What is FTM Top Surgery?
Female to male top surgery, also known as FTM Surgery, is aimed at transgender men who want to achieve a more masculine-looking chest that appears flatter and contoured. There are several types of FTM top surgery. The most common procedure involves surgically removing breast tissue, also known as a mastectomy, and eliminating excess skin and fat. The nipple and areola complex is often repositioned to achieve a more natural look. Many trans men prefer smaller areola dimensions, which can be surgically reduced as part of an areola reduction procedure. The most appropriate type of female-to-male top surgery will depend on the existing breast size and the skin and soft tissues inherent elasticity surrounding the breasts.
Previous treatments for achieving a flatter chest often involved chest binding. This method of flattening the chest often causes injury to the skin and is linked with difficulty in breathing due to the tightness of the binder. FTM top surgery is considered the most effective cosmetic surgery procedure for trans men wanting to achieve a flat-looking chest.
What are the benefits of FTM Top surgery
Female-to-male top surgery is increasingly requested by trans men who want to achieve a masculine-looking chest with natural contours. FTM surgery is one of the best ways to treat symptoms of gender dysphoria. Gender dysphoria is linked with feelings of significant distress and is most often due to a mismatch between a person’s gender identity and biological sex.
Female to male gender surgery is highly effective for treating gender dysphoria. Anxiety and depression are frequently associated with this condition. FTM top surgery has been proven to lead to a significant boost in confidence and emotional well-being. This helps many trans men have an improved quality of life and a better ability to form more robust personal and professional relationships.
Am I a good candidate for Female to Male Surgery?
FTM top surgery is ideal for trans men diagnosed with gender dysphoria, affecting their quality of life. Current guidelines recommend that trans men live in their chosen gender for at least 12 months and have completed an in-depth psychological assessment before being considered for the female-to-male top surgery. All patients should be aged over 18 before they can be considered for FTM top surgery. There are certain preoperative steps which patients should take to ensure they are optimally prepared for surgery. Smokers should stop at least four weeks before surgery. Any significant medical conditions, including hypertension and diabetes, should be well controlled. Being significantly overweight increases the risks of surgery, and we advise your body mass index should be 25 or below. Your surgeon must also be fully assured that you are in the best possible mental condition prior to FTM surgery. As with any type of surgical procedure, it is important to have realistic expectations of what female to male gender surgery can achieve.
Female to male procedure details
FTM top surgery involves several different surgical techniques to create a more masculine and flatter-looking chest. The most appropriate surgical method used will vary based on the existing size of the breasts, the size of the nipples and areola and how much skin laxity is present. Those who have lost significant amounts of weight may have significantly more skin laxity, requiring a more invasive procedure. Female-to-male top surgery is most commonly performed under general anaesthetic, and the procedure takes approximately three hours to carry out. FTM top surgery is an outpatient procedure which means you’ll be able to go home later the same day once you have recovered from the anaesthetic effects.
Double incision top surgery with free nipple grafting
This is the most commonly performed type of FTM talk surgery. The procedure involves surgical removal of the nipples and areola and reducing their size if required. Incisions will then be made to remove breast tissue as part of a mastectomy procedure. Liposuction is then used to remove excess fat. Excess skin over the breasts is also removed to tighten and flatten the chest. Your surgeon will reconstruct the chest and minimise the appearance of indentations or puckering with the meticulous surgical technique. The detached nipple and areola complex are then fixed back in the new position on the flat chest.
Periareolar top surgery
Periareolar top surgery, also known as double incision surgery, is ideal for trans men with smaller chests. The procedure involves a circumferential incision around the margins of the areola. A second incision is then made around the first incision. Any breast tissue is surgically removed, with liposuction performed to remove excess fat. The two edges of the skin are then stitched back together, which helps to create smaller-looking areolas.
In some cases, your surgeon may recommend inverted T surgery, especially if you have a larger chest with extra skin. The incision for this procedure involves making an anchor-shaped incision, and the nipple and areola are not affected. This procedure preserves nipple sensitivity, although an extra vertical incision will be required as part of the technique. This technique is often preferred by trans men who would like to preserve nipple sensation, and the risk of nipple loss is minimised. A drawback of the procedure is that some residual tissue must be preserved to ensure adequate blood supply to the nipple. This means the surgeon may be unable to completely flatten the chest compared with double incision periareolar top surgery.
Keyhole top surgery
Keyhole top surgery is ideal for trans men with smaller chests and tighter skin. The procedure involves making a small incision at the lower margin of the areola. The areola remains attached to the underlying breast tissue. Breast tissue is then carefully removed. Liposuction may be performed to remove excess fat. As with other types of FTM surgery, the areola size can be surgically reduced if necessary. This procedure helps to preserve nipple sensitivity with the added benefit of achieving a good level of chest flatness.
What does recovery after FTM top surgery involve?
After surgery, it is normal to feel mild to moderate discomfort and stiffness. Any discomfort is most commonly felt during the first few days after FTM surgery. You will be prescribed painkillers by your surgeon to help keep you comfortable throughout your recovery. Most patients can return to work approximately two weeks after surgery, although this depends on the type of surgical technique used as well as your overall state of health. Strenuous activity must be avoided for six weeks after surgery. Most pain and swelling will resolve over the first few weeks after surgery. We would advise sleeping on your back for at least two weeks to avoid putting any pressure on your chest. Your surgeon will provide customised recommendations for minimising scarring after FTM top surgery. If you fail to follow your surgeon’s instructions in full, you may increase the risk of developing unsightly scarring after surgery. As part of the surgery, your surgeon may insert wound drains to prevent seroma or haematoma formation. These will be removed approximately 3 to 4 weeks after your procedure.
How much does FTM top surgery cost?
Every patient is different, and the cost of FTM top surgery in London will vary depending on the surgical technique used. Double incision top surgery with free nipple grafting will cost more than keyhole top surgery. Once you have consulted with your surgeon, you will receive a comprehensive quotation from your dedicated patient coordinator. FTN top surgery cost includes your surgeon’s fee, anaesthetist fee and facility fee. Postoperative checkups are included as part of the surgical package.
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What are the potential risks of FTM top surgery?
As with any type of surgery, there are certain risks involved with FTM top surgery. When performed by an experienced plastic surgeon, the risks of surgery are considered minimal. Your surgeon will discuss the potential risks and complications associated with FTM surgery at your consultation, which may include:
- Bleeding and haematoma formation – a blood collection beneath the skin at the surgery site.
- Seroma – straw-coloured fluid collecting at the site of surgery.
- Wound infection.
- Nipple necrosis or death of nipple
- Loss of nipple grafts.
- Altered skin sensation.
- Altered nipple sensitivity.
- Anaesthetic risks including anaphylaxis
- Deep vein thrombosis and pulmonary embolism
What are the benefits of FTM surgery?Female to male surgery is the ideal procedure for treating gender dysphoria to help trans men live happily in their chosen gender. Most people who have FTM top surgery often tell us how they have developed a significant boost in self-confidence once final results have appeared within three months. The procedure helps trans men to develop a better connection with their bodies and, by doing so, appreciate their preferred gender identity. Many mental health conditions, including anxiety and depression, can be effectively relieved with surgery. Trans men often develop confidence in socialising and achieved success in their professional careers and with more confidence in dating people.
If you want to achieve a more masculine chest profile, FTM top surgery can help eliminate female breasts. Centre for Surgery is renowned as an expert clinic for gender surgery, and our surgeons are ideally placed to assist you in your journey to live happier lives in your preferred gender.
Can I get transgender chest surgery on the NHS?Although it is possible to get FTM top surgery on the NHS if you meet all the criteria for treatment, NHS waiting lists are getting longer with each year. This makes the possibility of getting treatment for female to male gender reassignment virtually impossible.
Choosing Centre for Surgery to carry out your FTM top surgery means you can have treatment promptly and without the stress and anxiety of long waiting lists.
Is top surgery painful?It is normal to expect mild discomfort for approximately 3 to 5 days after FTM top surgery. Any discomfort can be easily controlled with over-the-counter painkillers such as paracetamol. It is normal to experience swelling of the chest and stiffness; these symptoms will take 3 to 4 weeks to settle down. It is important to remember that any residual swelling may take up to 3 months to disappear after top surgery. All patients have access to our experienced nursing team for any questions or concerns they may have about their healing and recovery.
What scars can I expect after transgender chest surgery?It is normal to have scars after any type of surgery as incisions are being made. Scars from a properly made incision most commonly appear as a thin, slightly raised line above the skin. With time the scar will flatten and become a pale white colour. The nature of the scars following FDM top surgery depends on the type of surgical method used to flatten the chest. The Perry areola and keyhole top methods are less invasive than double incision top surgery. These methods, therefore, result in less obvious scarring.
Fortunately, most scars will eventually fade over time, but how long this takes will differ between people. Your surgeon may recommend you use bio oil to massage the scars to improve their appearance. Certain activities should be avoided in the postoperative period, including tanning beds, smoking and traumatising the surgical sites by scratching or rubbing them. These adverse factors may result in scars appearing excessively prominent.
Keloid scars sometimes occur in certain people. Keloid scarring is much thicker than most common types of scars. They are often highly visible and seen as a cosmetic nuisance, although they may cause symptoms, including pain, particularly if they rub on clothing items. Wound infections sometimes result in excessive scarring and will require a longer period of time for them to flatten. Centre for Surgery is well known for its expertise in scar management and have access to the full range of treatments for improving the appearance of surgical scars.
When can I see the final results of FTM top surgery?Once post-operative swelling begins to settle down, you'll begin to see the final results of surgery. FTM top surgery is designed to produce a flatter, more masculine-looking chest with defined contours. Scarring is inevitable with any type of surgical procedure, including top surgery. The minimally invasive methods of top surgery, including keyhole top surgery, involve less scarring than double incision top surgery. Some patients may notice they have a change in nipple sensitivity or a complete loss of sensitivity depending on the type of surgical method used to achieve a flatter chest profile.
Once full recovery has occurred from transgender chest surgery, trans men can begin to enjoy the procedure's benefits. Symptoms of gender dysphoria are effectively alleviated, allowing Trans men to feel better connected with their new preferred gender identity. A boost of self-confidence and emotional well-being can be expected following top surgery.
What To Expect
Trans men who are considering having FTM top surgery will first need to have a consultation with an expert plastic surgeon to determine suitability for top surgery. The consultation will involve a detailed discussion about your needs and desires and whether your expectations are considered realistic.
Your surgeon will discuss the risks and complications of surgery and how these are minimised. Your surgeon will also take a detailed medical history, including any previous operations you may have had and what medications you are currently taking, including herbal supplements. This information will be used to determine your fitness for top surgery.
Once your surgeon decides you are appropriate for top surgery, we would recommend you reflect on all aspects of the procedure during a two-week cooling-off period. If you have any questions about any aspect of the procedure, please feel free to reach out to us to book a follow-up consultation so that you can make an informed decision about transgender chest surgery.
Before your procedure
Once your surgery has been booked, you will be assessed by a preoperative nursing team member to ensure you are in the best possible condition for FTM top surgery. We would recommend you stop smoking at least four weeks before surgery as smoking is associated with a higher risk of postoperative complications, including wound infection. You should also avoid taking aspirin or any medicines that contain aspirin to reduce the risk of postoperative bleeding. All patients having a general anaesthetic will be required to fast for six hours prior to the procedure for food and up to 2 hours before the procedure for clear fluids. Clear fluids include still water and black tea or coffee.
All FTM top surgery occurs at our state-of-the-art Baker Street clinic in Marylebone under a general anaesthetic. Once you have been placed under anaesthesia, the surgeon will make perform a mastectomy using one of three surgical techniques. Double incision top surgery with free nipple grafting, periareolar top surgery or keyhole top surgery. The exact technique used will depend on your expectations for treatment and will be determined at your consultation. Top surgery takes approximately three hours to perform, and once the procedure is finished, you will recover in our day ward. Once you are medically fit for discharge, a Family member or friend will need to take you home and look after you for the first 24 hours after top surgery.
After your procedure
You will need to follow all preoperative instructions given to you by your surgeon to ensure you get optimal healing after FTM top surgery. If you do not follow the instructions as recommended, the risk of complications occurring is significantly increased.
We would recommend taking two weeks off work after top surgery to allow you time to rest and heal properly. You should avoid any strenuous exercise, including going to the gym and sports for six weeks after surgery. After surgery, a compression garment will be applied to your chest to maintain its new flattened contour. Most patients feel they have completed full recovery by six weeks after surgery. As with any type of procedure Centre for Surgery, you will have access to our expert nursing team at any time if you have any questions or concerns about your healing and recovery.