Should You Consider FTM Top Surgery?

Female to male (FTM) chest gender reassignment or “Top” surgery refers to surgery used to contour the chest to a more masculine shape. It is one step that can be involved in the process of gender affirmation. The procedure aims to contour the chest such that it has a more masculine appearance.

While binding is an effective form of flattening chest tissue, it can cause pain, and respiratory and skin complications when used inappropriately or over long periods of time. Top surgery can improve physical and psychological health and wellbeing outcomes for those who seek it. For many people, this is the only surgery undertaken.

Other benefits include:

  • Improved confidence and self esteem
  • Reduced social and/or physical dysphoria
  • No need for breast strapping

Dr David Boudana is recognised as one of the leading specialised surgeons working with “top surgery” patients and performs gender reassignment chest and breast surgery.

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Are you a good candidate for FTM Top Surgery?

FTM top surgery is a solution for transgender men or non-binary transgender people who want to reduce or remove their breasts, to achieve a more masculine physique.

Special criteria need to be met to even consider FTM top surgery. This includes, but is not limited to:

  • Single letter of referral from a qualified mental health professional
  • Capacity to make a fully informed decision and to consent for treatment Age of majority (18 years of age or older)
  • If significant medical or mental health concerns are present, they must be reasonably well controlled
  • Persistent, well-documented gender identity disorder
  • You must not be smoking for at least 6 weeks before and after this surgery.

Masculinising hormone therapy is not a pre-requisite to qualifying for a mastectomy; however, if you are starting testosterone Dr Boudana recommends waiting at least 6 months for physical changes to stabilise.

Are You A Candidate?

Our Breast Enhancement Cosmetic Self Evaluation can help you decide if breast lift with augmentation is the right procedure for you.

What are the procedure techniques and scars

Top surgery involves removal of the breast tissue and skin from the chest wall. The type of operation suitable for each patient depends on the amount of both tissue and skin they have to be removed, as well as the elasticity of the skin.

The different types of technics that are available and can be performed are:

Keyhole Top Surgery

An ideal choice for trans men who have a small chest. A small incision made along the bottom of the areola to remove the breast tissue and the scarring is quite inconspicuous. Most men also opt for nipple resizing, which can be done in a few different ways but the nipple stalk is usually left intact which helps retain sensation.

Peri-Areolar Top Surgery

A very good option for trans men with A to B-sized chests and good skin elasticity. Concentric incisions are made around the areola, and breast tissue is removed. The skin is brought together like a drawstring purse and connected to the outer edge of the downsized areola, similar to a drawstring purse. which may be downsized. The nipple stalk is usually left intact which helps retain sensation.

Double Incision Top Surgery

The best choice for medium and larger chested trans men. Horizontal incisions along the bottom contour of the chest muscles are made, and the nipple and areola are removed, then resized and grafted back on. Sensation in the nipple and areola is usually compromised, if not completely numbed.

  • Anaesthesia:
    General
  • Duration:
    2 to 3 hours
  • Pain level:
    4 to 6/10
  • Recovery time:
    2 to 4 weeks
  • Resumption of physical activities:
    6 weeks

Why choose Dr. Boudana for your top chest surgery?

With several hundred successful gender reassignment surgeries under his belt, Dr. Boudana is highly experienced in this procedure. If you are considering sex reassignment procedure, Dr. Boudana offers a personalized approach that will meet your expectations.

Procedure details

In the consultation, Dr. Boudana will be attentive to your expectations.

At your consultation, Dr Boudana will go over your health history, discuss what you hope to achieve with FTM top surgery, and perform a physical examination.

During your exam, your breast health and appearance will be carefully assessed.

This includes checking for any tissue abnormalities, lumps or asymmetries. Dr Boudana will also measure the size, shape, positioning, and symmetry of your breasts. These details can help him design a custom surgical plan for your FTM top surgery, which he will discuss with you in detail.

Photographs will be taken of your breasts to further assist with treatment planning and to evaluate the improvement achieved in your post-operative results. These images are always kept strictly confidential within our practice.

More information about your procedure and recovery will also be explained, including what to expect after surgery and possible complications you should be aware of. Throughout your consultation process, you are encouraged to ask questions and express any concerns you may have.

It is vital to have a full understanding of the likely outcome for your own chest, and go into surgery with both positive health and attitude. It is imperative that you are not smoking before or immediately after this surgery, as this may have major complications and a much less satisfactory outcome.

FTM top surgery will vary depending on the type of mastectomy undertaken – either a subcutaneous mastectomy or a total mastectomy with nipple/areolar repositioning. These operations have different outcomes, particularly in terms of scars and nipple sensation; however, in creating a more masculine appearance, surgery always aims where possible, to preserve as much nipple sensation as possible, with as minimal scarring as possible.

Regardless of which technique is employed, the procedure generally involves a combination of the following:

  • Mammary glands and fatty tissue are removed
  • Elimination of the inframammary fold
  • Removal or tightening of excess skin
  • Reconstruction and repositioning of the nipple and areola so that it is more proportionate and aesthetically pleasing to the chest

Note that the muscles of the chest are not altered. After surgery drains will be inserted to remove any excess fluid/blood.

After surgery, you will receive a personalized follow-up. Our nurses will also be available to you. You will be given a postoperative instruction sheet when you are discharged as well as a prescription for pain medication.

All our follow-up appointments are free of charge for the first year after your surgery.

With hundreds of successful top surgeries under his belt, Dr. Boudana will guide and advise you to achieve the desired results.

Results

The results of top chest surgery are immediately visible.

Your breasts heal over a period of time after chest surgery. Initially there will be some swelling and bruising, and your breasts may look larger and fuller than the final result. Most of the swelling subsides over the first week or two, and will resolve by about 6 weeks. After 8 weeks, we recommend the use of a Scar Management Cream, available for purchase at the clinic. This is to be gently massaged in the incision line twice daily. The friction of massage helps in the maturation and fading of any scars.

Swelling will generally fully subside after 3 months.

Female to male top surgery
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** The photos and/or videos are not presented as a guarantee of result. The results may vary.
** Patients gave their consent for the publication of photos and/or videos.

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During your consultation, Dr. Boudana will take the time to address your specific goals and to discuss your treatment options. He will determine if you are a good candidate for top chest surgery and review the results that can be realistically achieved. He will also help you determine which complementary procedures may benefit you the most.