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Female to Male (FTM) Top Surgery

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Female to Male Top Surgery Overview

Our goal is to help you feel comfortable throughout your transition and listen closely to your aesthetic goals to provide you with the life-changing transformation you desire.

At Richmond Aesthetic Surgery, we are proud to help patients as they transition into the gender with which they most identify. Our board-certified plastic surgeon, Dr. Neil Zemmel, and his team are experienced in performing female to male top surgery, which is intended to reduce the female breast to create a more masculine chest appearance. Transgender patients can trust that when they seek Dr. Zemmel for their sex reassignment, they are receiving the most compassionate, supportive care possible.

With his extensive training and surgical expertise, our surgeon will work with you to determine the best treatment plan for your unique needs.

The FTM Top Surgery Procedure

Our team will educate you on what to expect throughout the process of your female to male (FTM) transgender breast surgery. During your consultation, Dr. Zemmel will talk with you in detail about what you hope to achieve through surgery. This along with a review of your medical history and physical needs will allow Dr. Zemmel to determine what is necessary to help you obtain your goal results.

FTM top surgery procedures typically entail a breast reduction and often liposuction, as well, for further fat removal. The best technique for each patient – and extent of their procedure – will depend on the amount of breast tissue present. Once the fatty tissue has been removed, excess skin is excised and the area is tightened for a more toned chest appearance. If a large amount of breast tissue is removed, the nipple and areola may need to be relocated to a higher position. More details about your incision options can be found below.

FTM Top Surgery Incision Techniques

buttonholeButtonhole: It involves two incisions made along the inframammary fold (the crease under the breast) and one around the areola. This allows for breast tissue removal, relocation of the areola to a higher position, and excess skin removal. The areola is resized while staying attached by a pedicle, which allows the nerves and blood supply to stay connected and preserve sensation. To reposition the nipple and areola, a circular incision is created at the desired new location. The areola and nipple are then moved underneath the skin and pulled through the new opening where it is sutured into place. Liposuction may also be used to refine the contour of the chest.

double-incisionDouble Incision: With a double incision technique, a periareolar and inframammary incision is made similar to the buttonhole technique. This again allows breast tissue removal and excess skin removal. With this technique the nipple is completely removed and grafted (free nipple graft) to its new location. Liposuction may be used to contour the chest as well. This technique is typically best for medium to large starting breast sizes.

wise-patternWise Pattern: The wise pattern technique is similar to a standard breast reduction incision pattern. A periareolar, vertical and inframammary incision are made. This maximizes access to the breast allowing aggressive breast tissue and skin removal. This nipple and areolar may be grafted (free nipple graft) or may be relocated higher on the chest with on a pedicle. Liposuction may be used to contour the chest as well with this technique. This technique may be needed for patients with large breasts.

periareolarPeriareolar: When the periareolar approach is employed, a small incision is made around the border of the areola, and a second, larger circular incision is made, allowing for the skin to be removed. This technique is often best for those with smaller chests and good skin elasticity—it often includes liposuction as well. Once the skin has been removed, a “pursestring” technique is then employed to close the skin and areola. This location typically heals well and is easily concealed since it is on the line between the dark areola skin and the regular skin of the breast.

minimal-scarMinimal Scar: Patients with small chests and great skin elasticity are often candidates for the minimal scar technique, which is the least invasive of all techniques. It entails small incisions made on the side of the chest and on a small edge of the areola. Similar to gynecomastia surgery, the minimal scar technique typically uses liposuction to extract fat from the chest for a more masculine appearance with minimal scarring. This technique is used in patients who require minimal breast tissue and skin removal.

Recovery from FTM Top Surgery

As a proud supporter of the LGBTQ community, Dr. Zemmel and his team are committed to helping transgender patients feel comfortable and confident in their bodies.

Recovery from FTM top surgery will vary based on the individual. A compression garment is often worn to help reduce swelling and improve healing. Drains are removed within the first couple days following your surgery.

Swelling and bruising are normal but should gradually fade as your body heals. Most patients feel comfortable returning to work and their normal routine after about five days. However, strenuous activities should be avoided for several weeks. More specific details of your recovery will be discussed with you during your consultation.

Your Results

As your body continues to heal, you can gradually see your new, more masculine breasts taking shape. Due to mild swelling within the weeks following surgery, your breasts may appear fuller than they ultimately will be when fully healed. As a result, it will take some time before you can see what your final outcome will look like. It can take around three months to see your final results.

Like any breast surgery, scarring from FTM top surgery is possible, but Dr. Zemmel does his best to minimize scars by placing incisions in easily concealed areas, such as around the areola or in the natural crease underneath the breast. Over time these scars should lighten and fade.

I came to RAS for a 2nd opinion consult, FTM breast reduction. I had previously had the surgery at another location and wasn’t happy with my results. The staff at RAS made me feel comfortable and at ease from the moment I arrived. My wait time to reach the consult room wasn’t even long enough for me to make a cup of coffee! I was roomed in a nice consult room w/ a sofa and chairs, told what to expect as far as the consult process and did not even wait 15 minutes for Dr. Zemmel to arrive. I was given a couple options for my revision and had a quote for both given to me that day. I wanted to think about which way I wanted to proceed and did not feel any pressure or obligation from the staff to make my decision that day. Postoperatively, I received the same awesome experience. I am so happy with my results and know that I have found something exceptional in the team at RAS. I wish I would have found them for my original surgery!!

Tommy Koch

February 24, 2016


FTM Top Surgery Risks

As with any surgical procedure, there comes some degree of risk with FTM top surgery. In addition to milder symptoms, including bruising and swelling, some rare complications are possible. These include bleeding, infection, loss of nipple sensation, and breast asymmetry. Should you have any issues, we will do our best to help correct the issue.

Contact Richmond Aesthetic Surgery

As proud supporters of the LGBTQ community, Dr. Zemmel is committed to helping transgender patients feel comfortable and confident in their bodies. By offering procedures like FTM top surgery, he is able to assist patients as they transform into their true gender identities. To learn more about FTM top surgery, please contact us to schedule your consultation and get started.