What is FTM Transgender Top Surgery?

What Does the FTM Breast Procedure Entail?

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.

I am a transgender male and Dr. Turkeltaub did my top surgery. I am very pleased with my results and everyone that I show my chest to is very impressed. My scarring is minimal, my nipples are very well shaped, and Dr. Turkeltaub did an amazing job at keeping everything symmetrical. I was really large chested and a bit nervous as to how the final result would look, but from the very first day I was really pleased! My results just keep getting better and better. He is also very gentle handed so I only bruised in one very small area and I probably only bruised because I was a bit more active than I should have been 1 week after surgery. The office staff are very knowledgeable, friendly, and answer all questions without issue. I called many, many times with all kinds of questions and the staff always put my concerns or questions to rest with spot on answers. They were also very quick at getting my surgery scheduled and took on all communication with my insurance. I recommend Dr. Turkeltaub to everyone interested in getting any type of surgery with him but I really, really recommend him for transgender surgeries. The whole office and Dr. Turkeltaub are extremely LGBT+ friendly and they are dedicating a portion of their practice to transgender procedures. Both my partner and I felt very comfortable with every interaction with the entire office. I recommend Dr. Turkeltaub 100% and I am very grateful that I came across his practice!

What Are the Different 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:

• Keyhole mastectomy – This 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 (see concentric circle below).
• Concentric circle mastectomy – This is the same technique as the keyhole mastectomy 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 also be incorporated into this approach. This technique is usually reserved for those individuals who have some excess skin or enlarged areolas.
• Double incision free nipple graft mastectomy – This approach involves a mastectomy with the excision of a large ellipse of skin at or near 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 moderate to large sized breasts, skin laxity and drooping.
• Inverted “T” mastectomy – 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 to the bottom of the breast and then horizontally along the inframammary (breast) fold for a variable length. Using this approach, the nipple-areola complex is reduced in size and then repositioned as a free nipple graft in the desired new location. This technique is used very infrequently.

During your consultation with Dr. Turkeltaub, the techniques that would be most relevant and appropriate for your particular situation will be discussed with you in great detail.

What Is FTM Breast Surgery Recovery Like?

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 two to three weeks thereafter.Drains, which are tubes coming out through the skin on the sides of the chest and which serve to remove unwanted fluid in the surgical field, usually stay in on average for one to two weeks. Those individuals who have had their top surgery using the double incision free nipple graft technique will have a special dressing on around their “new” nipples for two weeks in order to protect them and allow them to be revascularized (get a new blood supply). See photo here.

Recovery Dressings & Drains for Double Incision Free Nipple Graft

This is the typical appearance of someone six days post a double incision free nipple graft mastectomy. Butterfly tapes (steri-strips) are covering the incisions. The dressings seen in the photo on both breasts, called “bolus dressings,” serve to immobilize and protect the free nipple grafts. They are usually kept in place for around two weeks.

On either side of the chest are the drains coming through the end of the incision. These serve to drain fluid following the mastectomy and are usually kept in for around ten days to two weeks.

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 to nine months.

The final outcome of FTM breast surgery can be truly life-changing for individuals transitioning from female to male.

Real Patient Experience: Early Recuperation from Keyhole FTM Top Surgery

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*Individual Results May Vary

At only three and a half weeks, the early results can be seen and are significant (post-op photos). No pain medication is being taken. Swelling is present though not overwhelming and no bruising is present. The incisions with areas of redness seen on the side views are where the drains exited the skin.

Swelling can take up to two months to maximize then start to resolve. It can take up to a year for maximal resolution of the swelling in order to see the long-term results. The drain exit sites should ultimately heal as fine lines.

The results should be a masculine appearing chest with virtually invisible, very short scars.

Real Patient Experience: Early Recuperation from Double Incision Free Nipple Graft FTM Top Surgery

This is a relatively typical example of the results that can be seen at two months post FTM top surgery using the double incision free nipple graft technique. His nipple-areola complexes were covered by an “immobilization” dressing for two weeks and protected overall for four weeks to allow them to be revascularized (get a good blood supply back) and properly heal.

Due to social media policies, the following images have been censored. Please click on the button below to view the image.

*Individual Results May Vary

Scar gel was started at three weeks for the incision at the lower part of his breasts and then added around the areolas a week later. Full scar maturation will take a year or even longer for maximal improvement.

At four weeks, he was able to resume virtually all activities except for a few chest related workouts that he had to wait for one more month in order to fully resume.

Does Insurance Cover FTM Transgender Top Surgery?

Many major insurance companies do offer at least some insurance benefits for FTM top surgery but, like many other medically related issues, coverage is dependent on your specific policy. In order to be eligible for this coverage, however, you must comply with the delineated guidelines which do vary by company.

The following are generally required by most insurance plans:

1. Persistent, well-documented gender dysphoria.
2. A letter from a qualified mental health professional that, among other things, confirms your diagnosis of gender dysphoria and fully supports your desire to proceed with the gender affirming breast surgery.
3. Evidence of your capacity to make a fully informed decision and to consent for this surgery.
4. If there are significant medical or mental health issues at present, they must be reasonably well controlled.
5. Must be at least 18 years of age though there are some exceptions.

Since 2014, Medicare has been authorized to provide coverage for FTM breast surgery but only on a case by case basis. There is no blanket guarantee.

If you want to pursue FTM top surgery but don’t have insurance or insurance coverage, we do have “cosmetic” pricing available to help make this both more affordable and a reality. If needed, several financing options are available including with CareCredit and Alphaeon though you will have to meet their credit standards.

How Much Does FTM Transgender Top Surgery Cost?

According to data shared on RealSelf, the cost of FTM top surgery is generally between $4,900 and $12,000 in the Scottsdale area, with the average expense reported as $8,475. Although these numbers can provide a good point of reference, the exact pricing for your FTM breast procedure will depend on a variety of different elements that include:

• The specific technique employed during surgery
• The overall complexity of treatment
• The credentials, experience and level of skill of your plastic surgeon
• Fees for the surgical center and anesthesiologist
• Any pathology charges or lab work that might be necessary

Typically, medications and post-operative garments are not included in the pricing.

In order to provide a custom quote, Dr. Turkeltaub will need to meet with you for an in-person consultation at our practice. At this time, he can perform a thorough evaluation and give you a detailed breakdown of all associated costs based on an individualized treatment plan. If you wish, a team member can also introduce you to various financing and payment plan options that help to make FTM breast surgery expenses manageable for almost any budget.

Ancillary Procedures Offered to Our Transmen and Non-Binary Patients

Top surgery is, by far, the most important and requested gender affirming procedure that transmen with gender dysphoria pursue. The desire is even greater and the need more acute for those with more than an “A” size cup.

The results from the mastectomies are truly life changing. In fact, those individuals on whom we have performed the gender confirming mastectomies are among the happiest of all our patients.

For a variety of reasons, most transmen do not pursue bottom surgery or the extensive facial masculinization procedures. Some, however, are interested in seeking out less “radical” refinements of their body contours to reflect a more male appearance. Though long term usage of testosterone can assist in this transformation, the effects are often limited or incomplete.

A common path chosen is liposuction in order to reduce persistent feminine type fat deposits such as of the hips, thighs, abdomen and buttocks. This surgery, which we offer, is done as an outpatient with relatively minor and brief discomfort and minimal down time as relates to work or school.

Dermal fillers such as Juvederm® Ultra Plus and Voluma™ can be injected into various areas of the face to create more masculine angles and contours. BOTOX® can also be employed to precisely reshape the brows and affect their position as relates to the forehead and eyes to be more consistent with the male gender.

These same procedures are available to our non-binary patients though consideration would need to be given to their individualized goals as relates to masculine and feminine characteristics.

Additional FTM Top Surgery FAQs

Transgender Breast Surgery Patient Testimonials*

Hand Written Notes

Interested in FTM Breast Surgery?

If you are considering FTM 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.