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 14

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

Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

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

Keith M. Blechman, MD
New York Plastic Surgeon
5.0 out of 5 stars 18 reviews

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.  

Douglas M. Senderoff, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 32 reviews

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

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 91 reviews

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. 

Jaime Caloca, Jr., MD
Mexico Plastic Surgeon
5.0 out of 5 stars 8 reviews

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.

Sheldon Lincenberg, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 26 reviews

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.  

Josef Hadeed, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

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.


Dr. Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 44 reviews

FTM Breast Reduction

Although an exam would be needed your photos indicate that both skin reduction using a minimal scar technique and free nipple grafting is probably your best option. See below link on hint on selecting your surgeon

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Double incision mastectomy

The best choice for FTM transition in this case would be double incision mastectomy with nipple graft.  You need to find a board certified plastic surgeon that specializes in the treatment of transgender patients to get the best results.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 135 reviews

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.