Gender-Affirming Top Surgery at NCSH

For individuals with gender dysphoria, choosing to undergo surgical procedures to better physically resemble their gender identity is a life-changing experience. When one’s body aligns with their gender identity rather than the sex that was assigned at birth, they can feel more comfortable, confident, and healthy expressing who they really are.

Transgender men often choose to have female to male chest surgery to create a more masculine-looking chest. The plastic surgeons at North Carolina Specialty Hospital are regional leaders in performing these surgeries, combining unparalleled surgical expertise with compassion in a non-judgmental and supportive environment. Patients from the Raleigh-Durham area seeking FTM top surgery can feel confident that they will receive the highest-quality care that puts their health and well-being at the forefront of every decision.

Choosing Female to Male Chest Surgery

Chest surgery is one of the most common gender-affirming surgeries, with patients more than twice as likely to undergo a top transformation than a genital procedure. It is common for transgender men to choose FTM top surgery to prevent the need for chest binding. Wearing tight-fitting compression garments to create a flatter-appearing chest can result in a host of health issues, including skin damage, breathing problems, and even broken ribs.

Any patient who wishes to have female to male chest surgery, also known as top surgery or FTM top surgery, must undergo a mental health evaluation and meet the criteria established by the World Professional Association of Transgender Health (WPATH) standards of care. These include:

• Being at least 18 years old (the legal age for making health care decisions in the U.S.)
• Having documented persistent gender dysphoria
• Having the ability to make an informed decision and provide informed consent
• Managing any significant mental or medical health concerns.

Patients must also be aware that it can take up to a year or longer post-surgery to achieve the full effect of a masculine or non-binary chest. Typically this involves additional procedures to remove fat from the chest and broaden the shoulders, as well as testosterone therapy.

Types of Female to Male Chest Surgery

Patients have several options for achieving their goals through female to male chest surgery. All involve removing existing breast tissue, eliminating excess skin, and changing the nipple and areola.

Double-Incision Top Surgery with Nipple Grafts

This is the most common top surgery option. It begins with a double mastectomy to remove the breasts and may require liposuction to remove excess chest fat. The nipples and areolas are also removed and made smaller before being reattached. The procedure also may require removing excess skin and using special techniques to prevent skin puckering near the incision.

This type of surgery is very natural-looking, and there is little risk of chest sagging in the future. However, it does eliminate nipple sensation, and there is the possibility of scarring.

Periareolar Top Surgery

Transgender men with smaller chests may undergo this procedure, which begins by making two circular incisions around the areola. One is right around the border of the areola, and the other is a larger one surrounding the first. Breast tissue and fat are removed, and the areola is then resized and reattached by bringing the edges of the larger incision together.

This type of surgery may preserve nipple sensation, and scarring is minimal.

Keyhole Top Surgery

Patients with very small breasts and tight skin may qualify for keyhole top surgery. This procedure begins by making an incision to semi-detach the areola, removing breast tissue and fat, and then resizing the nipple if needed.

The surgical option also causes minimal scarring and may preserve nipple sensation.

The plastic surgery team at North Carolina Specialty Hospital works with patients to develop custom, personalized treatment plans based on their goals, needs, and individual body type.

Why Choose North Carolina Specialty Hospital for Gender-Affirming Surgery?

NCSH is home to some of the most accomplished surgeons in the Southeastern United States. In addition to providing access to the most advanced surgical techniques, Dr. Keelee MacPhee is committed to treating transgender patients with compassion as they transition. Dr. MacPhee is proud to provide patient care in a comfortable, personalized environment that has achieved a five-star rating from CMS for patient experience.

NCSH patients can expect the highest-quality patient experience from start to finish. Our operating rooms are equipped with state-of-the-art, innovative medical technology. Patient rooms are private and spacious, and the waiting areas for friends and family are comfortable and inviting.

When you choose NCSH, you can expect:

• Comfortable rooms: Patients requiring overnight stays after surgery receive care in private rooms equipped with televisions, Wi-Fi, and private baths.
• Individualized care: Every patient receives compassionate, attentive care thanks to the 4:1 patient-to-nurse ratio in inpatient units.
• Discharge planning: When you leave NCSH, you can be confident that you have the information, resources, and tools you need for a safe, healthy recovery.

Patients who undergo gender-affirming procedures at North Carolina Specialty Hospital can feel confident knowing they are receiving the most technologically advanced care at the hands of the most skilled surgeons in the region. They can also count on feeling supported and respected as they journey toward an outward appearance that aligns with their true identity.

If you are considering a female to male chest surgery, make an appointment with Dr. MacPhee today.