For most individuals, living with a physical body that does not match one’s actual gender identity is a very difficult and uncomfortable way to exist, function and interact. Transgender identity and the related issues often create a dysphoria associated with anxiety, depression, substance abuse and other negative issues. Fortunately, advancements in transgender plastic surgery and medicine have made gender transition easier, real and natural and with results that are far more satisfying.
At the Arizona Center for Aesthetic Plastic Surgery, board-certified plastic surgeon Steven H. Turkeltaub, MD offers female to male (FTM) and male to female (MTF) breast surgery in order to help his patients transition in their appearance to match their gender identity. When you visit his practice for your consultation and postoperative care, you can expect to receive non-judgmental professionalism, understanding, attention and support. He will strive to understand your unique desires and perspectives, develop a customized treatment plan with you based on your anatomical needs and lifestyle goals and then help you achieve the life-changing transformation that you deserve.
- FTM Breast Surgery Procedures
- FTM Breast Surgery Techniques
- FTM Breast Surgery Recovery
- Transgender Breast Surgery Patient Testimonials
FTM Breast Surgery Procedures
Female to male breast surgery entails masculinizing the appearance of the female breast and chest wall. The standard procedure is usually accomplished by the thorough removal of breast tissue with either a nipple sparing mastectomy (“keyhole”) or subcutaneous mastectomy with a free nipple graft (“double incision”). Liposuction may need to be employed in order to obtain a more thorough transformation. In addition, the large female nipple-areola complex typically needs to be substantially reduced in size and repositioned on the breast to create a more masculine appearance. Not addressing this can compromise the results. When excess skin is present with the nipple sparing mastectomy, a concentric circle (peri-areolar) mastopexy can be performed.
Just like all surgical procedures, there are certain risks associated with FTM breast surgery. Depending on the procedure selected, these are similar to the ones that can occur with breast reduction or gynecomastia surgery. Dr. Turkeltaub does everything in his power to avoid and minimize the risk of experiencing these complications.
FTM Breast Surgery Techniques
The incision pattern utilized to perform female to male breast surgery depends several factors that include the pre-existing breast size, configuration, degree of skin laxity and excess, and the size and location of the nipple areola complex. Dr. Turkeltaub offers the following FTM breast surgical approaches:
- Nipple sparing mastectomy (“Keyhole”) – method involves an incision along the lower half of the areola through which the mastectomy (breast tissue removal) can be performed. The scar is relatively minimal in size and is usually fairly inconspicuous. This approach is most appropriate for patients who have excellent skin elasticity and minimal breast tissue. For those with large areolas, the incision can be extended around the entire areolar circumference in order to reduce its size so as to provide for a more masculine appearance.
- Nipple sparing mastectomy with periareolar mastopexy (“Concentric circle”) – This is the same technique as the nipple sparing mastectomy above except that a periareolar (circumareolar) mastopexy is performed at the same time. Concentric circles are made around the areola enabling the removal of a ring of skin resulting in skin tightening. An areolar reduction can be incorporated into this approach. This periareolar approach is usually reserved for individuals who also have some excess and lax skin.
- Subcutaneous mastectomy and free nipple graft (“Double incision”) – This approach involves a mastectomy and the excision of a large ellipse of skin along the crease at the bottom of the breast. The nipple-areolar complexes are removed, reduced in size and then placed back in the appropriate location as full thickness skin grafts. This technique is commonly employed in patients who have a moderate to large amount of breast tissue and skin laxity.
- Inverted “T” – Similar to the standard incision used in most breast reduction surgeries, the inverted “T” incision (also known as the anchor-shaped incision or Wise pattern incision) encircles the areola, continues down the underside of the breast and continues horizontally along the inframammary fold for a variable length. Using this approach, the nipple-areola complex is usually repositioned as a free nipple graft and the mastectomy is performed. This technique is used very infrequently.
During your consultation, the techniques that would be most relevant and appropriate to your particular situation will be discussed in great detail.
FTM Breast Surgery Recovery
To help minimize any post-operative bruising, swelling and discomfort, a snug form-fitting dressing is placed around the chest following surgery and kept on for a few days. This is then replaced with a form-fitting garment that is worn for at least one to two weeks thereafter.
The majority of patients experience only a mild degree of discomfort that can typically be alleviated with oral medication. Most individuals feel well enough to return to school and/or non-strenuous office jobs within a few days of surgery but any vigorous physical activity or heavy lifting will need to be avoided for a minimum of three to four weeks.
Results of the transgender surgery are evident immediately though it can take up to a year for all the swelling to fully resolve and the incision lines to mature and largely fade. You actually may see some increased swelling for the first two months which then gradually subsides. For all practical purposes, though, the final results are close to being realized at about six months.
The final outcome of FTM breast surgery can be truly life-changing for individuals transitioning from female to male.
MTF Breast Surgery Procedure
Male to female breast surgery is performed the same as a standard breast augmentation. During the procedure, breast implants are carefully inserted through a predetermined incision and placed either above or below the pectoralis major muscle to achieve a more feminine-appearing chest. Dr. Turkeltaub employs a very gentle and meticulous surgical technique to help limit any post-operative discomfort and allow you to achieve the results that you desire.
The potential risks associated with MTF breast surgery are identical to those experienced in breast augmentation. These will be discussed with you at the time of your consultation.
Breast Implant Options
At the Arizona Center for Aesthetic Plastic Surgery, Dr. Turkeltaub offers a wide array of breast implant sizes, configurations, shapes, types and implant fill material that includes various levels of silicone gel cohesiveness in order to help meet the unique needs and desires of every individual. The implant options will be discussed comprehensively at the time of your consultation with Dr. Turkeltaub. Based on a multitude of factors, he will make recommendations to you that will help you to obtain the results that you desire.
For more specific information about implants, please visit Dr. Turkeltaub’s page on breast implants.
MTF Breast Surgery Incision Choices
Individuals considering male to female breast surgery have three incision options through which implants can be placed. These include:
- Inframammary – This incision is made at the crease beneath the breast known as the inframammary fold. The location of the inframammary incision allows for optimal short- and long-term flexibility, improved exposure and visualization during surgery and better predictability of results. For these reasons (among several others), it is the most common incision used for the placement of implants.
- Transaxillary – Located in the armpit, the transaxillary incision is the second most popular technique due to the absence of any incisions/scarring on the breasts themselves. Despite this key benefit, there are a number of factors that need to be taken into consideration before selecting this approach, all of which will be discussed at the time of the consultation.
- Periareolar – The periareolar incision is made along the lower-half margin of the areola. When performed skillfully the resulting scar can be relatively inconspicuous. This approach, however, is rarely a viable option especially when silicone breast implants are selected. The reason for this is that it is difficult or impossible to realistically insert fully filled silicone implants through incisions made along the lower half of the generally smaller-sized nipples one is starting out with.
Following a thorough review of the advantages and disadvantages of each option, Dr. Turkeltaub can help you select the best incision location for your unique needs and desires.
There are two implant placement options for MTF breast: in front of the pectoralis major muscle (submammary) or behind it (submuscular or subpectoral). For the reasons highlighted below, Dr. Turkeltaub recommends placing breast implants submuscularly most of the time.
- The risk of capsular contracture (hardening of scar tissue around the implant) is reduced
- There is more tissue to cover and conceal any potential implant rippling
- The superior interface between the chest wall and implant creates a more natural look
- The muscle provides added support for the weight of the implant
MTF Breast Surgery Recovery
A firm, form-fitting compression dressing is placed immediately after surgery and remains on for about two to three days before being replaced by a sports-type bra. This is to be worn all day and all night for approximately two weeks, after which it is strongly recommended that you wear a bra that provides optimal support as often as possible to help maintain an ideal breast shape and limit sagging over time.
Swelling and firmness in the breasts will typically be experienced initially, sometimes causing the breasts to look larger and feel harder than anticipated. Fortunately, these symptoms should resolve over the course of several months to eventually reveal a size and contour closer to what was originally envisioned.
There may be some mild to moderate discomfort within the first few days of recovery, but most patients are able to return to non-strenuous jobs and normal daily routines after about five to seven days. It is strongly recommended that any sports, vigorous exercise and other similar activities be avoided for at least three weeks.
Though the overall results can be seen initially, it can take several months or longer for most all of the swelling to subside, the skin to stretch out and the muscles to relax. By six months you will be very close to seeing the long-term results.
These results can dramatically improve one’s comfort, confidence and appearance allowing for a very positive and successful transition.
*Individual Results May Vary
Interested in FTM or MTF Breast Surgery?
If you are considering FTM or MTF breast surgery, Dr. Turkeltaub would be happy to assist you in your gender transformation. Please contact our practice online or by phone today to schedule a consultation.