If I have a bra size, c cup, will I be able to get keyhole top surgery?

Question

Hello I am a FTM male, I am quite concerned of keyhole top surgery based on the size of my fat balloons on my chest. Keyhole surgery is my only option because my parents don't want big scars on me (I could care less) but I'm terrified that I am to big. I still have a long way to go till I can get surgery but is there anyway I can stop the growth of them to make it possible.

Jaime S. Schwartz, MD, FACS · Answer

Excellent question. 
In my practice, we understand that transgender patients are on a journey to aligning their physical body with their gender identity, and that the journey can be a long and sometimes difficult one. Top surgery is the most commonly performed gender reassignment surgery for transgender individuals. Although the decision is very personal, many transgender people say this procedure was a vital step toward alleviating their gender dysphoria and the key to being more comfortable with their appearances. But ultimately the decision will be yours. 
During your initial consultation, we determine based on your individual goals and desired body shape how to tailor your top surgery specifically to you. I require all transgender clients who are considering a top surgery to have been on hormones for at least 18 months prior to their breast augmentation. The reason for this is that hormones alone may result in an increase of breast tissue development, and other significant physical changes. 
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, c-cup or larger. During this procedure, the skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. (The muscle itself is not touched.) The skin is pulled back and the breast tissue is then removed. In both techniques, additional liposuction may be performed to adjust the contour of the chest. In addition, the areola complex can be resized and made smaller and more oval for a more masculine appearance. 
  
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

Jed H. Horowitz, MD, FACS · Answer

hello nathanpine Personally, I frequently use liposuction along with the double incision for larger breasts and some variation for smaller breasts depending upon the position of the Areola. And the female breast the nipple is often centered on the breast but in the male patient the nipple and Areola is lower and closer to the outside edge of the pectoralis muscle. #scar #options

Paul M. Steinwald, MD · Answer

In my experience, the inverted-T approach (while keeping the nipple attached, which both "heals and feels" better - that is, less scarring/tension on the nipple, and at least some sensation is retained) is necessary for even smaller B-cups (and beyond), as there is little way to control the amount of skin that remains (or how much it retracts) with less aggressive approaches.  Unfortunately, once the breast areas have stretched, it is difficult to get skin to shrink/retract (even with weight loss, or binding), although some patients on adequate doses of testosterone report that their chest size decreased at least a cup size.

Keith M. Blechman, MD · Answer

Having a C cup bra size probably indicates that your breasts are too big for the keyhole procedure.  There will be too much skin left over.  Although the scars from the double incision are larger, they may be somewhat less noticeable if you're on testosterone and have significant hair growth on your chest.  Some patients get tattoos to cover them.A visit to a plastic surgeon's office will help you to understand if you're a candidate for the procedure, and what aesthetic outcomes are realistic in your particular case.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
I'm happy to see you for a free consultation in my New York office.
Best of luck,
Keith M. Blechman, MD
New York, NY

Chris Porter, MD · Answer

In my experience keyhole surgery works best in patients who are B cup or smaller. Larger breasts sizes are best managed by a double incision approach, although there is additional scarring with this approach the scars generally fade well and are readily accepted. The other important point to consider is correct masculine location of the nipple, this is easily performed in a double incision approach but difficult if not impossible for C cup breasts or larger using a keyhole approach. Parents are an important part of your support but ultimately FTM surgery is about you, if you are OK with double incision scars then it would pay to talk your parents into understanding why it is the best approach for you as an individual. All the best.

Brian Arslanian, MD · Answer

Thanks for the question. A photo would help answer this question, and obviously an in person examination with a board certified plastic surgeon. But if you are truly a C cup the breast is likely too large and has too much excess skin to just perform a keyhole. This will typically require a complete mastectomy using the double incision with free nipple graft in order to achieve the best contour and shape. Good Luck"The above answer has been given without seeing this patient and cannot be substituted for actual in-person examination and medical advice; it is only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Anthony J. Wilson, MD · Answer

Thank you for your question. It is necessary to do an in person consultation and you should see multiple consultations. Some surgeons feel more comfortable with the keyhole than others. In my experience, however, the double incision is necessary for breasts larger than a B cup. Good luck!

Lisa Friederich, MBBS, FRACS · Answer

Hi, thanks for your question.  I've found that breasts above a B cup are too big to do key hole surgery in one stage. I did do it for a patient with 200cc breasts and although initially no excess skin was obvious, with the resolution of swelling there was a little bit of sagging. 
If too much skin is removed, when the skin is sutured down around the reduced areola diameter there will be too much gathering/puckering (think of a shoe-bag or dice-bag with drawstrings). Too much gathering can restrict the blood supply into the nipple-areola as well. 
You could consider having your surgery in two stages.

Josef Hadeed, MD, FACS · Answer

The best suited technique will depend on the amount of breast tissue and excess skin on your chest.  A C cup is likely too big for a keyhole technique.

Babak Dadvand, MD · Answer

Hi nathanpine,Thanks for the post. Typically keyhole surgery is best for patients with small breasts and no excess skin, as well as good size and location of their areolas. With larger breasts, keyhole surgery will not be effective and will likely leave the patient with a deflated breast with excess skin, especially in the lower part of the breast. Double incision is very effective for larger breasts because it not only treats the breast tissue and fat, but also the excess skin and the size and location of the areolas. The scar is the main disadvantage of this approach but it is necessary to achieve a masculine chest in these cases. Sincerely,Dr. Dadvand

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