FTM Top Surgery

What is FTM top surgery?

FTM (Female-to-Male) top surgery is a gender-affirming procedure for transgender men or non-binary individuals assigned female at birth, aiming to create a masculine chest. The surgery typically involves the removal of breast tissue (mastectomy) to flatten and reshape the chest, giving it a more traditionally male appearance.

 

This surgery is typically part of a broader transition process, which may include hormone therapy and other surgeries, depending on the individual’s goals. The decision to undergo FTM top surgery is deeply personal and often involves discussions with healthcare providers, mental health professionals, and surgeons, like Dr. DeConti,  specializing in transgender healthcare.

What are the benefits of FTM top surgery?

FTM surgery offers several benefits, both physical and emotional, for transgender men and non-binary individuals seeking a more masculine chest.

 

Here are the key benefits:

 

1. Gender Dysphoria Relief

  • Alleviates discomfort: Top surgery helps reduce or eliminate gender dysphoria, the distress some individuals experience when their physical body doesn’t align with their gender identity.
  • Improves body congruence: It allows individuals to feel more comfortable in their own bodies, enhancing their sense of self.

2. Increased Confidence and Well-being

  • Enhanced self-esteem: A more masculine chest appearance can improve body image, leading to greater self-confidence.
  • Reduced mental health challenges: Many people report reduced anxiety, depression, and other mental health issues post-surgery, as they feel more aligned with their gender.

3. Freedom from Binding

  • No need for chest binders: Individuals often wear chest binders to flatten their chest, which can be uncomfortable and restrictive. After surgery, there’s no need for daily binding, which can lead to greater physical comfort.
  • Improved posture and breathing: Without the need for tight binders, many people experience better posture and easier breathing, enhancing physical well-being.

4. Improved Social Comfort

  • Comfort in public spaces: Many individuals feel more at ease in situations like swimming or being shirtless in public, allowing for more freedom in social activities.
  • Less fear of misgendering: A more masculine chest reduces the likelihood of being misgendered, which can improve social interactions and acceptance.

5. Physical Comfort

  • Reduced physical discomfort: For those with larger chests, top surgery can relieve back, shoulder, and neck pain caused by the weight of breast tissue.
  • Freedom of movement: The surgery allows for greater freedom in physical activities, such as sports, without the discomfort or insecurity associated with breast tissue.

6. Long-term Satisfaction

  • High satisfaction rates: Most individuals report high levels of satisfaction with the results of their top surgery, contributing to overall quality of life improvements.

In short, FTM gender reassignment surgery  offers substantial benefits in terms of emotional well-being, physical comfort, and social functioning, making it a key step for many in their gender transition journey.

What are the different procedures used for FTM top surgery?

There are several different types of top surgery FTM, with the choice of method depending on factors like chest size, skin elasticity, and personal goals. Each technique has its own approach to removing breast tissue, reshaping the chest, and managing the nipples.

Here are the most common procedures used top surgery for FTM:

1. Double Incision Mastectomy

  • Best for: Individuals with medium to large chests, or those with less skin elasticity.
  • Procedure:
    • The surgeon makes two horizontal incisions below the pectoral muscles, along the chest.
    • Breast tissue and excess skin are removed, reshaping the chest to create a flatter, more masculine contour.
    • The nipples and areolas are usually removed, resized, and repositioned as skin grafts to match the new chest contour.
  • Pros:
    • Effective for larger chests or those with less skin elasticity.
    • Allows for significant reshaping.
  • Cons:
    • Scarring is more visible across the chest.
    • Potential loss of sensation in the nipples due to skin grafting.

2. Periareolar FTM Keyhole Top Surgery

  • Best for: Individuals with small chests and good skin elasticity.
  • Procedure:
    • The surgeon makes an incision around the edge of the areola.
    • Breast tissue is removed through the incision, leaving the nipple and areola in place.
    • If necessary, the areola may be resized, but in many cases, it remains untouched.
  • Pros:
    • Minimal scarring, as the incision is made only around the areola.
    • Greater chance of preserving nipple sensation.
  • Cons:
    • Limited to individuals with small chests.
    • May not achieve the desired flatness for individuals with more breast tissue.

3. Inverted-T or Anchor Mastectomy

  • Best for: Individuals with large chests, significant sagging, or excess skin.
  • Procedure:
    • The surgeon makes incisions in the shape of an upside-down “T,” which includes both a horizontal incision at the chest and a vertical incision leading up to the nipple.
    • This technique allows the surgeon to remove a larger amount of tissue and skin while reshaping the chest.
    • The nipples may be resized and repositioned, similar to the double incision procedure.
  • Pros:
    • Ideal for larger chests with more sagging.
    • Allows for more significant contouring of the chest.
  • Cons:
    • Results in more scarring than other methods.
    • Potential for reduced nipple sensation.

4. Buttonhole Technique

  • Best for: Individuals with medium to large chests who prefer to retain nipple sensation.
  • Procedure:
    • Similar to the double incision technique, but instead of removing the nipple and grafting it, the surgeon creates a “buttonhole” in the chest skin to reinsert the nipple at the new location.
  • Pros:
    • Preserves nipple sensation in some cases.
    • Allows for repositioning without fully removing and grafting the nipple.
  • Cons:
    • Scarring is still present across the chest.
    • Sensation preservation isn’t guaranteed.

5. Liposuction-Assisted Chest Contouring

  • Best for: Individuals with small to medium-sized chests and good skin elasticity.
  • Procedure:
    • Liposuction is used to remove breast tissue through small incisions.
    • In some cases, liposuction is combined with other techniques, such as the periareolar or keyhole approach.
  • Pros:
    • Minimally invasive with small scars.
    • Faster recovery time.
  • Cons:
    • May not be sufficient for larger chests or those requiring more significant reshaping.

6. Minimal Scar Technique

  • Best for: Individuals with small to moderate-sized breasts who wish to minimize scarring.
  • Procedure:
    • This technique uses small incisions, typically around the areola or in other inconspicuous areas.
    • It may involve liposuction to remove fat, combined with removal of glandular breast tissue.
  • Pros:
    • Less visible scarring.
    • Suitable for those with minimal excess skin.
  • Cons:
    • Not suitable for larger chests or significant excess skin.

Each of these procedures has its own advantages and disadvantages, and the best method will depend on an individual’s chest size, skin elasticity, and desired outcome. Consulting with Dr. DeConti who has an extensive experience in gender-affirming surgeries will help determine the most appropriate approach.

What do I need to do before my FTM top surgery?

Before undergoing FTM top surgery, there are several important steps you should take to ensure you’re physically, mentally, and logistically prepared for the procedure.

 

Here is a general checklist of things to do:

 

1. Medical and Psychological Preparation

  • Consultation with FTM Surgeons:
    • Have a detailed consultation with a surgeon experienced in FTM top surgery to discuss the appropriate procedure, expected outcomes, and risks. This is also the time to ask any questions about the surgery, recovery, and long-term care.
  • Obtain a Letter of Support (if needed):
    • Many surgeons require a letter of support from a licensed mental health professional or a primary care provider. This letter typically confirms that you meet the criteria for gender-affirming surgery and are psychologically ready for the procedure.
  • Hormone Therapy:
    • If you’re taking testosterone, some surgeons may require you to have been on hormone therapy for a specific amount of time before surgery, although this is not always required.
    • Discuss with your surgeon if testosterone or other treatments should be paused or adjusted before surgery.
  • Medical Clearance:
    • Some surgeons will request medical clearance, especially if you have any pre-existing health conditions. This may involve blood tests, a physical exam, or consultations with specialists.
  • Stop Smoking:
    • If you smoke, you’ll likely be advised to quit smoking several weeks before surgery, as smoking can negatively affect wound healing and increase the risk of complications.

2. Physical Preparation

  • Healthy Diet and Hydration:
    • Prior to surgery, maintain a balanced diet and stay hydrated to ensure your body is in its best condition for recovery.
  • Exercise:
    • If possible, stay active and healthy, as good physical fitness can aid in faster recovery. You might want to focus on core strength and flexibility, as these muscles can help support you during your post-surgery healing period.
  • Stop Certain Medications:
    • Your surgeon may advise you to stop taking certain medications, like blood thinners, anti-inflammatory drugs, or herbal supplements, which can increase bleeding risks. Always check with your surgeon before making changes to your medication routine.

3. Mental and Emotional Preparation

  • Manage Expectations:
    • Understand that the results of FTM top surgery may take time to fully realize due to swelling and healing. Having realistic expectations about scarring and recovery time can help you prepare mentally.
  • Support System:
    • Make sure you have friends, family, or community members to support you through the surgery and recovery process. Emotional and practical help during the first few weeks can be invaluable.
  • Therapy:
    • If you’re working with a therapist, consider discussing the emotional and psychological aspects of the surgery. Preparing mentally for the physical changes is an important step.

4. Prepare for Recovery

  • Plan for Time Off:
    • Depending on the nature of your job and the procedure chosen, plan for at least 2–4 weeks of recovery time where you’ll need to limit physical activity.
  • Arrange Post-Surgery Care:
    • You will need someone to help you for the first few days after surgery, especially with tasks like lifting, showering, or cooking. Arrange for someone to be with you, at least for the initial recovery phase.
  • Stock Up on Supplies:
    • Prepare your home with supplies like loose-fitting shirts, a wedge pillow or extra pillows to keep you comfortable while sleeping, bandages, compression garments, and prescribed medications or over-the-counter pain relief.
    • Having pre-made meals and other essentials can be very helpful during the initial healing phase when mobility is limited.

5. Pre-Surgery Instructions from Your Surgeon

  • Fasting Instructions:
    • If you’re having general anesthesia, you’ll likely need to fast for a specific period (usually 8–12 hours) before surgery.
  • Showering:
    • Your surgeon may instruct you to shower using a special antibacterial soap the night before and the morning of your surgery to minimize the risk of infection.
  • Compression Garment:
    • You may need to purchase or be fitted for a post-surgical compression vest or chest binder FTM, which helps with healing and reduces swelling. Your surgeon will advise on the type of garment to wear post-surgery.

By carefully preparing for your FTM top surgery, you can ensure a smoother process, both physically and emotionally, and enhance your recovery experience.

What should I expect on the day of my FTM top surgery?

On the day of your FTM top surgery, you can expect the following process to unfold, from arrival at the surgical center to post-operative care.

 

Here is a detailed breakdown of what typically happens:

 

1. Arrival at the Surgical Center

  • Check-In:
    • You will likely be asked to arrive at the hospital or surgical center a few hours before your scheduled surgery time to complete check-in procedures. You’ll fill out any necessary paperwork and verify personal and medical information.
  • Meet with Surgical Team:
    • You will meet with your surgeon and anesthesiologist to review the surgery plan. The surgeon may mark your chest with a surgical marker to guide the incisions. This is also an opportunity to ask any last-minute questions.
  • Change into Surgical Gown:
    • You’ll be asked to change into a hospital gown. Any personal belongings, including jewelry, should be removed beforehand.

2. Pre-Operative Preparations

  • Vital Signs and IV Insertion:
    • A nurse will take your vital signs (blood pressure, heart rate, etc.) and place an intravenous (IV) line in your arm. This IV will be used to administer fluids, medications, and anesthesia.
  • Meeting the Anesthesiologist:
    • You’ll discuss anesthesia options with the anesthesiologist. FTM top surgery is typically done under general anesthesia, meaning you’ll be asleep during the procedure. If you have any allergies or concerns, make sure to discuss them.
  • Last-Minute Instructions:
    • The medical team will give you any last-minute instructions, such as deep breathing exercises or what to expect after waking up from surgery.

3. The Surgery

  • Anesthesia:
    • Once you’re in the operating room, you’ll be positioned on the surgical table. The anesthesiologist will administer the general anesthesia, which will put you to sleep and ensure you don’t feel pain during the surgery.
  • Surgical Procedure:
    • The type of surgery (double incision, periareolar, etc.) will determine the steps your surgeon follows, but the overall goal is to remove breast tissue, reshape the chest, and reposition or resize the nipples if necessary.
    • The procedure can take anywhere from 1.5 to 4 hours, depending on the complexity and the technique used.
  • Incision Closure:
    • After the breast tissue is removed and the chest is reshaped, the surgeon will close the incisions using sutures, staples, or surgical glue. Drain tubes may be placed to prevent fluid buildup, depending on the method used.

4. Waking Up in the Recovery Room

  • Post-Anesthesia Recovery:
    • After the surgery is complete, you’ll be moved to a recovery room where medical staff will monitor you as you wake up from the anesthesia. You may feel groggy or disoriented at first, which is normal after general anesthesia.
  • Pain Management:
    • You’ll be given pain medication through your IV or orally to help manage any discomfort. Many patients experience mild to moderate pain and tightness across the chest, but this can be controlled with medication.
  • Vital Sign Monitoring:
    • Nurses will monitor your vital signs to ensure your body is recovering well from the surgery and anesthesia. You may feel drowsy, and it’s important to rest at this stage.

5. Immediate Post-Op Care

  • Drains and Dressings:
    • If drain tubes were placed during surgery, the medical team will show you how to care for them. You’ll likely have bandages or a compression vest around your chest, which helps reduce swelling and support healing.
  • Breathing and Mobility:
    • You’ll be encouraged to take deep breaths and move your legs slightly to prevent complications such as blood clots. While you’ll need to limit physical activity, gentle movement is important early on.
  • Eating and Drinking:
    • Once you’re fully awake and the medical team approves, you may be allowed to drink water or eat light snacks. Some people experience nausea after anesthesia, but anti-nausea medication can help if needed.

6. Discharge or Overnight Stay

  • Same-Day Discharge:
    • Many FTM top surgeries are performed as outpatient procedures, meaning you’ll be discharged the same day. If this is the case, you’ll need someone to drive you home, as you won’t be able to drive yourself due to the effects of anesthesia.
  • Overnight Stay:
    • In some cases, especially if there are medical concerns or if your surgery is more complex, you may need to stay in the hospital overnight for observation. This allows the medical team to monitor your recovery and manage pain or complications.

7. Post-Operative Instructions

  • Compression Garment:
    • You’ll likely be fitted with a compression vest or FTM binder that you will need to wear 24/7 (except during showering) for a few weeks to help with healing and to minimize swelling.
  • Caring for Drains and Incisions:
    • If you have drains, your surgeon or nurse will explain how to empty and care for them. You’ll also receive instructions on how to care for your incisions, including when and how to change dressings.
  • Follow-Up Appointment:
    • You’ll be scheduled for a follow-up appointment with your surgeon, usually within the first week after surgery, to assess your healing and remove any drains, if applicable.

8. Going Home

  • Pain Management:
    • You’ll be given a prescription for pain medication and possibly antibiotics to prevent infection. Be sure to fill these and follow the instructions carefully.
  • Rest and Recovery:
    • Rest is critical during the first few days. Avoid any heavy lifting, stretching, or physical activity that could strain your chest or incisions.
  • Arrange for Assistance:
    • Make sure you have a friend or family member to help with daily tasks, especially during the first 48 hours.

By knowing what to expect on the day of surgery, you can feel more prepared and comfortable.

What can I expect after my female to male surgery?

There are several stages of FTM top surgery recovery and physical changes that you can expect. The healing process and post-op experience vary depending on the type of surgery, your health, and your body’s response to the procedure.

 

Here is a general guide to what you can expect post op FTM in the days, weeks, and months after your surgery:

 

1. Immediately After Surgery (First Few Days)

  • Swelling and Discomfort:
    • It’s normal to experience swelling, bruising, and discomfort in the chest area after surgery. Pain is typically mild to moderate and can be managed with prescribed pain medications.
  • Nausea or Dizziness:
    • You may feel groggy, nauseous, or dizzy due to the anesthesia. This usually subsides within the first day or two. Anti-nausea medication can be prescribed if needed.
  • Compression Garment:
    • You will be wearing a compression vest or binder around your chest to help reduce swelling and support the healing process. You’ll likely need to wear it 24/7 (except when showering) for the first few weeks.
  • Drains:
    • If you have drain tubes inserted, they will help prevent fluid buildup at the surgical site. Your surgeon will instruct you on how to care for them. These are usually removed within the first week during a follow-up visit.
  • Limited Mobility:
    • Your upper body movement will be restricted to avoid straining the incisions. Lifting your arms above your head or lifting heavy objects should be avoided in the first few weeks.

2. First Week After Surgery

  • Follow-Up Visit:
    • Your first post-op visit to the surgeon will likely occur within 5 to 7 days after surgery. The surgeon will check your healing progress, remove drains (if any), and may adjust your dressings or compression garment.
  • Pain and Swelling:
    • While pain and swelling will still be present, they should begin to decrease gradually. Continue taking your prescribed pain medication as needed.
  • Bruising:
    • You may notice bruising around the chest area, which is normal and will fade over the next few weeks.

3. 2–6 Weeks Post-Surgery

  • Gradual Return to Activity:
    • After 2–3 weeks, you’ll likely begin to feel more comfortable and can start incorporating light activities into your routine. However, you’ll need to avoid strenuous exercise, lifting heavy objects, or raising your arms high for at least 4–6 weeks, depending on your surgeon’s advice.
  • Nipple Healing:
    • If your surgery involved nipple grafts (such as with the double incision method), the nipples may appear scabbed or discolored in the early stages. This is part of the healing process, and the scabs will fall off over time. Follow your surgeon’s instructions carefully on how to care for the grafts.
  • Reduced Swelling and Improved Comfort:
    • By the 3rd or 4th week, you’ll likely notice a significant reduction in swelling, and your range of motion will begin to improve.
  • Scar Management:
    • Your surgeon may recommend silicone sheets or scar gels to help reduce the appearance of scars. Massaging the scars once your surgeon gives approval can also help with the healing process.
  • Compression Garment:
    • You’ll continue wearing your compression garment, typically for about 4–6 weeks, but your surgeon will let you know when you can start wearing it less frequently.

4. 6 Weeks to 3 Months Post-Surgery

  • Returning to Normal Activities:
    • Most people are cleared to resume normal activities, including work (if it’s not physically strenuous) and light exercise by 6–8 weeks post-op. However, it’s important to gradually ease back into your normal routine and avoid any activities that could strain your chest, such as heavy lifting or intense upper-body workouts.
  • Full Healing of Incisions:
    • Your incisions should be fully healed by 6–8 weeks, though the scars will continue to evolve over the next few months. They may appear red or raised at first, but with time and proper care, they should fade.
  • Nipple Sensation:
    • If you had nipple grafts, sensation in the nipples may be reduced or lost initially. Some people regain partial sensation over time, but this varies from person to person.
  • Physical Appearance:
    • By the 2–3 month mark, most of the swelling will have subsided, and your chest will begin to settle into its new shape. Keep in mind that final results can take several months to fully manifest, as healing continues.

5. 3–12 Months Post-Surgery

  • Scarring:
    • Your scars will continue to mature over the course of the year. They may initially appear pink or raised but will typically flatten and lighten with time. Some patients choose to use scar treatments or even laser therapy to minimize scar appearance.
  • Return of Full Activity:
    • By the 3- to 6-month mark, most patients can fully resume all activities, including weightlifting, swimming, and intense physical exercise. Always consult your surgeon before returning to high-impact activities.
  • Emotional and Psychological Adjustments:
    • Many people experience a boost in confidence and relief from gender dysphoria after surgery, but emotional recovery can vary. Some may feel a period of adjustment as they become accustomed to their new appearance. It’s important to continue seeking support from friends, family, or a therapist if needed.

Long-Term Considerations

  • Satisfaction with Results:
    • Most individuals are highly satisfied with their results, but it’s important to have realistic expectations. Your chest will continue to evolve and improve as it fully heals.
  • Scarring:
    • While the appearance of scars can improve over time, they may never fully disappear. However, many people find that the benefits of the surgery far outweigh the presence of scars.
  • Follow-Up Appointments:
    • You will likely have follow-up appointments with your surgeon to monitor healing and ensure that everything is progressing as expected. These appointments are important to identify any potential complications early.

How much does top surgery cost without insurance FTM?

The Female-to-Male FTM top surgery cost can vary widely depending on several factors, including the surgeon’s expertise, location, the type of procedure, and whether insurance covers part of the cost.

Below is a breakdown of what to expect in terms of costs for FTM top surgery near me:

1. Average Cost

  • In the United States: The total FTM top surgery cost can range from $8,000 to $15,000 or more. This price typically includes the surgeon’s fee, anesthesia, facility fees, and post-surgical care.
    • Double Incision Mastectomy: $8,000 to $15,000
    • Periareolar/Keyhole Surgery: $6,000 to $10,000
    • Inverted-T Mastectomy: $8,000 to $15,000

2. Factors Influencing the Cost

  • Surgeon’s Experience: Highly experienced and specialized surgeons may charge more for their services.
  • Geographic Location: Costs are typically higher in large cities or regions with a higher cost of living.
  • Type of Procedure: More complex procedures (like double incision with nipple grafts) generally cost more than simpler techniques (like keyhole surgery).
  • Hospital vs. Outpatient Clinic: Surgery performed in a hospital may have higher facility fees than surgery done in a private clinic.

3. Additional Costs

  • Consultation Fees: Some surgeons charge an initial consultation fee, typically ranging from $100 to $300.
  • Pre-Surgical Tests: Blood tests, medical clearances, and other pre-operative evaluations may incur additional costs.
  • Post-Surgery Medications: Pain medications, antibiotics, and any required medical supplies (compression garments, scar treatments, etc.) could add to the overall cost.
  • Travel and Accommodation: If you need to travel to another city or country for surgery, you’ll need to account for transportation, accommodation, and meals during your stay.
  • Time Off Work: Recovery may require taking time off from work, which could result in lost wages.

4. Financing Options

  1. Payment Plans: Some surgeons offer payment plans, allowing you to pay for the surgery in installments rather than in one lump sum.
  2. Medical Loans: Medical financing companies offer loans for surgery. Be sure to check interest rates and terms before committing to a loan.
  3. Fundraising: Many people use crowdfunding platforms like GoFundMe to raise funds for gender-affirming surgeries.
  •  

FAQ

Yes, you will have scars after FTM top surgery, but the location, size, and visibility of the scars depend on the type of procedure you undergo and how your body heals. Scarring is a natural part of the healing process, but many factors influence how prominent your scars will be over time.

Types of Scars Based on Surgery Technique:

  1. Double Incision Mastectomy:

    • Scarring Location: Two horizontal scars are typically located beneath the pectoral muscles, running across the chest. These are usually the most visible scars after surgery.
    • Nipple Grafts: If you have nipple grafts, there may also be scars around the nipples where they were resized and repositioned.
    • Visibility: These scars tend to be the most noticeable because of their length, but they often fade significantly over time. They may initially be red or raised but usually flatten and lighten over 1 to 2 years.

  2. Periareolar (Keyhole) Surgery:

    • Scarring Location: The scars are minimal and usually placed around the areola. Since the incision follows the natural curve of the areola, these scars tend to be more discreet.
    • Visibility: These scars are often very subtle and less visible than those from the double incision technique. However, this procedure is usually only suitable for individuals with smaller chests.

  3. Inverted-T Mastectomy:

    • Scarring Location: This method leaves both horizontal and vertical scars, resulting in a pattern similar to an inverted “T” or anchor shape.
    • Visibility: The scars are more extensive than those from other methods, but they tend to heal well with proper care.

  4. Buttonhole Technique:

    • Scarring Location: Similar to the double incision, but the nipples are inserted into a “buttonhole” without being fully detached, leaving horizontal scars and minimal scarring around the nipple area.
    • Visibility: The chest scars will still be visible, but this technique may help reduce the size of the scars around the nipple.

Factors Affecting Scar Appearance:

  1. Healing Process:

    • Individual healing patterns play a significant role in how scars look. Some people are prone to raised or thick scars (hypertrophic or keloid scars), while others heal with flatter, less noticeable scars.

  2. Skin Type:

    • Skin color and type also influence scar visibility. Darker skin tones may develop more noticeable pigmentation around scars (hyperpigmentation), while lighter skin tones may have lighter scars.

  3. Scar Care:

    • Compression Garments: Wearing a compression vest as instructed helps reduce swelling and aids in proper scar formation.
    • Silicone Sheets/Gels: These are commonly recommended to help flatten and fade scars. They should be used after the incisions have fully closed, usually 2–3 weeks post-op.
    • Scar Massage: Once your surgeon gives the okay, gentle scar massage can help break down scar tissue and improve the appearance.
    • Sun Protection: Scars are sensitive to sunlight. Avoid direct sun exposure on your scars or use sunscreen with a high SPF, as UV exposure can darken the scars and make them more visible.

  4. Time:

    • Scars will be most noticeable during the first few months but will typically fade significantly over 1 to 2 years. They may go from red or pink to a lighter color closer to your skin tone.

Minimizing Scars:

  • Scar Reduction Treatments: Some people opt for additional treatments to reduce scar visibility, such as laser therapy, microneedling, or corticosteroid injections for raised scars.
  • Tattooing: Some individuals choose to tattoo over their chest scars after fully healing to make them less noticeable or to create an aesthetic design that integrates the scars.

Emotional Aspect:

  • While scars are a natural part of top surgery, many individuals find that the physical and emotional benefits of having a more masculine chest far outweigh the presence of scars. Over time, many people become more comfortable with their scars as a part of their gender-affirming journey.

TM (Female-to-Male) top surgery, like any surgical procedure, comes with potential risks and complications. While most individuals experience a successful outcome with minimal issues, it’s important to be aware of the possible risks.

Here are common and rare complications associated with FTM top surgery:

1. General Surgical Risks

  • Infection: As with any surgery, there is a risk of infection at the incision sites. Signs include redness, swelling, fever, or discharge. Most infections can be treated with antibiotics, but severe infections may require further intervention.
  • Bleeding (Hematoma): Excessive bleeding or the development of a hematoma (a collection of blood under the skin) can occur. If significant, it may require drainage or additional surgery.
  • Seroma: This is a buildup of clear fluid under the skin at the surgical site. Seromas often resolve on their own but may need to be drained if they persist.
  • Anesthesia Risks: General anesthesia can lead to complications such as allergic reactions, respiratory issues, or heart problems, though these are rare. Your anesthesiologist will evaluate your overall health to minimize these risks.
  • Blood Clots (Deep Vein Thrombosis or Pulmonary Embolism): In rare cases, prolonged immobility during and after surgery can lead to blood clots in the legs or lungs. Early movement and compression devices can help reduce this risk.

2. Specific Risks Related to FTM Top Surgery

  • Nipple and Areola Complications:
    • Loss of Nipple Sensation: After surgery, it’s common to experience reduced nipple sensation, especially if nipple grafts were used. Some people regain sensation over time, but for others, it may be permanent.
    • Nipple Necrosis: This is a rare but serious complication where the nipple grafts don’t receive enough blood supply and the tissue dies. This can lead to partial or complete loss of the nipples, requiring further reconstructive surgery.
  • Scarring:
    • Hypertrophic or Keloid Scarring: Some individuals may develop thick, raised scars known as hypertrophic or keloid scars, which are more prominent than typical scars. This is more common in individuals with darker skin tones or a genetic predisposition to raised scarring.
    • Poor Wound Healing: In some cases, wounds may take longer to heal, or the edges of the incision may not close properly, leading to wound separation or reopening, which may require additional treatment.
  • Chest Asymmetry:
    • After surgery, some individuals may experience noticeable differences in the size, shape, or position of the chest or nipples. Minor asymmetries are common, but in some cases, revision surgery may be needed to improve the appearance.
  • Contour Irregularities:
    • Sometimes, the chest contour may not be completely flat or smooth after surgery. This can occur due to uneven fat removal or scar tissue formation, and some individuals opt for revision surgery to address these issues.

3. Long-Term Risks

  • Loss of Nipple or Chest Sensation:
    • Some individuals may permanently lose sensation in the chest or nipples due to nerve damage during surgery. While some sensation may return over time, it may not be the same as before.
  • Breast Tissue Regrowth:
    • While the vast majority of breast tissue is removed during top surgery, a small amount of residual tissue may remain. In rare cases, especially for those on hormone replacement therapy (HRT) with testosterone, there could be minor regrowth of this tissue.
  • Scar Tissue Formation:
    • Over time, scar tissue can form under the skin, which may affect the appearance or texture of the chest. In some cases, this scar tissue can cause discomfort or tightness, particularly if it forms adhesions between the skin and underlying tissue.

4. Emotional and Psychological Risks

  • Post-Surgery Emotional Adjustment:
    • Although most individuals feel relief and satisfaction after FTM top surgery, there can be an emotional adjustment period. It may take time to mentally adjust to the new appearance of the chest, and some individuals may experience temporary feelings of regret or emotional difficulty during recovery.
  • Body Image Concerns:
    • Scarring or chest asymmetry may lead to dissatisfaction with the results, especially if expectations are not aligned with the surgical outcome. It’s important to discuss realistic outcomes with your surgeon before surgery to minimize potential disappointment.

5. Rare Complications

  • Tissue Death (Necrosis):
    • In rare cases, parts of the skin or tissue may die due to poor blood supply, especially in areas with tight closures or in nipple grafts. This can require further surgical intervention.
  • Allergic Reactions:
    • Some people may have allergic reactions to medications, surgical dressings, or other materials used during the procedure. Be sure to inform your surgical team of any known allergies beforehand.
  • Fat Necrosis:
    • This occurs when fatty tissue under the skin dies, forming lumps or hard spots in the chest. Fat necrosis is usually not harmful but can create an uneven appearance. In some cases, these areas may need to be removed surgically.

How to Minimize Risks:

  1. Choose an Experienced Surgeon: Selecting a board-certified surgeon with extensive experience in gender-affirming surgeries like Dr. DeConti can significantly reduce your risk of complications.
  2. Follow Pre- and Post-Op Instructions: Carefully following your surgeon’s pre- and post-operative instructions, including wearing a compression vest, caring for your incisions, and attending follow-up appointments, will help minimize complications.
  3. Maintain a Healthy Lifestyle: Prioritize proper nutrition, hydration, and avoiding smoking before and after surgery to promote optimal healing. Smoking in particular can impair wound healing and increase the risk of complications.
  4. Monitor for Signs of Complications: Be vigilant for signs of infection (such as redness, warmth, or pus), unusual pain, or any other concerning symptoms and report them to your surgeon immediately.

While complications are possible, FTM top surgery is generally a safe and effective procedure with high satisfaction rates. Being informed about potential risks can help you prepare for the procedure and recovery process.

You will begin to see the results of your FTM top surgery soon after the procedure, but the full and final results take time to develop.

Here is a general timeline for what to expect in terms of seeing the results:

1. Immediately After Surgery

  • Initial Results: You will see an immediate reduction in chest size and contour once the surgery is complete. However, your chest will be swollen, and it may be difficult to fully appreciate the final shape due to bandages, swelling, and possibly surgical drains.
  • Compression Garment: After surgery, you’ll be required to wear a compression vest or binder, which will help reduce swelling and support healing. While this will help shape your chest, it may obscure the initial appearance of your chest for a while.

2. First 1–2 Weeks

  • Swelling and Bruising: During the first week or two, swelling and bruising will be at their peak, which can make your chest appear puffier or uneven. It’s important to be patient during this phase, as your body is still healing.
  • Drains Removed: If you had surgical drains placed, these are usually removed within the first week, and you’ll begin to see a clearer outline of your chest.

3. 4–6 Weeks

  • Significant Reduction in Swelling: By the 4- to 6-week mark, much of the swelling will have gone down, and you’ll start seeing more defined results. You’ll also likely be cleared to reduce the use of your compression garment or wear it only part-time, depending on your surgeon’s advice.
  • Improved Chest Shape: The chest will start to settle into its new shape, although there may still be some residual swelling, particularly in the nipple and areola area if grafts were used.

4. 3–6 Months

  • More Refined Results: By 3 months post-op, most of the swelling will have resolved, and the overall contour of your chest will be much more defined. Your scars will still be visible but will start to lighten and flatten over time.
  • Nipple Healing: If you had nipple grafts, the scabs will have fallen off by this point, and the nipples will have mostly healed. Sensation in the nipples may begin to return during this period, though it varies by individual.

5. 6–12 Months

  • Final Results: Most people will see their full, final results by the 6- to 12-month mark. By this time, the swelling will be completely gone, and your chest will have settled into its final shape. Your scars will continue to heal and fade, though they may still be somewhat visible.
  • Scar Fading: Over time, your scars will continue to fade and may become less noticeable. It typically takes up to 1 to 2 years for scars to fully mature and lighten.

Long-Term Considerations:

  • Ongoing Scar Care: Scars can continue to improve for up to 2 years after surgery. Using scar treatments like silicone sheets, gels, or massage (as recommended by your surgeon) can help reduce their appearance.
  • Asymmetry or Revision: Some minor chest asymmetry or irregularities may not become apparent until later in the healing process. If needed, some individuals opt for revision surgery to further refine their chest contour, but this is not always necessary.

Factors That Affect How Quickly Results Show:

  • Type of Surgery: Individuals who undergo the periareolar (keyhole) method may see results faster because the incisions are smaller and there’s less swelling. The double incision method typically has more swelling and takes longer to reveal the final results.
  • Skin Elasticity: Younger individuals or those with good skin elasticity may experience faster recovery and better results as their skin adjusts more quickly to the new chest contour.
  • Post-Surgical Care: Wearing your compression garment as instructed, following post-operative care guidelines, and avoiding strenuous activity can help your chest heal more quickly and smoothly.

Patience is Key:

It’s essential to be patient during the healing process. While you’ll see some immediate changes, it can take several months for your chest to fully heal and for the final results to become apparent.

In some cases, individuals choose to combine FTM top surgery with other procedures to further align their physical appearance with their gender identity or to achieve other aesthetic or functional goals.

Here are common procedures that can be combined with FTM top surgery:

1. Liposuction for Chest Contouring

  • Purpose: Liposuction can be used to remove excess fat in the chest area or around the sides of the chest to improve contour and create a more masculine appearance. This is often done alongside top surgery for those with extra fat deposits that would benefit from further refinement.
  • Combination Benefits: Including liposuction in your top surgery can create a smoother, more defined chest shape and remove excess fat that isn’t addressed by the mastectomy alone.

2. Hysterectomy and Oophorectomy

  • Purpose: A hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries) are procedures some transgender men undergo as part of their medical transition. These surgeries eliminate the need for menstruation and lower the production of estrogen, contributing to a more masculinized hormonal profile.
  • Combination Benefits: For those who are interested in undergoing both chest masculinization and hysterectomy or oophorectomy, combining the procedures can minimize the total recovery time and reduce the need for multiple surgeries.
  • Logistics: These procedures may be performed by different surgeons (one for the top surgery and one for the gynecological procedure), so coordination between the medical teams is required.

3. Body Contouring (Liposuction or Fat Redistribution)

  • Purpose: Some individuals opt for additional body contouring to create a more masculine appearance, particularly in areas like the waist, hips, or abdomen. Liposuction can be used to reduce fat in areas with a more feminine shape, or fat redistribution can be used to enhance areas like the shoulders.
  • Combination Benefits: This can provide a more comprehensive masculine silhouette beyond the chest, aligning the overall body shape with a more traditionally masculine appearance.

4. Facial Masculinization Surgery (FMS)

  • Purpose: FMS includes a variety of procedures to create a more masculine facial appearance. Common FMS procedures include jawline contouring, chin augmentation, and rhinoplasty (nose reshaping).
  • Combination Benefits: Some people may opt to combine top surgery with facial masculinization if they are looking for a more comprehensive transformation. However, combining these surgeries may require a longer recovery period and greater coordination between specialists.

5. Phalloplasty or Metoidioplasty (Bottom Surgery)

  • Purpose: Phalloplasty and metoidioplasty, bottom surgery FTM, are genital reconstruction surgeries that create a penis as part of a full gender transition. While bottom surgery is a more complex and lengthy procedure, some people choose to combine it with top surgery to streamline their transition process.
  • Combination Benefits: Combining top and bottom surgeries reduces the total number of surgeries, hospital stays, and recovery periods, though this is a more intensive option and requires careful planning.
  • Considerations: Due to the complexity and length of bottom surgery, these procedures are typically not performed at the same time as top surgery. However, in some cases, they may be staged close together.

6. Nipple Tattooing

  • Purpose: After top surgery, some individuals choose nipple tattooing to enhance or recreate the appearance of the areolas and nipples. This is especially common for those who had their nipples removed or repositioned during the double incision procedure.
  • Combination Benefits: While nipple tattooing is usually done after the initial healing phase, some may opt for this in conjunction with other surgeries or revisions to complete their chest masculinization.

7. Scar Revision or Refinement

  • Purpose: For individuals who are concerned about scarring or experience raised scars after top surgery, scar revision can be performed to reduce the appearance of scars. This may include surgical scar revision, laser treatments, or microneedling.
  • Combination Benefits: Scar revision may be combined with other minor procedures, such as chest contouring or nipple revision, to optimize the aesthetic results after the initial healing process.

8. Abdominal Masculinization Surgery

  • Purpose: Some transgender men opt for abdominal masculinization surgery, which is a form of body contouring or abdominoplasty (tummy tuck) that helps create a more sculpted, masculine abdominal appearance. Liposuction is often used in this procedure to define the waistline.
  • Combination Benefits: Combining top surgery with abdominal masculinization can create a more masculine upper body profile in a single procedure.

9. Revision Surgery

  • Purpose: In some cases, individuals choose to have revision surgery after the initial top surgery to address concerns such as asymmetry, nipple placement, or chest contour irregularities. This is usually a minor surgical procedure.
  • Combination Benefits: If a patient is undergoing other cosmetic or gender-affirming procedures, they may choose to combine them with a revision surgery to improve overall satisfaction with their results.

10. Fat Grafting

  • Purpose: Fat grafting involves removing fat from one part of the body (through liposuction) and injecting it into areas where additional volume or contouring is desired, such as the pectoral muscles to enhance a more masculine chest shape.
  • Combination Benefits: This can enhance the chest contour and give a more sculpted appearance if combined with top surgery.

Considerations Before Combining Procedures:

  • Longer Recovery: Combining procedures means a longer recovery period. Be prepared for additional downtime and post-operative care.
  • Higher Surgical Risk: Each additional procedure adds complexity to the surgery and increases the overall risk of complications. Your surgeon will evaluate whether it’s safe to combine procedures based on your health and goals.
  • Financial Cost: Combining surgeries may increase the overall cost, though it can sometimes reduce expenses by combining facility fees and anesthesia costs.

It’s important to discuss your goals and the feasibility of combining procedures with your surgeon, as they can help you plan an approach that minimizes risks and maximizes the results.

Insurance coverage for top surgery (gender-affirming chest surgery) depends on the specific insurance plan, provider, and regional regulations. Many insurance plans in the U.S. now cover top surgery for transgender individuals under certain conditions, as it’s often deemed medically necessary for treating gender dysphoria.
 
Here is a breakdown:
  • Background:
    • Under the Affordable Care Act (ACA), insurance plans cannot discriminate based on gender identity, and many private insurers (e.g., Blue Cross Blue Shield, Aetna, UnitedHealthcare) cover top surgery if criteria are met, such as a diagnosis of gender dysphoria, a letter from a mental health professional, and sometimes a period of hormone therapy or documented persistent gender dysphoria.
    • Medicaid coverage varies by state. States like California, New York, and Washington often cover top surgery, while others may have stricter criteria or no coverage.
    • Medicare typically covers top surgery if deemed medically necessary, following similar guidelines to private insurers.
  • Criteria: Insurers often require:
    • A formal diagnosis of gender dysphoria.
    • A letter from a qualified mental health provider or physician.
    • Documentation of persistent gender dysphoria (e.g., for 1–2 years).
    • In some cases, proof of hormone therapy or other treatments, though this is less common for top surgery than other procedures.
  • Out-of-Pocket Costs: Even with coverage, patients may face copays, deductibles, or costs for non-covered aspects (e.g., specific surgeons or cosmetic refinements). Costs without insurance can range from $5,000 to $15,000+ depending on the surgeon and location.
  • International Context:
    • In countries with universal healthcare (e.g., Canada, UK), top surgery may be covered under public health systems, but wait times can be long (1–3 years). Private options exist but are often not covered.
    • Coverage in other countries varies widely based on local laws and healthcare systems.
  • Steps to Confirm Coverage:
    1. Check your insurance policy’s gender-affirming care section or contact the provider directly.
    2. Ask about specific requirements (e.g., pre-authorization, documentation).
    3. Verify if your chosen surgeon is in-network to reduce costs.

Dr. DeConti does accept insurance for FTM top surgery.  FTM top surgery is considered a reconstructive procedure and is covered by some insurance companies. Although more and more insurance companies are offering coverage for gender reassignment surgery, keep in mind that coverage will vary between companies, states, and plans.

The top surgery cost with insurance varies depending on the insurance plan, provider, surgeon, and location. Here’s a concise overview:

  • With Insurance Coverage:
    • If top surgery (gender-affirming chest surgery) is covered, insurance may pay for most or all of the procedure, but you’ll likely still face out-of-pocket costs like:
      • Deductibles: $500–$7,500, depending on your plan.
      • Copays/Coinsurance: 10–30% of the procedure cost, typically $100–$2,000.
      • Non-covered services: Cosmetic refinements or out-of-network surgeons may add $1,000–$5,000.
    • Total out-of-pocket costs, average cost of top surgery, often range from $0–$5,000, with $1,500–$3,000 being common for insured patients, assuming the surgery is deemed medically necessary and pre-authorized.

Dr. Robert DeConti is an excellent choice for FTM top surgery due to his extensive experience in gender-affirming surgeries, commitment to personalized care, and emphasis on achieving aesthetically pleasing results. With over two decades of surgical expertise, Dr. DeConti has developed a deep understanding of the unique needs of transgender patients, making him a trusted surgeon for those seeking chest masculinization.

 

Dr. DeConti takes a patient-centered approach, ensuring that each individual receives a tailored treatment plan based on their body type, goals, and preferences. He offers various techniques, including double incision mastectomy and keyhole surgery, to provide the best outcomes for his patients. His meticulous attention to detail and dedication to minimizing scarring help deliver natural-looking, masculine chest contours.

 

Moreover, Dr. DeConti’s practice emphasizes compassionate care, with a supportive and welcoming environment for transgender patients. He prioritizes open communication, answering all questions and addressing concerns throughout the process, from consultation to post-operative care. His commitment to safety and patient satisfaction, combined with his surgical skill, makes him a top choice for those looking to undergo FTM top surgery and achieve life-changing results.

 

For those seeking a skilled and empathetic surgeon for FTM top surgery, Dr. DeConti is an outstanding choice.  Contact DeConti Plastic Surgery at 804 673-8000  and schedule your consultation today!

Learn More:

Cleveland Clinic: FTM Top Surgery

Mayo Clinic: Masculinizing Surgery

Liposuction

804 673-8000