Which FTM top surgery options would work for me? (Photos)

Question

I'm a non-binary (afab) looking to get top surgery as my next step. I'm not super interested in keeping my nipples or nipple sensation. I'm not against keeping them either. But my main goals are a flat, tight chest and the least amount of recovery time necessary. I'm pretty small (B cup) and have never done chest binding. I am not on T and don't plan on it. Based on the attached photos should I be considering peri-areolar or double incision? (I'm guessing I'm too big for keyhole)

Richard H. Tholen, MD, FACS · Answer

Your breasts are small, but not small enough for periareolar (keyhole) surgery to work; plus, your areolas (and nipples) are too large. Removal of the nipple/areola complexes and "just going without" will leave your chest looking abnormal-enough that you will likely be self-conscious about your appearance, limiting your ability to ever remove your shirt, wear swim trunks without a t-shirt, or feel comfortable in a locker room. Trust me on this! Keep your parts, just reduce the nipple and areola sizes and ensure they are grafted to an appropriate masculine position.

Sure, you will have scars, but if your surgeon skillfully places them to mimic your pec creases rather than slope down like a mastectomy scar, they can be pretty acceptable once they fade. It's taken me many years to learn how to minimize dog ears and poorly-positioned scars, but if you look at my website's before and after photographs (or those here on RealSelf), you can see how my results stack up against other surgeons performing this surgery. I state this not to "brag" but to support my recommendation.

This surgical procedure (transgender mastectomies) is NOT being taught in most plastic surgical programs, and top surgery is NOT the same as mastectomies taught in our general surgery programs for cancer surgery, nor is this a "mega" breast reduction/lift. Female scar patterns are as bad as transmen being described by "she" or "her."

Your anatomy requires skin reduction (double-incision) total mastectomies, proper scar position and orientation along your lower pec borders, avoidance of dog ears, as well as nipple and areola reductions and placement of your masculine-sized nipple areola complexes in masculine position. Anything else will land you a place on the "disasters of top surgery" page, and require re-do surgery. Best wishes! Dr. Tholen

Mario Arturo Moran Romero, MD · Answer

In your case, I would recommend a double incision mastectomy with free nipple-areola complex (NAC) grafts. This approach allows us to achieve a flat, masculine chest contour and gives us excellent control over nipple size, shape, and position &mdash; which is really important for a natural result.I would also suggest adding some fat grafting to the pectoral muscle area. This doesn’t add bulk but helps create a softer, more aesthetic transition and enhances the overall shape of the chest.Regarding sensation &mdash; it’s important to know that with free nipple grafts, most patients will lose some or all sensation in the nipple area initially. However, nerve regrowth can happen over time, and some patients recover light or protective sensation.There are also newer techniques we can use during surgery to attempt nerve reconnection (called nipple reinnervation). While this is still considered experimental and results vary from patient to patient, it's an exciting area of development in top surgery. Many of us are actively using these techniques to improve long-term sensation, with encouraging early results

Krishna Vyas, MD, PhD, MHS · Answer

If your primary goal is achieving a flat, more masculine chest, the double incision technique would likely be the best option for you. This procedure allows for significant skin and tissue removal, providing a smooth, tight chest contour. The decision to keep or remove the nipple and areola is a personal one and should be based on your goals and preferences.

It's crucial to consult with a skilled gender-affirming plastic surgeon who can assess your unique anatomy and customize the surgery to achieve the best possible results. During your consultation, be sure to discuss your specific goals, inquire about the surgeon's experience, and explore various surgical options, including incisions, liposuction, and nipple reinnervation if desired.

Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained 
Aesthetic Plastic Surgeon
New York, New York

Jaime Caloca, Jr., MD · Answer

A Double Incision Mastectomy is best. You can have the nipples reconstructed or removed. Beautiful and predictable flat chest is definitely possible with the Double incision technique, guaranteed.

Irena Karanetz, MD · Answer

Hello, 
And thank you for the question.
Based on your photos you are a good candidate for Double Incision Top Surgery, which is recommended for patients with medium to large size breasts. During this procedure, the breast tissue is removed through the incision at the breast fold and the second incision ends up being around the nipple, because the nipples are removed, re-sized and then grafted on the chest, in order to create a masculine chest.
Additional liposuction may be performed to provide a more masculine contour and definition, and help prevent Dog Ears, however, there is usual additional cosmetic cost for it.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Transgender Top surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
I hope this helps.Good luck!
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Which FTM top surgery options would work for me? (Photos)

Answers (8)

Answer: Double Incision is Best

Answer: Double Incision is Best

Answer: Which FTM top surgery options would work for me?

Answer: Which FTM top surgery options would work for me?

Recommended reading

Everything you need to know about Masculinizing Top Surgery

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Which FTM top surgery options would work for me? (Photos)

Answers (8)

Answer: Double Incision is Best

Answer: Double Incision is Best

Answer: Which FTM top surgery options would work for me?

Answer: Which FTM top surgery options would work for me?

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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.