FTM top surgery is a gender-affirming procedure intended to remove mammary gland tissue and sculpt the chest to create a masculine contour. This surgery offers physical alignment with gender identity and helps alleviate gender dysphoria. It focuses on creating a smooth, symmetrical chest appearance that complements the patient’s body proportions. The surgeon removes most of the breast tissue and excess skin, often repositioning and resizing the nipple and areola complex to achieve a natural, masculine aesthetic.
Pre-Surgical Requirements and Planning
The journey toward surgery begins with a thorough evaluation process to ensure a patient is physically and psychologically ready for the procedure. A formal diagnosis of gender dysphoria is a prerequisite, typically established through a psychological assessment by a licensed mental health professional. This assessment also confirms the patient’s capacity to make a fully informed decision and provide consent for the treatment.
Medical clearance requires a review of the patient’s overall health to ensure any existing medical or mental health concerns are well-controlled. During the surgeon’s consultation, aesthetic goals are established, and the surgeon evaluates the patient’s existing anatomy, including chest size and skin elasticity. This anatomical assessment directly influences the choice of the most appropriate surgical technique.
Understanding the Surgical Approaches
The specific technique used for FTM top surgery is determined by the patient’s chest size, skin quality, and desired scar outcome. The Double Incision Mastectomy with Free Nipple Grafts (DI) is the most common technique, particularly for individuals with larger chests or those with reduced skin elasticity. This method involves making horizontal incisions along the lower boundary of the pectoral muscles to remove the maximum amount of breast tissue and excess skin.
The nipple and areola are completely removed, reshaped to a smaller, more masculine size, and then reattached as a free graft to the newly contoured chest. This approach ensures a flat chest with precise nipple placement, though it results in two prominent horizontal scars. The Keyhole or Peri-Areolar technique is suitable only for patients with a very small chest size and excellent skin elasticity.
The Keyhole technique uses a small incision made along the bottom edge of the areola to remove the underlying glandular tissue, often with the assistance of liposuction. Since no significant skin is removed, the existing skin must be elastic enough to naturally tighten down to the new chest contour over the following months. This less-invasive procedure offers the advantage of minimal scarring, which is often hidden around the areola, and has a higher chance of preserving nipple sensation.
The Day of Surgery and Immediate Post-Operative Care
The surgical procedure is performed under general anesthesia and typically lasts between two to three hours. Once the patient is asleep, the surgeon makes the predetermined incisions and meticulously removes the breast tissue and any necessary excess skin. The remaining chest tissue is then sculpted to create the desired masculine contour, focusing on the shape of the underlying pectoral muscles.
If the Double Incision technique is used, the resized nipple grafts are carefully secured in their new, higher position on the chest. After tissue removal and contouring, the incisions are closed with sutures, and the patient is moved to the recovery room. Small surgical drains, one on each side, are inserted beneath the skin as part of immediate post-operative care.
These drains are essential for removing excess fluid, such as blood or seroma, that can accumulate in the surgical space. A compression vest or binder is applied to minimize swelling and support the newly formed chest shape. Patients are monitored for a few hours and typically return home the same day with pain medication and antibiotics to manage discomfort and reduce the risk of infection.
The Healing Process and Long-Term Results
The initial recovery phase requires strict adherence to rest and activity restrictions for the first few weeks. The surgical drains are usually removed during the first post-operative appointment, which often occurs about one week after the surgery. The compression binder is worn for approximately one month to help the skin adhere to the chest wall and reduce swelling.
Patients can generally return to light, non-strenuous activity after one to two weeks, but full physical activity and heavy lifting are restricted for about six to eight weeks. Swelling and bruising are expected and will gradually subside, though complete resolution of swelling can take several months. Once the incisions are fully closed, typically around three weeks post-surgery, scar care can begin, often involving massage and the use of silicone sheets or gels to help the scars soften and fade.
While the immediate results are visible, the final chest contour takes about six to twelve months to settle as the deep swelling resolves and the scars mature. Changes in sensation are common; numbness or tingling around the surgical site may last for months, and while sensation can return, some areas may experience permanent alteration. In some cases, a minor revision surgery may be necessary later to refine the contour, adjust the size of the areola, or address any excess skin at the ends of the incision lines.