FTM top surgery, top surgery scars and keyhole top surgery

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 fight 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.

Table of contents

• What Does Top Surgery Mean?
• Who Can Have Transmasculine Top Surgery?
• FTM Top Surgery Types
• Keyhole Top Surgery
• Donut Procedure (Peri-Areolar Top Surgery)
• Double Incision Top Surgery
• Batwing Procedure (Fishmouth Incision)
• Preparing for Top Surgery
• Inverted-T or T-Anchor Top Surgery
• Recovery After Top Surgery
• Additional Procedures for Masculinization
• Non-Surgical Alternatives
• Psychological and Social Considerations
• Liposuction and Body Contouring
• Phalloplasty and Metoidioplasty
• Scrotoplasty and Testicular Implants

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 is an operation where the breast tissue is removed. Mastectomy is performed not only for FTM people but also in cases of breast cancer or even as breast cancer prevention. Well-known actress Angelina Jolie announced her preventative mastectomy in 2013.

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

FTM top surgery not only serves as a medical solution for gender dysphoria but also significantly improves psychological well-being and quality of life.

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):

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

Some surgical centers may also have BMI (Body Mass Index) requirements to minimize surgical risks. You may need a recent mammogram, especially if you are over 40.

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 tell them exactly what you are expecting from the surgery, how your chest should look, and your biggest concerns. Remember that a good and qualified specialist will explain everything thoroughly, clearing up any doubts. 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 with smaller chests. This procedure is suitable when the skin is elastic; if the skin is dry or less elastic, 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.

Patients undergoing keyhole surgery may experience less postoperative discomfort due to its minimally invasive nature. However, achieving a perfectly flat contour might require additional procedures.

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 patients with more skin who 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, a special “purse-string” technique is used to bring the skin together. If there is a need to minimize puffiness of the chest, liposuction can be combined with the donut procedure.

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.

DOUBLE INCISION TOP SURGERY

This procedure is the most popular and most often performed surgery. This is the best option for people who have 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.
Postoperative scarring can be managed using silicone gel sheets or scar creams. Patients are advised to protect scars from sunlight for at least one year to improve healing and reduce redness.

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. 

Preparation for top surgery

Preparing for top surgery is an essential part of ensuring a smooth procedure and recovery process. Taking the time to get organized, both physically and mentally, can help set you up for success. From consultations with your surgeon to planning for aftercare, each step plays a crucial role in achieving the best possible outcome. Here’s what you need to know to get ready for your journey.

• Consult with Your Surgeon: Schedule a detailed consultation to discuss your goals, surgical options, and any concerns you might have.
• Obtain Necessary Documentation: Ensure you have referral letters, insurance authorization, and any required health evaluations, such as a mammogram if needed.
• Make Lifestyle Adjustments: Avoid nicotine, alcohol, and certain medications before surgery as advised by your surgeon.
• Plan for Recovery: Arrange for someone to help you during the first few days post-surgery, and prepare your home with essential recovery items such as compression garments and ice packs.
• Focus on Physical Health: Maintain a healthy diet and stay active to optimize your body for surgery and healing.
• Mental Health Support: Consider pre-surgical counseling to address any emotional concerns and to prepare for the changes ahead.

Proper preparation can significantly improve your surgical experience and recovery, helping you achieve the best possible results.

RECOVERY

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

The first few days after the procedure are the most uncomfortable for patients. The anesthesia, the compression binder, the fuss about the surgery, and the future result – all these points usually are the main reason causing discomfort.

It is important to follow your surgeon's postoperative instructions closely, including wearing a compression garment, attending follow-up appointments, and managing drains if they are used.

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:

• Don’t take a shower. You should avoid washing your chest until the dressing is removed.
• Ice. Using ice packs helps to relieve pain and decrease inflammation.
• Control your physical activity. Avoid lifting heavy items or exercising strenuously for the first few weeks.

By adhering to these practices, you may achieve a smooth recovery and be able to resume normal activities within 4–6 weeks.

Important Considerations for FTM Top Surgery

Patient Suitability

The choice of top surgery technique depends largely on the patient’s anatomy and overall health.

• Breast Size and Skin Elasticity: Smaller breasts with good skin elasticity may qualify for less invasive options such as the Keyhole or Periareolar methods. Patients with larger breasts or less elastic skin often require Double Incision surgery to achieve optimal results.
• Health Evaluation: A comprehensive health review is necessary. This includes medical history, physical exams, and a BMI check. Patients over 40 may need a mammogram to ensure safety and mitigate risks.
• Insurance Documentation: Most surgical centers require referral letters and insurance authorization to proceed. Confirming coverage and preparing documents in advance can streamline the process.
• Lifestyle Adjustments: Avoid nicotine in all forms and adhere to preoperative instructions, including dietary restrictions, to promote better healing and minimize surgical risks.

Additional Procedures

For patients seeking a more comprehensive masculinization, several additional procedures can complement FTM top surgery to enhance overall results. These options are particularly useful for individuals aiming to refine their body contour or achieve a more cohesive masculine aesthetic.

• Liposuction and Body Contouring:
  Liposuction can effectively remove excess fat deposits from areas such as the chest, abdomen, flanks, and underarms, helping to define the natural contours of a masculine physique. This procedure can be performed concurrently with top surgery, allowing for a single recovery period.

• Benefits: Improves overall chest contour, minimizes bulk, and enhances symmetry.

• Process: Surgeons use liposuction to sculpt specific areas, creating a tailored result that aligns with the patient’s goals and body type. This might include liposculpting to emphasize the pectoral region or flattening areas around the armpits for a cleaner silhouette.

• Complementary Surgeries:

• Phalloplasty: The surgical creation of a penis, often considered by transmasculine individuals seeking further alignment with their gender identity. This complex procedure involves tissue grafting to construct a phallus, which may include urethral lengthening for urination and the option of a penile implant for erectile function.

• Metoidioplasty: This procedure utilizes the natural enlargement of the clitoris, achieved through testosterone therapy, to create a smaller, functional penis. It is less invasive than phalloplasty and preserves more sensation.

• Scrotoplasty and Testicular Implants: For patients desiring a complete genital reconstruction, scrotoplasty involves the creation of a scrotum, often using tissue from the labia, with optional insertion of testicular implants.

These procedures, while independent of top surgery, can provide a cohesive result, offering both functional and aesthetic benefits to those seeking a full masculinization process.

However, if surgery isn't the right option for you, there are still effective ways to feel more comfortable and confident in your body. Products offered by Emisil provide non-surgical alternatives, such as high-quality prosthetics designed to help you align with your gender identity. These options can enhance your sense of self and comfort, allowing you to feel more at ease in your daily life without undergoing invasive procedures.

Psychological and 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 reduce dysphoria, boost self-esteem, and provide freedom from binders, allowing for greater comfort and self-expression. Pre- and post-surgical mental health support ensures emotional readiness and aids in adjustment, while community connections offer encouragement and a sense of belonging. For many, this surgery marks a vital step toward a more authentic and fulfilling life.