FTM Top Surgery
Everything you need to know about gender-affirming chest surgery — surgical techniques, costs by state, insurance coverage, recovery, and choosing the right surgeon.
FTM Top Surgery is a transformative, gender-affirming procedure designed to help individuals achieve a masculine chest contour. This surgery involves removing breast tissue and reshaping the chest — a critical step for many transgender men and non-binary individuals seeking physical alignment with their gender identity.
The procedure serves both functional and aesthetic purposes, significantly enhancing self-confidence and alleviating gender dysphoria. This comprehensive guide covers everything you need to make informed decisions about your journey.
Types of FTM Top Surgery
There are four main surgical techniques, each suited to different body types and goals. Your surgeon will recommend the best approach based on your anatomy and desired outcomes.
1. Double Incision Mastectomy
Most CommonHorizontal incisions across the chest remove breast tissue and excess skin. Nipples are resized and repositioned as grafts to create a flat, masculine contour.
Pros
- Achieves flat, masculine chest contour
- Allows significant reshaping and customization
- Ideal for larger chests or excess skin
Cons
- Prominent horizontal scars (fade over time)
- Reduced or complete loss of nipple sensation
- Longer recovery time
Best For
- Individuals with larger chests or reduced skin elasticity
- Patients requiring significant reshaping and skin removal
2. Keyhole / Periareolar Technique
Minimal ScarringA minimally invasive procedure using a small incision around the areola. Relies on natural skin retraction for a flat appearance with minimal visible scarring.
Pros
- Minimal scarring, often nearly invisible
- Preserves natural skin integrity
- Faster recovery compared to other techniques
Cons
- Limited ability to resize or reposition nipples
- May leave residual breast tissue
- Unsuitable for larger chests
Best For
- Patients with small breasts (A cup or smaller)
- Individuals with minimal skin excess and good elasticity
3. Buttonhole Technique
Preserves SensationPreserves nipple sensation by maintaining nerve connections during tissue removal. Nipples remain attached through a "buttonhole" incision rather than being grafted.
Pros
- Higher likelihood of retained nipple sensation
- Avoids nipple grafting, natural position
- Balance between aesthetic and functional outcomes
Cons
- May leave more residual chest tissue
- Visible scarring around buttonhole site
- May not suit those with larger chests
Best For
- Individuals prioritizing nipple sensation
- Patients with moderate breast sizes seeking natural nipple placement
4. Gender-Affirming Breast Reduction
Gradual ChangeRemoves a portion of breast tissue to create a smaller, masculine chest without complete flattening. Focuses on reshaping rather than dramatic transformation.
Pros
- Natural, less drastic transformation
- Minimal scarring depending on technique
- Gradual transition, psychologically easier for some
Cons
- Leaves more residual tissue
- Not ideal for significant skin excess
- May require additional surgeries later
Best For
- Individuals with medium-sized chests not seeking fully flat appearance
- Those desiring a subtle masculine contour
Costs of FTM Top Surgery
Surgery costs vary significantly by location, surgeon experience, and technique. Here's a breakdown of costs across different states.
📈 Higher Cost States
Renowned surgeons, high demand, advanced facilities
💚 Lower Cost States
Competitive pricing, lower operational costs
Cost comparison across U.S. states
Additional Potential Costs
| Category | Estimated Cost | Details |
|---|---|---|
| Consultation Fees | $0 – $500 | Many surgeons offer free virtual consultations |
| Pre-Surgery Testing | $200 – $1,000 | Lab work, chest X-rays, medical clearances |
| Travel & Accommodation | $500 – $2,000+ | For patients traveling to another state |
| Compression Garments | $50 – $200 | Required for proper healing post-surgery |
| Medications | $50 – $300 | Pain management, antibiotics, recovery meds |
| Scar Treatment | $50 – $150/treatment | Silicone gels, sheets, or steroid injections |
| Revisions | $1,000 – $5,000 | For correcting aesthetic issues if needed |
Insurance Coverage by State
Insurance coverage for FTM top surgery varies significantly by state. Here's what you can expect:
| State | Mandate | Medicaid | Private Insurance |
|---|---|---|---|
| California | Yes | Covers | Kaiser, Blue Shield cover |
| Massachusetts | Yes | Covers | Harvard Pilgrim, Blue Cross cover |
| Illinois | Yes | Covers | Aetna, BCBS cover extensively |
| Washington | Yes | Covers | Premera, Regence cover |
| Colorado | Yes | Covers | Rocky Mountain, Cigna cover |
| Virginia | Yes | Covers | Anthem Blue Cross covers |
| Minnesota | Varies | Covers | UCare Minnesota covers |
| Florida | No | Limited | Mixed — Cigna, United may cover |
| Texas | No | Excludes | Depends on plan — Aetna, BCBS may cover |
| Georgia | No | Limited | Limited — some Humana plans cover |
Documentation Required
Most insurers require: letters from mental health providers confirming gender dysphoria, evidence of medical necessity, and pre-authorization approval.
Financial Assistance Resources
If insurance doesn't cover your surgery, several organizations offer grants and financial assistance for gender-affirming procedures.
Pre-Surgery Preparation
Proper preparation is essential for ensuring the best outcomes. This involves meeting health requirements and making informed decisions about the procedure.
Requirements
Stable Mental Health
Emotional readiness is critical. Many surgeons require a letter from a mental health professional.
Non-Smoking Status
Quit smoking 6–8 weeks before and after surgery to reduce complications and improve healing.
Healthy BMI
Maintaining a healthy weight improves surgical outcomes and reduces risk of complications.
Support System
Arrange for help during initial recovery — you'll need assistance with daily activities.
Questions for Your Consultation
Ask Your Surgeon
What techniques do you recommend for my body type? How do you minimize complications? Can you provide references or before/after photos? What is the complete cost including all fees?
The Surgical Procedure
Each technique is tailored to your anatomy and goals, but there are common steps across all methods.
1. Tissue Removal and Contouring
Depending on the technique, incisions are made to remove breast tissue and excess skin. Double incision allows for the most reshaping, while keyhole is minimally invasive.
2. Nipple Treatment
For double incision, nipples are removed, resized, and grafted (may reduce sensation). For keyhole and buttonhole, nipples often remain in place with preserved sensation.
3. Post-Operative Drains
Small drains prevent fluid build-up, reduce swelling, and support healing. Typically removed within 1–2 weeks during a follow-up appointment.
Recovery Timeline
Understanding what to expect during recovery helps you prepare and ensures the best possible results.
Initial Recovery
Rest at home, wear compression garment 24/7, manage pain with prescribed medications, avoid raising arms above shoulders.
Drain Removal
Follow-up appointment for drain removal, wound check, and progress assessment. Swelling and bruising begin to decrease.
Light Activity
Light daily activities can resume. Continue wearing compression garment. Avoid heavy lifting or strenuous movements.
Compression Phase
Continue compression garment as directed. Most swelling subsides. Many patients return to work (desk jobs).
Full Recovery
Resume exercise and strenuous activities once cleared by surgeon. Scars continue to fade over the following months.
Important Recovery Rules
Never sleep in a compression garment that's too tight. Avoid lifting anything over 10 lbs for 4-6 weeks. Attend all follow-up appointments even if you feel fine.
Choosing the Right Surgeon
Selecting the right surgeon is critical to achieving the best possible outcomes. Here's what to look for:
Board Certification
Verify credentials through the American Board of Plastic Surgery (ABPS) or state medical boards.
Gender-Affirming Experience
Choose surgeons who specialize in FTM procedures with a proven track record.
Before/After Portfolio
Review photos of past patients with similar body types to assess the surgeon's artistry.
Transparent Pricing
Choose surgeons who provide detailed cost breakdowns including all fees and follow-up care.
Patient Reviews
Read testimonials and reviews from previous patients about their experience and results.
Comfortable Communication
Your surgeon should listen, explain clearly, and make you feel respected throughout.
Ready to Take the Next Step?
FTM Top Surgery is a transformative procedure that can significantly enhance your quality of life. With proper research, planning, and the right surgical team, you can achieve the masculine chest contour that aligns with your identity.
While You Plan Your Surgery
Emisil offers high-quality prosthetics to help you feel comfortable and confident today.