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For transmen, transmasculine and non-binary individuals, especially those with significant gender dysphoria, top surgery is incredibly rewarding and life changing. In fact, it has been my personal experience that those individuals who have undergone gender affirming mastectomies are right at the top as our happiest patients – along with our breast reduction patients.

There is no more need to bind with its associated issues. Anxiety is reduced or eliminated. Issues related to being “found out” are largely mitigated. Flexibility in clothing is far greater without the need for concealment considerations.

And, most importantly, physical appearance completely confirms who they are.

The aesthetic results from FTM and FTN top surgery can vary over a broad spectrum of outcomes and are affected by numerous factors. Many of these are patient related issues such as weight and BMI, compliance, nutrition, smoking and activities. Some are surgeon related such as experience, judgment and skill. Finally, some things are just plain random and not generally predictable.

The concentric circle mastectomy is one of the major techniques that can be effectively used in gender affirming top surgery. It can yield excellent outcomes with relatively inconspicuous scarring especially when compared to the double incision free nipple graft approach. However, this approach works best in a specific subset of patients – best summed up as neither very small, as in an “A” or possibly “B” cup, or too large, as in a “D” cup or larger or with breast drooping. There are also gray areas where there may be two options each with its pros and cons.

For larger and drooping breasts, the double incision free nipple graft approach is the gold standard.

The following photos are a representative example of an outcome that can be realized using the concentric circle mastectomy in an appropriate situation.

Before

8 months post-op

Before

8 months post-op

Before

8 months post-op

This is a 27 year old non-binary individual with gender dysphoria who had been binding for ten years. By the time that they consulted with me they were so ready to proceed with gender affirming top surgery.

Based on their breast size, skin tone and other factors, it was my recommendation that the concentric circle approach would give them the best possible outcome as compared to the other techniques. It should also be noted that they were at a very high risk of developing thick, raised and dark scars as part of their outcome.

Their postoperative results are seen at eight months. Even without full maturation of the healing process which may take a year or more, the breast contours are excellent and the scars relatively inconspicuous. The appearance of their chest easily passes for masculine or non-binary and would generally not attract any unwanted attention from others.

This is how they and most transmen and non-binary patients want their results to be.

For my patient, the results were absolutely life changing and they couldn’t have been any happier.

That is exactly the way it should be.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

 

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