Female to Male Transgender Surgery (FTM)

transgender top surgeryGender transition is a brave and sensitive decision. Dr. Vaniver’s superior level of skill and compassionate care has been extremely helpful for individuals who have made this choice.

Female to Male Chest Transition Surgery (FTM) refers to the process that converts female breasts to a male chest form. This procedure involves removal of breast tissue, removal of excess skin, obliteration of the inframammary fold, repositioning of the nipple areola complexes to the male position, and placement of scars at the inferior level and lateral sweep of the pectoralis muscle.

The best candidates for FTM surgery are those who are under the care of a supportive, knowledgeable mental health care provider and an experienced endocrinologist. The ideal candidate has been living as a male for one year. They have been receiving testosterone for approximately one year. If they have elected not to use testosterone, they are supported by their mental health professional.

Alternative treatments to FTM Chest transition Surgery include breast binding and use of testosterone, which will reduce breast size to some degree. Weight loss may also help reduce breast size.

In order to get ready for FTM surgery, you will want to be as close to your ideal body weight as possible. If defined pectoralis muscles are important to you, you may wish to embark on an exercise program to develop your chest before surgery. You must be smoke- free for a month before surgery. It is also recommended that you not use other recreational drugs before surgery. Dr. Vaniver will review your medication list with you before surgery. On the night before surgery, you will take a shower using Hibiclens, a disinfectant cleanser.

Depending on your body frame and breast size, two different techniques may be employed. If you have small breasts and the nipple areola sites close to the final desired position, a periareolar approach may be used, in which the nipple areola is left attached to the breast, and the skin envelope is cinched around the areola. The upside is that your nipple areola may retain sensation, and the downside is that you may have some pleating of the skin around the areola. There is also a slightly higher rate of complication with this technique. If you have large or droopy breasts, a free nipple graft technique will be used. With this technique, the nipple areolas are reduced in size to a male diameter, and then removed. The breast tissue is removed with a horizontal incision that lies in the lower edge of the pectoralis muscle and tracks laterally across the chest wall. The site for the new nipple areolas is selected, and the top layer of skin is removed. The nipple areolas are then sutured in this area as grafts. Yellow bolsters are sutured over the grafts to hold them in position and to prevent fluid build-up beneath the grafts. The grafts obtain new blood supply from the deep tissue beneath them. The upside is that the scars are well placed and enhance the appearance of the pectoralis muscle. The downside is that the scars are larger than with the periareolar approach and the nipples will lack sensation. With either technique, drains are placed in both chest pockets. Postoperative dressings and a postoperative binder will be applied.

The surgery takes 3-4 hours. General anesthesia is used. If you have a known history of postoperative nausea or vomiting or a history of motion sickness, you may be give n a scopolamine patch to place behind your ear the night before surgery. Generally, you may go home the same day as surgery. Most patients return to work in 1-2 weeks.

You may shower the day after surgery. Remove all dressings except the yellow bolsters. Wash with gentle soap and water in the shower. You may get the drains and the bolsters wet. Apply Bacitracin ointment to suture lines and drain holes. Apply ABD dressings or mini or maxi pads over the incisions and drain holes and then apply your binder. The bolsters are usually removed a week after surgery. You may take a bath after the incisions are healed. This is usually about two weeks after surgery. You will wear your binder for 6 weeks after surgery. This will help to reduce swelling and to mold the final shape.

You will be given prescriptions for pain medicine, antibiotics, muscle spasm relief, stool softener, and Bacitracin. Continue the antibiotics as long as the drains are in.

Early after your recovery, you may walk slowly, so that you do not increase your blood pressure. This is important to prevent swelling, hematoma, and seroma formation. After 4 weeks, you may slowly increase your activity. After 6 weeks, you may resume your usual level activity, provided all wounds are healed.

Possible complications include, but are not limited to, bleeding, infection, wound separation, scar, hematoma, seroma, altered sensation, asymmetry, partial or total loss of the nipple areola complex, dissatisfaction with cosmetic results, and need for revision in the future. Possible revisions may include correction of asymmetry, removal of lateral dog ears, and revision of scars.

It will take approximately one year to see your final results. Weight changes, aging, and changes in hormonal status may affect your long term result.

Other surgeries considered by those who undergo FTM chest transition include penile reconstruction or monsplasty, and general body contouring surgeries.