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For most transgender males (transmen), 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 female to male (FTM) 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) 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.

Dr. Turkeltaub is a member of the “World Professional Association for Transgender Health” (WPATH).

What is FTM Transgender Top Surgery?

FTM (Female to Male) transgender top surgery is the gender affirming breast surgery that transforms a genetically determined female chest to a masculine appearing one and in line with the person’s inherent gender identity. This is extremely effective in addressing gender dysphoria. It is the first and, far more often than not, the only surgical procedure pursued in one’s transformation to successfully and happily living as a male.
In general terms, the surgery entails the removal of the female breast through a mastectomy and altering other structures (nipple-areola complex) in a variety of ways in order to provide a manly appearance with minimal tell-tale signs of a previous female anatomy. The specific procedure that would be most appropriate to accomplish this is precisely individualized for each individual patient.

For those individuals who are non-binary, the term “FTM” transgender top surgery is not accurately descriptive. Nevertheless, the concepts are similar but there are often variations that must be addressed such as the desire not to have any nipple-areola complexes at all. Again, the treatment plan is aligned based on each person’s desires and goals.
We have found that our FTM breast surgery patients are at the top among our happiest, most satisfied and appreciative patients. Truly for them, this is really an overwhelmingly positive life changing experience.

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.

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

Generalizations can be made about the expected early recuperation from the keyhole approach for FTM top surgery but this does not guarantee that it will perfectly match your experiences. The reason for this is that each person’s unique constellation of factors and variables strongly affects the outcome and perceptions. Nevertheless, the following patient of Dr. Turkeltaub can illustrate what you may be able to expect.
This 20s patient underwent a FTM mastectomy using the keyhole approach under general anesthesia (before photos). A drain tube was placed on each side along with a postoperative compressive dressing. Two days later the dressing was removed and replaced by a compression garment. At eight days, both of the drain tubes were removed in the office. Discomfort level at this time was fairly minimal.

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

Before
After

*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.

I initially chose to see Dr. Turkeltaub because he was one of the very few local surgeons who could perform a bilateral mastectomy. But BOY did I make the right decision. I’m currently 5 weeks post op. Dr. Turkeltaub and those in his office have made this experience so smooth. From the moment I scheduled my consultation they have been highly attentive, kind, reassuring and have been willing to answer the gazillion questions I’ve had along the way.

From a technical standpoint, my procedure and recovery have been so clean and accurate to the timeline they originally estimated. My scars are razor thin and looking more even and natural every day. The followup care I’ve experienced has been reassuring and they’ve allowed me to schedule unexpected followup appointments just because I wanted to make sure everything was okay. They’ve been incredibly patient and professional and I couldn’t recommend a better or more qualified surgeon.

5/5 stars

Taylor Blackmore

January 10, 2020

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.

Before
After

*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

Do I have to stop my testosterone before my top surgery? If so, how soon before my surgery?
The short answer to this is yes. Though there has not been any definitive studies done on this issue, anecdotally it has been noted that there seems to be an increased risk of developing blood clots in the legs (deep vein thrombosis or DVT’s) in those individuals who have not stopped their testosterone prior to surgery. In rare cases, these clots can travel to the lung resulting in a pulmonary embolus which can be lethal. Therefore, we request that you stop your testosterone at least two weeks prior to surgery and don’t restart until at least two weeks after surgery.
How likely is it that my insurance company will cover my top surgery?
More insurance companies today and far more plans do provide benefits for top surgery. However, that does not mean that your plan does so you will have to specifically check for these benefits. We can assist you if needed. If you do have benefits, we can also help you determine what your financial responsibility would be.
Do I need a “letter” such as from a therapist, counselor or psychologist before I have my top surgery?
Yes, a letter documenting your gender dysphoria is required before you can have your top surgery. No insurance company will approve your request for coverage without having this letter. Before we can authorize your surgery, we will need this letter to submit to your insurance company in order to obtain authorization.

In addition, whether you have insurance coverage or are paying for the surgery out of pocket, the surgery centers require this letter before your top surgery can be scheduled.

Do I have to have drains after my top surgery?
Yes, drains are used in all our top surgery patients no matter what technique is used and for good reason. They have been empirically found to be effective in reducing certain postoperative risks—particularly of fluid accumulation (seroma).
I am having the double incision free nipple graft approach for my top surgery. How long can I expect to have my drains for?
Most of our patients having their top surgery using this technique will have their drains in place for ten days to two weeks. A small percentage will have them removed earlier while a few will have them in for up to three weeks, rarely longer.

Transgender Breast Surgery Patient Testimonials*


*Individual Results May Vary

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.

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A Message Regarding Coronavirus/COVID-19

In light of the coronavirus/COVID-19 pandemic, we would like to let you know of some of the major precautions we are taking in our office to maximize cleanliness and keep the environment as sanitary and safe as possible. Our highest priority is always to ensure the safety of every individual who sees us and we are taking extreme infection-control measures to maintain cleanliness and “sterility” of surfaces and the overall environment.

We will be limiting dates and times for office appointments and consultations due to safety and other issues. Consequently, if you have already made an office appointment or consultation prior to March 18, 2020 to occur at a later time, this may need to be changed.

For anyone considering plastic surgery, we are now offering Virtual Consultations and Telemedicine through Skype. A great number of aesthetic or insurance-related issues can be evaluated via pictures and online video conferencing, making this an excellent way to find out more about particular procedures, determine candidacy for treatment, receive answers to questions and facilitate being able to move forward with care once the government lifts all restrictions.

In an abundance of caution, we are asking all current patients who are experiencing a fever, cough, chills, fatigue or any type of respiratory illness to please delay any upcoming appointments at our practice. We can talk with you by phone or email to establish a new date and time for the appointment.

We are all in this together. Our team urges everyone to follow the guidelines recommended by local health authorities and the Centers for Disease Control and Prevention, which include frequent handwashing for a minimum of 20 seconds, social distancing, staying home if you are feeling sick, and contacting your healthcare provider if you feel you are experiencing symptoms.

For more information, please read our blog – Coronavirus and You: Important Information

For further updates, please check our blog.

If you have any questions or concerns, please contact us by phone or email.

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