I’m starting testosterone soon, will I need top surgery?

Question

I’m only an A cup, I can wear a sports bra and be flat chested, so would I need to have top surgery?

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.
In my practice, I require transgender (and non-binary) clients who are considering a top surgery to have been on hormones for at least 18 months prior to their top surgery. The reason for this is that hormones alone may result in a decrease of breast tissue, increased body and facial hair, and other significant physical changes. Keep in mind, the decrease in estrogen will shrink your breasts, but ultimately you may still need surgery to achieve your desired results.   The two major methods I use for FTM top surgery are double incision mastectomy with nipple grafting and keyhole. Keyhole (also known as peri-areolar) is ideal for small chested transgender men, up to a b-sized chest, with good skin elasticity. Double incision mastectomy procedure is ideal for medium to large chested transgender men. In both techniques, additional liposuction may be performed to adjust the contour of the chest.  
  Which method we choose for your top surgery will depend on the size of your breasts. But, rest assured, no matter how much breast tissue there is to remove, there is a surgery for you. Our goal is to help you feel comfortable, happy, and confident in your own skin. 
 
 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
  
Board Certified Plastic Surgeon
  
#RealSelf100Surgeon
  
#RealSelfCORESurgeon

Babak Dadvand, MD · Answer

Hi,Thanks for the post. Testosterone has the following effects on the breast: 1) Variable decrease in the amount of breast tissue 2) Variable growth of the pectoralis muscle. I recommend waiting a year to see the full effects of testosterone therapy to see if you would still wish to have surgery.Sincerely,Dr. Dadvand

Christopher J. Inglefield, MBBS, FRCS(Plast) · Answer

Hi There.  THank you for your question.  Testosterone will reduce breast fullness to some degree which is variable.  If you can manage wearing a sports bra, I would recommend being on testosterone for 12 months before deciding on Top Surgery.  If you achieve good reduction in size and your skin is good than a periareola technique may be suitable.  Remember any technique must remove all of the breast tissue to avoid the need for breast screening in the future.  Good luck.

Sheldon Lincenberg, MD · Answer

Thank you for your question. It is well known that testosterone results in shrinkage of breast tissue, however the amount of shrinkage is unpredictable. If your breasts are high and firm, you may find that the amount of shrinkage is enough to avoid the need for top surgery. Although if your breasts have extra skin and sag to some degree, you will probably still want to consider surgery to achieve that nice smooth male contour chest.

Lisa M. DiFrancesco, MD · Answer

Thank you for your question. I would recommend you use testosterone for 1 year. At 1 year if you have a breast mound I would recommend considering top surgery. Good luck.

I’m starting testosterone soon, will I need top surgery?

Answers (5)

More Masculinizing Top Surgery Questions

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Answers (5)

More Masculinizing Top Surgery Questions

Can nipple length be a risk to successful nipple grafts?

I'm FTM but only want bottom surgery. As far as breast augmentation, I think I still want implants? Is this unusual?

Had periareolar top surgery last month. A small hole appeared, and there is pus under the skin? (Photos)

Can breast tissue grow back after keyhole/gyno surgery?

This is a followup to my "numbness after top surgery" question.What are other ways to get rid of neuroma or scar tissue pain?

For top surgery, is it common to lose tactile sensation from surrounding areas of the actual operated location?

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