Types of Top Surgery for Female-to-Male Gender Identity

For transgender men suffering from gender dysphoria, the decision to undergo female-to-male top surgery (FTM) is an important step in their transition journey to create a more masculine-looking chest. Choosing the right type of top surgery is crucial to ensure you achieve the desired results and feel more comfortable in your own body. But with several procedures available, how can you determine which type of top surgery is right for you? For a better idea of what to expect, below are the details about three FTM procedures, their differences, the results, and the recovery.

Get the Facts About FTM Top Surgery Types

A female plastic surgeon waits in an operating room for her nonbinary top surgery patient. In general, female-to-male top surgery is used to create a flatter, more masculine-looking chest by:

  • Undergoing a double mastectomy to remove both breasts
  • Removing excess skin around the breasts
  • Adjusting the position of each nipple and areola (the skin around the nipple)

However, there are several types of FTM top surgery to achieve your desired results. Here’s what to expect about the procedures, the recovery, and the pros and cons of each.

Double-Incision Top Surgery: This is the most popular top surgery procedure for transgender men. It involves two horizontal incisions along either side of the chest, which are then used to remove breast tissue and reshape the underlying chest muscles. The nipples may remain in their original position or be repositioned slightly higher on the chest.

  • Recovery Time: You can typically return to light activity after one week, although it takes six weeks for swelling and bruising to subside fully.
  • Pros: After healing, this method produces a more masculine-looking chest with flat contours between the pectoral muscles. You may also have more natural nipple positioning and a lower risk of sagging tissue.
  • Cons: This procedure leaves permanent double-incision top surgery scars that run across the chest in an “anchor” or “T” shape.

Periareolar Top Surgery: This surgery is less invasive than double-incision surgery and involves making a circular incision around each nipple to remove excess breast tissue and create a flatter chest contour.

  • Recovery Time: Similar to double-incision surgery, you can typically return to light activity after one week, although it takes only three weeks for swelling and bruising to subside fully.
  • Pros: This method allows for minimal scarring as the incisions are hidden in the transition from skin to nipple. Also, there is possible preservation of nipple sensation.
  • Cons: Results may not be as drastic as those achieved with double-incision surgery since some tissue will remain behind.

Note that some transgender men opt for both procedures—double-incision followed by periareolar—to achieve their desired outcome.

Keyhole Top Surgery: This is a less-invasive procedure than the double-incision and periareolar top surgeries. The surgeon makes one small incision in the center of the chest and then removes excess breast tissue through the keyhole. This method is ideal for transgender men who have smaller breasts or those who want to avoid large scars.

  • Recovery Time: Recovery is usually quicker with this method—you can typically return to light activity after two days, and swelling and bruising take three weeks to subside fully.
  • Pros: This method is less invasive than double-incision or periareolar top surgery, with less scarring and a quicker recovery time. It also allows for the preservation of nipple sensation.
  • Cons: Results may not be as drastic since some tissue will remain behind. This method may also not be suitable for larger chest sizes.

The right type of top surgery is a personal decision that should take into account your desired results, medical history, and comfort with scarring. Speak to your doctor and surgeon to determine which of these three procedures is best for you.

What to Expect After FTM Top Surgery

As with any surgical procedure, there are risks of bleeding, bruising, blood clots, poor healing, and infection. After the surgery, it is important to follow all the instructions given by your doctor and surgeon to minimize any risks and ensure proper healing. This may include taking antibiotics, wearing a compression garment for several weeks, sleeping on your back, restricting physical activity and the lifting of objects, and keeping the incision area clean.

More specific risks of top surgeries include:

  • Scarring
  • Loss of nipple sensation
  • The need for liposuction to remove fat tissue that may develop
  • Uneven nipples or other issues that need additional surgery

However, after the recovery period is over, most patients feel confident in making the decision to undergo top surgery and are eager to move forward, living the life of their choosing.

NCSH FTM Top Surgery Experts Are Here for You

Undergoing FTM top surgery is a big decision. If you or someone you love is ready to learn more about types of top surgeries, make your first call to North Carolina Specialty Hospital’s Dr. Keelee MacPhee. She is a highly skilled plastic and reconstructive surgeon with a focus on breast surgery and transgender reconstruction who is passionate about helping her patients become more confident and comfortable with their bodies. You’ll be welcomed in our nonjudgmental and supportive space, experience our high standard of compassionate care, and receive the latest surgical treatments available today. To make an appointment, simply click the link next to her photo.



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