Female to Male 'Top' Chest Surgery

Many people are born with female bodies that do not match the gender they identify with. This can cause years of distress and an intensely emotional journey of transitioning.

Female to male transitioning—what is it?

To address the emotional journey of gender affirmation, you may decide to transition. So what it is female to male transitioning? If you are a transgender male, it means you were born into a female body but truly believe you are male. But, because you have a female body, your family and society see you as female. This disconnect can cause you all sorts of emotional problems.

Life can be emotionally difficult. You can experience deep anxiety and depression as well as relationship problems and you may be diagnosed with the medically recognised condition called gender dysphoria. Children, teenagers and adults who develop this condition have an intense, persistent desire to become their identified gender by minimising the sexual features they were born with.

There are many ways you can unite your physical, emotional and social identities through FTM transitioning. FTM transitioning involves many things, including changing your name legally, hormone therapy and surgery to help you become more masculine. A common surgery for transgender men is female to male “top” (chest) surgery.

What Female to Male ‘Top’ Chest Surgery Involves

To undergo gender affirming chest surgery you will need a GP referral and a letter of assessment and support from a suitably qualified mental health professional. This letter needs to specify you meet the WPATH 7 criteria for surgery. Under 18 year old patients also need parental support and a “cooling off” period may be required between your consultation and surgery.

Two preoperative consultations are required with our specialist plastic surgeon, Dr Steve Merten.

FTM top surgery is a major procedure so let’s break down the surgical steps and techniques.

Once you have a date for the surgery, you will receive instructions to follow beforehand. These may include:

  • Do not drink alcohol or take blood thinners for at least two weeks before the procedure.
  • Do not eat or drink anything 12 hours before the operation.

You will be under a general anaesthetic for the operation which involves incisions in the chest area to remove skin and breast tissue, then sutures to close up the area.

There are several techniques your specialist plastic surgeon can use. Your surgeon will discuss the options with you and make a recommendation based on the shape and size of your breasts, areolas and nipples.

The following are the most common techniques.

Bilateral Mastectomy with Nipple Grafts “Full Scar” Surgery

A bilateral mastectomy is ideal if you have a larger chest and/or looser skin on your chest. During this surgical procedure, your surgeon makes either a curved or horizontal incision at the upper and lower edge of the chest muscle. They will then separate the skin to uncover the tissue and fat underneath to remove it. They remove the nipples, resize and reposition them correctly, and then graft them back onto the chest wall to give you a more masculine appearance. Then the skin is sewn into place just under the pectoral muscle.

A bilateral mastectomy usually takes three or four hours as an inpatient procedure so you will likely stay overnight in hospital.

You can expect to lose some sensation in your nipples after surgery and there can be significant scarring that fades over time.

Keyhole Surgical Technique “Short Scar” Surgery

Keyhole surgery is usually only done if you have a small chest with tight skin because there is no or minimal skin removed during this procedure. Your surgeon makes a small incision under the areola at its edge to remove the tissue. This procedure results in a very flat chest but there is less opportunity to reposition the nipple and areola.

This is usually an inpatient procedure that takes up to three hours to complete. There is minimal scarring and you will may have sensations in your nipples.

Bilateral Mastectomy with “Button Hole” Technique (Nipple Pedicle)

This is a variation of the full scar technique, but rather than the nipples being fully removed and reattached as grafts, part of it stays attached to its internal blood supply and is then brought out through a hole through the skin in the appropriate position. This is best for smaller chests who need more skin tightening then the “short scar” methods allow.

This technique leaves some tissue behind so the result can be a chest that is not as flat as the results of a nipple graft method, and may require a second surgery to address this.

Recovery and Aftercare

Because top surgery is a major operation, you need to time to recover. It is important to follow your surgeon’s post-operative instructions to minimise the risk of complications. In fact, the results partly depend on not having any issues while you recover.

When you leave hospital, you will be wearing a surgical binder to minimise any swelling. You will also receive a schedule of follow-up appointments.

During the first few days you will experience stiffness and pain, swelling and redness in the area. This is normal and will start subsiding soon enough. Take the pain medication so you can rest as comfortably as possible. Avoid lifting your arms too high or it can damage the stitches. You may shower over the dressings. You may sleep on your back or sides and do not need to be propped up on pillows. Stay at home and rest during this time.

You can return to school or work after two to four weeks and start doing light exercise from the fourth week and more strenuous exercise after week six.

It is important to encourage readers to consult with experts. Dr Steve Merten at Pure Aesthetics is one of the leading surgeons performing FTM top surgery. Contact us today to book a consultation with Dr Merten for specialist advice on surgery to help you transition to your affirmed gender.