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Chest Masculinization

Washington DC Top Surgery Services

What Is Chest Masculinization Surgery (FTM top surgery)?

Chest masculinization surgery, or “top surgery”, involves mastectomies (removal of the breast tissue), and repositioning/reshaping of the nipple and areola to create a masculine contour and appearance to the chest. Dr. Chao performs circumareolar (scar hidden around the areola) as well as double incision surgery (scar across the chest) and will discuss in depth with you what surgery is the most appropriate for your individual body type. Often, liposuction of fatty areas of the chest is done at the same time to help with contour.

  • Circumareolar (“Donut”) – This surgery is ideal for patients without a significant excess of skin or breast tissue laxity. The breast tissue is removed through a small incision around the areola, and a limited degree of skin tightening can be achieved. The areola is resized at the same time.
  • Double incision – This surgery obtains ideal chest contouring for patients with a larger amount of extra skin or breast tissue laxity. The nipple and areola are resized and repositioned as grafts which heal in about 7 days.

Am I A Good Candidate For Chest Masculinization Surgery (FTM top surgery)?

You may be an excellent candidate for chest masculinization (top surgery) if you have socially transitioned and are seeking to have your chest appearance mirror your gender identity.

  • At your visit, Dr. Chao will assess:chest-photo
    • Your overall physical health and medical history
    • Discuss whether you are a good candidate for surgery and expected outcome
    • Take photographs for your medical record
    • Discuss the planned appearance of surgical scars after surgery
    • Discuss the pros and cons of the different surgeries for chest masculinization
    • Perform a detailed physical exam of the chest
    • Your expectations and motivations for surgery.

What Are The Risks Of Chest Masculinization Surgery (FTM top surgery)?

Rarely, there can be residual extra skin that needs to be excised under local anesthesia as a secondary procedure. Some possible risks include bleeding, infection, asymmetry, poor scarring, loss of the nipples, changes in pigmentation of the nipple and areola, permanent changes in sensation, asymmetry, and contour irregularities.

How Is Chest Masculinization Surgery (FTM top surgery) Surgery Done?

Chest masculinization (top surgery) is performed as an outpatient surgery. The length of the incision will depend on planned approach to the mastectomy, which will be decided with your input. Dr. Chao will remove the breast tissue through the incision as well as resize the nipple and areola. After appropriate symmetry is confirmed and adjusted, additional chest wall contouring will be performed with liposuction. The incisions will be repaired using absorbable sutures. A drain will be placed which helps to prevent accumulation of fluid and allow the tissues to heal together. The surgery takes approximately 2-3 hours.

What Will My Recovery Be Like After Chest Masculinization Surgery (FTM top surgery)?

After surgery, a compressive vest will be placed on the chest to help control swelling. This is usually worn for 1 month after surgery and is removed for bathing. This can be switched to your own chest binder if that is more comfortable. Your drains will be removed approximately 1 week after surgery. If you had a double incision surgery, the grafts on the nipples will be removed at this appointment. Narcotic pain medications are usually not needed past 1 week after surgery. Typical time off from work is 1-2 weeks. After 2 weeks, you may begin aerobic activities. After 6 weeks, you may begin heavy lifting and/or contact sports. It may take 1-2 years for the scars to fully fade and Dr. Chao will follow your scars and instruct you on taking care of these along the way.

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