For thousands of transgender men, top surgery is often more than enough to complete their transition and alleviate their dysphoria. Top Surgery eases the distress many transgender men experience from dysphoria by surgically removing the breast in a procedure clinically known as a ‘Subcutaneous Mastectomy.’ When surveyed, the top surgery procedure of chest masculinization was among the top interventions that can be undertaken in the FtM transition that enabled one to pass more readily and feel more comfortable in their desired gender.
If your a transgender man who is seeking to complete his transition through top surgery, allow Dr. Salgado and his team with the privilege to sculpt the man you were always destined to be.
Top surgery removes the breast in order to bring out the more masculine contours of your body. Depending on the size of your nipples and areolas, this procedure may involve the use of grafts, as well as reposition and resizing techniques to create a chest that comfortably corresponds to your gender identity.
Before the procedure
You will have the chance to discuss the procedure in great detail with Dr. Salgado during your initial consultation. It is essential to come in with an open mind and address any concerns you may have with Dr. Salgado. You will be required to provide a complete medical history and must have undergone at least one year of hormone replacement therapy (HRT). A letter, per World Professional Association for Transgender Health guidelines, is needed from your mental health therapist recommending you for top surgery.
Preparing for the procedure
If you are a heavy drinker or a smoker, it is advised that you stop for at least one month before and after your surgery. All hormonal therapy should be stopped for four weeks prior to surgery.
You must not eat or drink anything after midnight on the day of your surgery. You may be allowed to take a small sip of water in cases vital medications need to be taken prior to the procedure.
During the Procedure
Two forms of anesthesia are available for our patients; general anesthesia and intravenous sedation. Based on the current state of your health, Dr. Salgado will make the best choice to ensure you are comfortable during surgery. In addition regional blocks of anesthetics by our anesthesia team have brought significant pain relief to our transmen following their chest procedures particularly if the regional anesthetic block is given prior to surgery.
Currently the most common form of chest masculinization surgery in the world is the double incision mastectomy technique. It has the lowest amount of complications compared to others however the incisions are long under the pectoralis major muscle. Free nipple grafts are performed to to mimic the male chest and as expected with any graft nipple sensation is decrease but will re-innervate over the course of a year. Also pigmentation may decrease which can either come back with time or require tattooing if desired.
The procedure may take 3 – 4 hours and patients commonly stay in the hospital one night and discharged the next day. The bolsters on the nipples are removed after 5-7 days. Strenuous activity is restricted for six weeks.
The initial incisions are made along the edges of the areola if the patient is a candidate for removal of the breast tissue through the incision and there is no ptosis (sagging of the chest tissue). Since the peri-areolar or circum-areolar approach does not remove skin and only breast tissue, therefore, the breast must be A cup or small B cup at most.
Inverted-T/T- Anchor Incision
A less popular choice for many transgender men. Because the nipples are not removed, this procedure maintains the most sensation in the nipple/areola complex. However, this approach carries a high revision rate and has an unfavourable scar from the bottom of the areola to the inframammary fold. This surgery may last up to 4 hours.
After the Procedure
You will spend the night in the hospital for one night and have drains coming from the side of your chest and they are removed at about one week. In addition, you will be advised to wear a compression binder for up to 6-8 weeks. This will prevent the build-up of fluid and allow your chest to adjust to its new shape. It is vital to get plenty of rest during this period and refrain from any form of heavy lifting and strenuous exercise or activity. You may be able to return to work after approximately 3-4 weeks.
By its very nature, top surgery is a very straightforward procedure with minimal complications. However such complications can include:
- Post-operative bleeding and infections
- Short-term or long term pain
- Swelling along the walls of the chest.
- Reaction towards anesthesia and medication
- Wound separation and tissue loss
- Failed nipple grafts or nipples requiring removal and reconstruction
Scarring is normal and to be expected. The extensiveness of your scars will depend on the incision technique used during surgery. While the scars can be hidden in certain areas of your chest, some scars will remain visible even after it has properly healed and faded.
Results from top surgery are noticeable almost immediately. As your body begins to heal, you will start to observe a chest that is powerful and strikingly masculine. Once your body has healed, you will experience a renewed sense of confidence and feel a lot closer to your body.
Dr. Salgado will do what he can to ensure that costs remain at a minimum and will seek insurance authorization if possible. However, the final costs if not approved by insurance will depend on the factors:
- Medical center and facility fee
- Anesthesia and other medications that will need to be administered
- Surgeon’s fee
Once the results from top surgery have settled, you can begin to enjoy a body shape and contour that is undeniably masculine. Your masculine body will ease the top- dysphoria experiencing, allowing you to live a happy and comfortable life with a renewed sense of self.