FTM top surgery, top surgery scars and keyhole top surgery

Types of transman top surgery, tips & advice, the process of FTM top surgery recovery - click here and learn more!

Transgender people are very familiar with feeling uncomfortable with their bodies. Although it is an unpleasant feeling, you shouldn't feel ashamed of feeling this way, since gender identity sometimes doesn't match with gender. Some transgender people are happy by changing their looks without any medical influence. What does that mean? Choosing special clothes or using make-up to achieve a particular look is enough for some people. For others, there is a huge need to change their bodies drastically – even with the help of plastic surgery. One of the most common surgeries, that help fighting body dysphoria, is top surgery.

Top surgery refers to a procedure or breast tissue removal. It is important to mention, that this kind of surgery is generally safe and the possibility of negative aspects is minimal. One of the main aspects of successful top surgery is qualified plastic surgeons. 

Let‘s learn more about top surgery - how it works and what to expect?

WHAT DOES TOP SURGERY MEAN?

Top surgery is a transmasculine operation to recreate a masculine chest. To put it in other words, this surgery is called mastectomy. Mastectomy – an operation, where the breast tissue is removed. Mastectomy is performed not only for FTM people, but in case of breast cancer, or even as breast cancer prevention. Well-known actress Angelina Jolie announced her preventative mastectomy in 2013. 

Top surgery generally is a safe type of plastic surgery when performed by a qualified plastic surgeon. It could not be called a very simple procedure, because a possibility of infection or complications always exists, but with a help of a professional, the risk of negative outcomes is minimal. 

WHO CAN HAVE TRANSMASCULINE TOP SURGERY?

The World Professional Association of Transgender Health (WPATH) provides standards of care criteria that many specialists follow. The main requirements for top surgery by WPATH (2012):

1. “Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the SOC for children and adolescents);
4. Insignificant medical or mental health concerns are present, they must be reasonably well controlled.” (p. 59)

FTM TOP SURGERY TYPES

There are several types of top surgery: keyhole, donut procedure, batwing procedure, double incision, and inverted T. General anesthesia is used during these top operations. The most suitable type of operation is chosen after consultation with a medical professional. Sometimes anatomical characteristics are the main aspect of choosing the type of top surgery. It is important to feel free to communicate with the surgeon and telling him what exactly you are expecting from the surgery, how your chest should look like, your biggest concerns. Remember that a good and qualified specialist will explain absolutely everything and all the doubts can be cleared up. Clarity brings peace of mind, so let's learn more about the different types of top surgery.

KEYHOLE TOP SURGERY 

This type of top surgery is perfect for trans people who own smaller chest. This procedure is suitable when the skin is elastic, and if the skin is dry, you should consider another surgery. The main idea of this type of surgery is to remove the breast tissue through the small incision along the bottom of the nipple’s areola. No changes or reconstructions of the nipple are made. If there is a need to make the chest flatter, this operation can be combined with liposuction. Usually, the drain is placed for seven days and then removed.   

This procedure is quite simple, and no visible top surgery scars occur after keyhole top surgery. Unfortunately, only less than 5% of patients have anatomy favorable for this procedure.

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DONUT PROCEDURE (PERI-AREOLAR TOP SURGERY)

The donut procedure is the best option for FTM people who have small or B-sized chests, and elastic skin. The Peri-areolar type fits for those patients who have more skin and want as minimal skin incision as possible. This type of surgery is different from keyhole top surgery. During donut top surgery, two incisions are made. The first incision is made all around the areola of the nipple, the second incision is made larger, to create a skin “ring” or “donut” shape. The next step is to remove the breast tissue. After removing the breast tissue, there is a special “purse-string” technique used to bring the skin together. If there is a need to minimize puffiness of the chest, the liposuction can be combined with the donut procedure. In some cases, this procedure is called “Peri” as well.

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BATWING PROCEDURE (FISHMOUTH INCISION)

This type of Top surgery is the best option for people who are B-sized chested, have less elastic skin, and a little ptosis. This type of surgery is unique since the results are exceptionally effective - the chest becomes incredibly flat. As you can see in the picture below the first incision is made around the areola of the nipple. The second incision is made similar to during the donut procedure. The last incision is made on both sides of the ring in the shape of a triangle. Before considering having this procedure, you should consider how much important to you is the location of incisions. If you are not willing to have visible top surgery scars – this type of surgery may not be the best option for you.

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DOUBLE INCISION TOP SURGERY

This procedure is the most popular and the most often performed surgery. This is the best option for people who own medium to large chests. During this operation, the nipples are removed, reshaped, and grafted back to the correct place. Unfortunately, the scars will be visible after the double incision surgery. FTM people can achieve great results by choosing this method of surgery – the highest degree of tightness and flatness of the chest. People who had this type of surgery are extremely satisfied with their choice and the final result.

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INVERTED-T OR T-ANCHOR TOP SURGERY 

This type of Top procedure is the best option for people who have large chests and inelastic skin. Inverted-T or T-anchor Top surgery is similar to the Double Incision Top surgery. The main difference between these procedures is that during Inverted-T or T-anchor Top surgery the surgeon makes the vertical extra excision. By choosing this type of top surgery, the patient has a better chance to save the sensation in the nipples after the operation. Unfortunately, the sensation of the nipples can’t be guaranteed. 

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If you want to find more details about the types of top surgeries, please visit this webpage.

RECOVERY

The recovery is individual and depends on various aspects. So, what to expect after the top surgery? 

• First few days after the procedure are the most uncomfortable for the patients. The anesthesia, the compression binder, the fuss about the surgery, and the future result – all these points usually are the main reason causing the discomfort.
• You should sleep only on your back. This sleeping position ensures that your chest is not going to get any additional pressure.
• You will have your postoperative appointment with your doctor 6-7 days after the surgery. Usually, this is the first time patients see their new chest.
• The swelling is common after any kind of procedure. It should decrease 2-3 weeks after top surgery, but sometimes swelling may be leading you even 6 months after the operation.
• A successful and fluent process of recovery mostly depends on the behavior of the patient. You should control your movements after the surgery. It is strongly recommended not to lift your hand above the head 2-3 weeks after top surgery, because it may increase scarring.

SOME ADVICE ON HOW TO MAKE YOUR RECOVERY EASIER:

There are some tips on what to do or not to do after the top surgery. All these tips are important to make your healing process faster. Let’s take a look at what do many surgeons advise to their top surgery patients:

• Don’t take a shower. You should avoid washing your chest till the dressing is removed. You can always use baby wipes or a wet towel to stay clean.
• Ice. Using ice packs helps to relieve pain and decrease inflammation.
• Control your physical activity. You should avoid lifting things the first week after surgery. It is recommended not to exercise hard, but you can always take a calm walk that doesn’t increase your heart rate.
• Take care of yourself. You must understand how important is to stay calm, rest as much as possible, eat healthy food, drink enough water, and avoid alcohol and tobacco. It will help your body to heal faster.
• Scars. Use special products for your scar’s treatment. It will help to decrease scar tissue, redness and the healing process will be reduced.

Regarding the FTM top surgery, the advantages of the operation might overshadow the risks of the procedure. It is important to understand that every single surgery or procedure can cause complications and risks, such as blood clots, infections, or even disillusion about the final result. Top surgery is not an exception. Lost sensation in the nipples, failed nipple graft, visible top surgery scars, need of additional surgery in case the result is not satisfying enough – these are the main risks and complications of top surgery. Despite these negative aspects, the majority of transgender people who had a top surgery are happy about changing their lives and starting this journey to a new and brighter life.