and repositioning of the nipples up to where they should be at the lower edge of the pectoral muscles. To accomplish this, there will be sizable scars on the chest, although the scars are a fair trade-off for the greatly improved contour.

Best Surgical Option for Gynecomastia/FTM Top Surgery

Based on your photographs, you would require a procedure that would address not only the breast tissue but also the excess skin and the position of your areola.  This is typically performed through a double incision mastectomy with free nipple grafting.  A consultation with a board certified plastic surgeon who specializes in gender confirmation surgery can help you to understand what your options are.  

Best Surgical Option for Gynecomastia/FTM Top Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Based on your photographs, you would require a procedure that would address not only the breast tissue but also the excess skin and the position of your areola.  This is typically performed through a double incision mastectomy with free nipple grafting.  A consultation with a board certified plastic surgeon who specializes in gender confirmation surgery can help you to understand what your options are.  

FTM Top Surgery Options

Hi curiouspreop,

Thanks for the post and pics.  The only procedure you should even consider having is double incision top surgery, with mastectomy, free nipple/areolar graft, and skin excision. Any other "less invasive" surgery will leave you very unsatisfied.

Sincerely,

Dr. Dadvand

FTM Top Surgery Options

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Hi curiouspreop,

Thanks for the post and pics.  The only procedure you should even consider having is double incision top surgery, with mastectomy, free nipple/areolar graft, and skin excision. Any other "less invasive" surgery will leave you very unsatisfied.

Sincerely,

Dr. Dadvand

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.