Female-to-Male (FTM) Top Surgery: A GUIDE TO GENDER-AFFIRMING TRANSFORMATION

Gender identity is a complex and personal experience, and for many transgender individuals, aligning their physical appearance with their gender identity is an important step in their journey. For female-to-male (FTM) transgender individuals, top surgery is a gender-affirming procedure that can help them achieve a more masculine appearance. In this guide, we will explore the basics of FTM top surgery, including the before and after process, and the different techniques used for chest wall masculinization.

What is FTM Top Surgery?

FTM top surgery, also known as chest masculinization surgery, is a surgical procedure that removes breast tissue (mastectomy) and reshapes the chest to create a more masculine appearance. This procedure is often a crucial step for transgender individuals who wish to align their physical appearance with their gender identity.

The Before and After Process

Before undergoing FTM top surgery, patients will have a consultation with a plastic surgeon who specializes in gender-affirming procedures. During this consultation, the surgeon will discuss the patient's goals and expectations, as well as their medical history and any potential risks or complications.

Once the patient is deemed a good candidate for the surgery, they will undergo a pre-operative evaluation, which may include blood work, imaging tests, and a physical exam. The surgeon will also provide instructions for preparing for the surgery, such as avoiding certain medications and fasting before the procedure.

After the surgery, patients will have a recovery period of several weeks, during which they will need to follow the surgeon's post-operative instructions carefully. This may include wearing a compression garment, avoiding strenuous activities, and attending follow-up appointments to monitor healing and address any concerns.

Techniques for Chest Wall Masculinization

There are several techniques used for FTM top surgery, and the best approach will depend on the patient's individual anatomy and goals. The most common techniques include:

• Double Incision: This technique involves making an incision across the chest and removing excess breast tissue and skin. The remaining skin is then repositioned and the incisions are closed, resulting in a flatter, more masculine chest.
• Periareolar: This technique is suitable for patients with smaller breasts and involves making an incision around the areola to remove breast tissue and reposition the nipple. This technique results in a smaller scar and is often used for patients with less excess skin.
• Keyhole: This technique is suitable for patients with minimal breast tissue and involves making a small incision around the areola to remove breast tissue. The remaining tissue is then contoured to create a flatter chest. This technique results in minimal scarring but is not suitable for patients with larger breasts.

Double-incision top surgery with nipple grafts

Double-incision top surgery with nipple grafts is the most common technique used for FTM chest wall masculinization. This technique involves making two incisions along the chest to remove excess breast tissue and skin.

The nipples are then removed and grafted onto the newly-contoured chest. This technique results in a flatter, more masculine chest and is suitable for patients with larger breasts. It is important to note that this technique will result in larger scars, as compared to the other techniques mentioned.

What is recovery from FTM top surgery like?

Recovery from FTM top surgery can vary from person to person, but there are some general aspects to consider. After the surgery, it is common to experience pain, swelling, and bruising in the chest area. Your surgeon will provide you with pain medication to manage any discomfort. It is important to follow their post-operative instructions, which may include wearing a compression garment, avoiding strenuous activities, and taking time off work or school to allow your body to heal.

During the initial recovery period, it is important to have someone to assist you with daily tasks as your mobility may be limited. You should also avoid lifting heavy objects or engaging in activities that strain the chest muscles. Maintaining cleanliness and dryness of surgical incisions is vital in order to avoid infections. Your surgeon will schedule follow-up appointments to monitor your healing progress.

It is important to note that the recovery time can vary depending on the individual and the specific type of surgery performed. On average, it may take several weeks to a few months for the initial swelling and discomfort to subside. However, it can take up to a year or more for the scars to fully fade and for the final results of the surgery to be visible.

Remember, this information is general and it is always best to consult with a qualified surgeon for personalized advice and guidance regarding your specific recovery process.

Benefits of FTM Top Surgery

FTM top surgery offers a range of physical and emotional benefits for transgender individuals. Some of the most significant benefits include:

Improved Self-Confidence and Mental Health

For many transgender individuals, aligning their physical appearance with their gender identity can have a significant impact on their mental health and self-confidence. FTM top surgery can help alleviate gender dysphoria and improve overall well-being.

Enhanced Physical Comfort

Large breasts can cause physical discomfort, such as back pain and skin irritation, for transgender men. FTM top surgery can alleviate these symptoms and improve overall physical comfort.

Increased Clothing Options

Many transgender men struggle to find clothing that fits their body shape comfortably. FTM top surgery can help create a more masculine chest, allowing for a wider range of clothing options and increased comfort in one's own skin.

Risks and Considerations

As with any surgical procedure, there are potential risks and considerations to keep in mind when considering FTM top surgery. These may include:

• Scarring: While surgeons strive to minimize scarring, it is inevitable with any surgical procedure. Patients should discuss their concerns and expectations for scarring with their surgeon before the procedure.
• Complications: As with any surgery, there is a risk of complications, such as infection, bleeding, and adverse reactions to anesthesia. Patients should carefully follow their surgeon's post-operative instructions to minimize these risks.
• Emotional Impact: FTM top surgery is a significant step in a transgender person's journey, and it is essential to consider the emotional impact of the procedure. Patients should have a strong support system in place and be prepared for potential emotional challenges during the recovery period.

What other gender-affirming surgeries are available to transgender men?

Transgender men have access to a range of gender-affirming surgeries to help align their physical appearance with their gender identity. In addition to FTM top surgery, which involves chest masculinization, there are other surgeries available, such as:

1. Metoidioplasty: This surgery involves releasing the clitoris to create a small phallus. It may also involve additional procedures to enhance the appearance and function of the phallus.

2. Phalloplasty: Phalloplasty is a more complex procedure that involves creating a neophallus using tissue from another part of the body, such as the forearm or thigh. It may also involve additional procedures to create a urethra and allow for urination.

3. Testicular implants: Some transgender men may choose to undergo testicular implant surgery to create a more masculine appearance in the genital area. This surgery involves placing silicone or saline-filled implants in the scrotum.

4. Vaginectomy: Transgender men who do not desire to retain their vagina may opt for a vaginectomy. This surgery involves removing the vaginal canal, closing the opening, and reshaping the surrounding tissue.

It is important for individuals considering gender-affirming surgeries to consult with qualified surgeons who specialize in these procedures. They can provide more detailed information about the available options and help determine which surgeries may be suitable based on individual goals and preferences.

Finding a Surgeon

When considering FTM top surgery, it is crucial to find a qualified and experienced surgeon who specializes in gender-affirming procedures. Some tips for finding a surgeon include:

• Research: Take the time to research surgeons in your area who specialize in FTM top surgery. Look for reviews and before and after photos to get a sense of their experience and results.
• Consultations: Schedule consultations with multiple surgeons to discuss your goals and expectations and get a sense of their approach and bedside manner.
• Ask for Referrals: If you know other transgender individuals who have undergone FTM top surgery, ask for referrals and recommendations for surgeons they have had a positive experience with.

Conclusion

FTM top surgery is a life-changing procedure for many transgender individuals, helping them achieve a more masculine appearance and alleviate gender dysphoria. By understanding the basics of the procedure, the different techniques used, and the potential risks and considerations, individuals can make an informed decision about whether FTM top surgery is right for them. With the help of a qualified and experienced surgeon, transgender individuals can take a crucial step in their gender-affirming transformation and improve their overall well-being and self-confidence.

If you are interested in FTM top surgery, please contact  plastic surgeon Hakkı İzmirli, MD at +90 532 292 59 83