FTM top surgery, top surgery scars and keyhole top surgery
Agata PajorFTM Top Surgery: Complete Guide
Everything you need to know about transmasculine chest surgery — from surgical techniques and eligibility requirements to preparation, recovery, and beyond. Make informed decisions about your transition journey.
Transgender individuals often experience discomfort with their bodies. While some find comfort through changes in clothing, grooming, or presentation, others feel a strong need for medical intervention. Top surgery — the surgical removal or reshaping of breast tissue — is one of the most common and life-changing procedures for trans men and transmasculine individuals.
Top surgery is generally safe when performed by a qualified plastic surgeon, and for many, it significantly improves psychological well-being and quality of life. This comprehensive guide covers everything you need to know to make informed decisions about this important step in your journey.
🏥 What This Guide Covers
- 5 different surgical techniques and who qualifies for each
- WPATH requirements and eligibility criteria
- Pre-surgery preparation and what to expect
- Recovery timeline and aftercare tips
- Additional masculinization procedures
- Non-surgical alternatives for those not ready for surgery
What Does Top Surgery Mean?
Top surgery is a transmasculine operation to create a masculine chest contour. Medically, it's called a mastectomy — the surgical removal of breast tissue. While mastectomy is also performed for breast cancer treatment and prevention (famously, Angelina Jolie announced her preventative mastectomy in 2013), for trans individuals it serves as a crucial step in gender affirmation.
Top surgery is generally safe when performed by a qualified plastic surgeon. While no surgery is without risk, with proper care and an experienced surgeon, the possibility of complications is minimal.
✅ Benefits of Top Surgery
- Reduces gender dysphoria — aligns physical appearance with gender identity
- Eliminates binding — no more discomfort, breathing restriction, or skin issues
- Improves quality of life — greater freedom in clothing, activities, and intimacy
- Boosts mental health — significant improvements in self-esteem and confidence
- Permanent results — one-time procedure with lasting effects
Who Can Have Top Surgery?
The World Professional Association for Transgender Health (WPATH) provides standards of care that most surgeons follow. Meeting these criteria helps ensure you're prepared — both medically and psychologically — for surgery.
📋 WPATH Requirements for Top Surgery
- Persistent, well-documented gender dysphoria
- Capacity to make a fully informed decision and consent to treatment
- Age of majority in your country (or follow adolescent guidelines if younger)
- Any medical or mental health concerns must be reasonably well-controlled
Source: WPATH Standards of Care (2012)
⚠️ Additional Requirements
Some surgical centers may have additional requirements:
- BMI requirements — to minimize surgical risks
- Mammogram — especially if you're over 40
- Referral letters — from mental health professionals
- Insurance authorization — if using insurance coverage
- No nicotine use — for several weeks before surgery
FTM Top Surgery Types
There are five main types of top surgery. The best option for you depends on your chest size, skin elasticity, and personal goals. All procedures are performed under general anesthesia. Your surgeon will recommend the most suitable technique during your consultation.
Keyhole Top Surgery
A small incision is made along the bottom of the areola, through which breast tissue is removed. The nipple remains intact — no resizing or repositioning needed. May be combined with liposuction for optimal contouring.
✅ Minimal scarring, quick recovery, nipple stays intact
⚠️ Only ~5% of patients qualify; requires very small chest
Donut Procedure (Peri-Areolar)
Two incisions are made — one around the areola and one slightly outside it, creating a "donut" shape. Breast tissue is removed, and skin is tightened using a "purse-string" technique. Nipple sensation is often preserved.
✅ Minimal visible scarring, nipple sensation often preserved
⚠️ May result in some puffiness; limited to smaller chests
Batwing Procedure (Fishmouth)
Two concentric incisions around the areola, plus triangular-shaped incisions on the sides to remove excess skin. Effective at achieving a flat chest contour when skin elasticity is limited.
✅ Good results for medium chests, effective skin removal
⚠️ More noticeable scars due to triangular incisions
Double Incision Top Surgery
Two horizontal incisions — one above and one below the nipple area. Breast tissue is removed and nipples are resized and repositioned as free grafts. The most versatile technique, allowing for significant chest contouring.
✅ Excellent results for larger chests, full contouring ability
⚠️ Visible horizontal scars, nipple sensation typically lost
Inverted-T / T-Anchor Surgery
Similar to double incision but with an additional vertical incision to remove more excess skin. Particularly useful when significant skin removal is needed for a smooth, flat result. May preserve nipple sensation in some cases.
✅ Best for very large chests, thorough skin removal
⚠️ Most visible scarring (T-shaped pattern)
Surgery Comparison Chart
This comparison helps you understand the key differences between surgical techniques at a glance:
| Procedure | Best For | Scarring | Nipple Sensation | Recovery |
|---|---|---|---|---|
| Keyhole | Very small chest, excellent elasticity | Minimal (around areola) | Usually preserved | 2-3 weeks |
| Donut (Peri-Areolar) | Small-medium chest, good elasticity | Circular around areola | Often preserved | 3-4 weeks |
| Batwing | Medium chest, some sagging | Moderate (wing-shaped) | May be preserved | 4-5 weeks |
| Double Incision | Medium-large chest | Visible horizontal lines | Typically lost | 4-6 weeks |
| Inverted-T | Large chest, poor elasticity | Most visible (T-shaped) | May be preserved | 5-6 weeks |
Keyhole
Donut (Peri-Areolar)
Double Incision
Inverted-T
Preparing for Top Surgery
Proper preparation is essential for a smooth procedure and optimal results. Taking time to prepare — both physically and mentally — sets you up for success.
📋 Pre-Surgery Checklist
Surgeon Consultation
Discuss goals, options, and concerns. Ask questions about technique, scars, and expected results.
Documentation
Gather referral letters, insurance authorization, and required health evaluations (mammogram if needed).
Lifestyle Changes
Stop nicotine (all forms), limit alcohol, and discontinue certain medications as advised.
Home Preparation
Arrange help for the first few days. Stock up on compression garments, ice packs, and easy meals.
Physical Health
Maintain a healthy diet and stay active to optimize your body for surgery and healing.
Mental Preparation
Consider pre-surgical counseling to address emotional concerns and prepare for the changes ahead.
Recovery After Top Surgery
Recovery is individual and depends on various factors including the surgical technique, your overall health, and how well you follow post-operative instructions.
📅 Recovery Timeline
Immediate Recovery
Most discomfort. Rest, pain management, wear compression garment.
Early Healing
Drains removed (if used). Light activity only. Follow-up appointment.
Continued Healing
Most restrictions lifted. Can return to work (desk jobs). Swelling decreases.
Full Recovery
Resume normal activities including exercise. Scars continue to fade.
Avoid Showering
Don't wash your chest until dressing is removed. Follow surgeon's specific instructions.
Use Ice Packs
Helps relieve pain and reduce inflammation. Use as directed.
Limit Activity
Avoid heavy lifting and strenuous exercise for first few weeks.
⚠️ Important Recovery Rules
- Wear compression garment as directed — essential for proper healing
- Attend all follow-up appointments — even if you feel fine
- Don't rush back to exercise — can cause complications and affect results
- Manage drains carefully — if used, follow care instructions precisely
- Watch for warning signs — excessive swelling, fever, unusual discharge
Additional Masculinization Procedures
For those seeking more comprehensive masculinization, several additional procedures can complement top surgery. These can be performed at the same time or as separate procedures.
Liposuction & Body Contouring
Removes excess fat from chest, abdomen, flanks, and underarms. Can be done during top surgery. Creates more defined masculine contours.
Phalloplasty
Surgical creation of a penis using tissue grafts. Complex procedure that may include urethral lengthening and penile implant options.
Metoidioplasty
Uses testosterone-enlarged clitoris to create a smaller, functional penis. Less invasive than phalloplasty, preserves more sensation.
Scrotoplasty
Creation of a scrotum using labial tissue. Can include testicular implants for a complete appearance.
Hysterectomy
Removal of uterus and sometimes ovaries. Eliminates menstruation and may be required before some bottom surgeries.
Hormone Therapy
Testosterone therapy for masculinizing effects. Often started before surgical procedures, continues long-term.
Non-Surgical Alternatives
Surgery isn't the right choice for everyone — whether due to medical reasons, personal preference, or not being ready yet. There are still effective ways to feel more comfortable and confident in your body.
Emisil Prosthetics
High-quality FTM prosthetics offer a non-surgical way to align your body with your gender identity. From packers for daily wear to STP devices for restroom confidence to pack-and-play prosthetics for intimacy — there are options for every need and lifestyle.
Explore Emisil Products →🔄 Other Non-Surgical Options
- Binding — chest compression garments for a flatter appearance
- Packing — prosthetics worn in underwear for a masculine bulge
- STP devices — stand-to-pee products for restroom confidence
- Pack & play — prosthetics suitable for intimate activities
- Clothing choices — strategic layering and fit for masculine silhouette
Psychological & Social Considerations
FTM top surgery is often a transformative experience that enhances both physical and emotional well-being. By aligning your chest appearance with your gender identity, it can significantly impact multiple aspects of your life.
💜 Positive Impacts
Reduced Dysphoria
Aligning physical appearance with internal identity significantly decreases gender dysphoria for most patients.
Improved Self-Esteem
Greater confidence in your body leads to improved self-image and comfort in social situations.
Freedom from Binding
No more discomfort, breathing restrictions, or skin issues from daily binding. Greater physical comfort.
🤝 Support Resources
- Pre-surgical counseling — helps prepare emotionally for the changes ahead
- Post-surgical support — assists with adjustment and any unexpected feelings
- Community connections — other trans individuals who've had surgery can offer encouragement
- Support groups — both online and in-person options available
Frequently Asked Questions
Is top surgery safe?
Yes, when performed by a qualified plastic surgeon, top surgery is generally safe. Like any surgery, there are risks of infection or complications, but with proper care and an experienced surgeon, these risks are minimal.
How do I choose which surgery type?
Your surgeon will recommend the best technique based on your chest size, skin elasticity, and goals. Smaller chests with good elasticity may qualify for keyhole or peri-areolar; larger chests typically require double incision.
Will I lose nipple sensation?
It depends on the technique. Keyhole and peri-areolar methods often preserve sensation. Double incision typically results in loss of sensation because nipples are removed and grafted. Some sensation may return over time.
Do I need to be on testosterone first?
No, testosterone therapy is not required for top surgery. Some people have top surgery before starting hormones, some after, and some never take hormones at all. It's your personal choice.
How visible will my scars be?
Scarring varies by technique and individual healing. Keyhole produces minimal scars; double incision leaves visible horizontal scars. With proper care (silicone sheets, sun protection), scars typically fade significantly over 12-18 months.
Is top surgery covered by insurance?
Coverage varies widely by insurance provider and location. Many insurance companies now cover top surgery as medically necessary. Check with your provider and obtain pre-authorization before scheduling surgery.
How long until I can exercise again?
Most surgeons recommend waiting 4-6 weeks before resuming upper body exercise. Light walking is usually encouraged within the first week. Follow your surgeon's specific guidelines — returning too early can affect results.
Top surgery is a deeply personal decision and a transformative step in many trans individuals' journeys. By understanding your options, preparing properly, and working with qualified professionals, you can achieve results that significantly enhance your quality of life and alignment with your authentic self. 🏳️⚧️
While You Consider Your Options
Whether surgery is in your future or not, Emisil offers products to help you feel more comfortable and confident today.