Candidates for MTF Top Surgery or FTM Top Surgery
Top surgery may be part of gender affirmation therapy for people with gender dysphoria, a condition in which the gender assigned at birth does not match a person’s gender identity. Patients with ongoing and well-documented gender dysphoria may qualify for top surgery if they have lived as the gender that they identify with for at least one year. You must be in good physical and mental health for optimal results. Individuals interested in transgender top surgery must have the legal and cognitive ability to make medical decisions.
Testosterone therapy may not be necessary for transgender men seeking chest masculinization surgery. Some plastic surgeons require a year of estrogen therapy to achieve maximum breast growth before placing an implant for MTF top surgery.
MTF Top Surgery Procedure Details
Male-to-female top surgery or chest feminization may involve breast augmentation with breast implants, fat grafting, or a combination of the two. Dr. Mabourakh offers silicone and saline breast implants in various sizes, shapes, widths, and profiles. The implant profile depends on your anatomy and desired results. Fat grafting with or without breast implants involves harvesting fat from another body area and transferring the purified fat cells into the breasts.
Breast implants should fit the width of your chest for the most natural-looking results. That way, the breast implant size and shape don’t overpower your figure. Anatomically shaped implants are tapered, with more volume in the bottom behind the nipple-areolar complex and thinner in the upper pole of the breast, creating a natural breast slope. Breast implants for MTF top surgery may be placed over or under the pectoral muscle. Dr. Mabourakh will discuss your implant options during your consultation.
Chest feminization surgery may take one to two hours and is typically outpatient, meaning you can go home that day. You will have general anesthesia or IV sedation, so you’re asleep during the procedure and will wake up with stitches and a surgical bra after MTF top surgery.
FTM Top Surgery Procedure Details
Chest masculinization with female-to-male top surgery may involve removing fatty, glandular, and skin tissues from the breasts. The procedure eliminates the inframammary crease under the bottom of the breasts and contours the chest to accentuate the pectoral muscles. The nipple-areolar complex is decreased, repositioned, or removed entirely depending on the patient’s preferences.
The surgical technique for FTM top surgery depends on the amount of breast tissue present. Dr. Mabourakh may recommend a reduction in breast tissue and a breast lift as needed along with an areola reduction. The technique will greatly depend on your needs.
This masculinizing surgery may involve a double incision mastectomy for transgender men with larger breasts. Dr. Mabourakh creates incisions beneath and above each breast to remove glandular tissue and some skin. This surgical approach combines breast reduction with breast lift and elevates the nipple location and reshapes the nipple-areolar complex to make the nipples more oval and smaller. Double incision mastectomy removes all nipple sensations because the nerves are severed and reattached higher on the chest wall.
Subcutaneous mastectomy is another option to preserve nipples in transgender individuals with smaller breasts. Dr. Mabourakh makes an incision under each breast to remove breast tissue but does not remove skin typically. The nipples and areolas remain in place but might be reshaped. This technique preserves nipple sensations.
Periareolar mastectomy is also used for small- to medium-sized breasts and involves a small incision around the areolas to remove breast tissue, and skin is not usually removed. The nipple-areolar complex remains attached and maintains feeling.
FTM top surgery requires general anesthesia or IV sedation and may take two to three hours. It is an outpatient procedure. When you wake up, you will have a special garment, stitches, and surgical dressings.
Removing the breast tissue does not eliminate the risk of breast cancer. Transgender men with a family history of breast cancer or higher risk may need a baseline mammogram before top surgery and continued monitoring of the remaining breast tissue.