Gender affirmation surgery, often referred to as gender affirming surgery or sex reassignment is a collective term that encompasses numerous surgical procedures performed on transgender men, women, and gender-nonconforming individuals. The goal is to make the individual’s outward appearance reflect their innate gender identity. 

This article provides an overview of the various components of gender reassignment, including FTM top surgery, MTF top surgery, and facial feminization. 

Gender Affirming Surgery – Female to Male Top Surgery 

FTM top surgery, short for “female-to-male top surgery,” refers to surgeries that transform feminine breasts into a masculine chest. 

While the specific steps may vary, the procedure includes the following essential steps: removing the breast tissue, eliminating the inframammary fold, removing excess skin, and repositioning and resizing the nipple and areola.

The FTM top surgery is performed using two possible techniques — subcutaneous mastectomy and total mastectomy. 

  • Subcutaneous Mastectomy: The nipple and areolas are lifted, and the breast tissues are removed from underneath. The incision might be made under the areola or all around the areola, depending on the volume or skin tightening necessary. This technique is only suitable for patients with small breasts and minimal excess skin. 
  • Total Mastectomy: This technique involves longer incisions — one underneath the breast and extending behind the hollow of the chest muscle. The surgeon removes the breast tissues and contours the chest to provide a masculine appearance. The nipple and areola are also repositioned and made smaller in the normal masculine location. Nipple sensation is usually lost as a consequence of this surgery.

Gender Affirming Surgery – Male to Female Top Surgery 

MTF top surgery, also known as “male-to-female top surgery,” refers to surgeries that enhance the breasts to provide a feminine appearance. 

MTF top surgery is similar to breast augmentation with implants, but it includes some surgical differences due to the patient’s current chest size and appearance. The specialist plastic surgeon will discuss all of your breast implant options, including the materials, sizes, and placement options, and recommend the ideal technique for a natural appearance. 

Patients undergoing MTF top surgery generally need cohesive silicone gel breast implants because they resemble the natural texture and feel of breasts. 

Breast implants can generally be placed in front of the chest muscles (subglandular) or behind the chest muscles (subpectoral).

Facial Feminization 

Facial feminization is a collection of procedures that alter facial features to provide a softer, more feminine appearance. Depending on the patient’s unique goals and concerns, the procedure may involve changing the shape or size of various features, such as the jaw, nose, and forehead. 

The following are some of the procedures involved in facial feminization: 

  • Hair advancement lowers the hairline and provides fuller temple hair. 
  • Forehead contouring provides a more convex forehead with rounded corners and a softer transition into the hairline. 
  • Temporal fossa augmentation fills out the hollow temples around the eye sockets. 
  • Cheek contouring elevates the cheekbones. 
  • Rhinoplasty softens the masculine nasal features. 
  • Genioplasty makes the chin look softer and more oval-shaped. 
  • Laryngeal shaving reduces the prominence of the Adam’s apple. 

Each individual is unique and has unique expectations. As such, no template can completely encompass all of your expectations as a transgender individual. To that end, you must consult a specialist plastic surgeon who patiently discusses your goals, explores your options, and curates a personalized gender reassignment plan. 


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