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For most transgender males (transmen) or AFAB (assigned female at birth) non-binary 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 or gender non-binary identity and the related issues often create gender dysphoria that is associated with anxiety, depression, substance abuse and other negative issues. Fortunately, advancements in transgender plastic surgery and medicine have made female to male (FTM) and female to non-binary (FTN) gender transitioning easier, with results that are often far safer and more natural-looking.

At the Arizona Center for Aesthetic Plastic Surgery, board-certified plastic surgeon Steven H. Turkeltaub, MD offers female to male (FTM) and female to non-binary (FTN) breast surgery in order to help his patients transition 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), an organization that sets international quality standards relating to the care of gender diverse individuals.

What Is Female to Male (FTM) Transgender Top Surgery?

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

What Is Female to Non-Binary (FTN) Top Surgery?

For those individuals who are gender non-binary, the term “FTM” transgender top surgery is not accurately descriptive. Nevertheless, the concept behind female to non-binary or FTN top surgery remains similar, although there are often variations that must be addressed, such as the size and location of the nipple-areola complexes or the desire to not to have any nipple-areola complexes at all.

Again, treatment is customized based on each person’s pre-existing anatomy as well as their aesthetic and gender goals. Dr. Turkeltaub will thoroughly discuss all of these with you and then formulate a plan for your top surgery that is optimally suited to delivering the results that you desire.

FTM and FTN Top Surgery Can Be Life-Changing

We have found that our FTM and FTN breast surgery patients are right at the top as our happiest, most satisfied and appreciative patients. Following this procedure, their experiences have universally been overwhelmingly positive. But don’t just take it from us—read the letter below that was written by one of Dr. Turkeltaub’s patients to get an idea of just how life-changing gender-affirming top surgery can be.

 

Dr. Turkeltaub,

I have been wanting to write you for some time now, as I have wanted to share with you the overwhelming positive impact having top surgery has had a my life.

To begin, I first want to say thank you for all that you do and am so grateful that you and your team were part of my journey. I cannot even begin to describe the terror, the dreaded fear, of announcing to someone that I want to top surgery. You may remember that I could barely speak and shook like a leaf. Being the professional that you are, you treated me with dignity and respect. Despite having just unloaded a lifelong secret, I was treated with kindness and respect. I knew that when the time was right, you were going to be the one I would entrust to do the procedure.

So, after working with an equally wonderful counselor, I was finally ready. You generously saw me for another consult and again, you treated me with dignity and respect. You answered all my questions, as well as my friend’s long list of questions. Your patience and kindness made what normally be abnormal feel totally normal.

The long awaited day of surgery came and I will never forget the overwhelming relief as I awoke in the recovery room and knew that 45 plus years of living with the wrong body parts was finally over….forever!

There are no words that can ever begin to describe that feeling…. that level of happiness transcends anything I had ever experienced. From that day on, I have had an entirely new outlook on myself, my body and my life.

It is not something that everyone will understand, but for those individuals struggling with body dysmorphia/gender identity, I think that top surgery is the best decision I have ever made. It has dramatically improved my life and I cannot thank you enough for the work that you do. I could not ask for better results and have to say, I think my chest looks perfect. Not a day will go by that I do not reflect on or think about this experience. I am much happier, confident and feel as if my body matches my mind.

I will close by saying again, thank you, from the bottom for my heart. I couldn’t be happier and owe it to you and your credible staff for making this dream my reality.

I will leave off my name for privacy reasons

Expand to read more

What Do FTM and FTN Breast Procedures Entail?

Female to male or female to non-binary breast surgery typically entails flattening and recontouring the appearance of a female-presenting chest for a more masculine or androgynous appearance. The standard procedure is usually accomplished by the removal of breast tissue (mastectomy) and either keeping the nipple-areola complex attached to its blood supply (“keyhole” and “concentric circle”) or detached and placed back as a free nipple graft (“double incision”) in a more desirable and appropriate location. There is also the option to permanently remove the nipple-areola complex—a selection that is most commonly made by gender non-binary individuals. Liposuction may need to be employed in order to obtain a more thorough and refined transformation.

Just like all surgical procedures, there are certain risks associated with FTM and FTN breast surgery. Dr. Turkeltaub does everything in his power to avoid and minimize your 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 and FTN Top Surgery Techniques?

The incision pattern utilized to perform female to male or female to non-binary breast surgery depends on 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 top surgery techniques:

  • 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 or gender non-binary appearance.
  • Concentric circle (periareolar) mastectomy – 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 variable sized 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 or lax skin or need a reduction in the size of the areola.
    A significant limitation with this approach is that the nipple-areola complex can’t be repositioned to a far more masculine location.
  • Double incision free nipple graft mastectomy – This approach involves a mastectomy along with the excision of a large ellipse of skin extending 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.
    Should the patient so desire, the nipples can also be left off entirely. This is a not an uncommon choice, especially with our non-binary patients.
    The double incision technique is commonly employed in patients who have a moderate to large amount of breast tissue and skin laxity. It is, in fact, the most common approach employed for FTM and FTN top surgery.
  • Inverted “T” mastectomy – Similar to the standard incision used in most breast reduction surgeries, the inverted “T” mastectomy 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 either still attached to its blood supply or as a free nipple graft. This technique is more of historical interest rather than being presently relevant.

During your consultation, the technique(s) that would be most appropriate for your particular situation will be discussed in great detail.

What Is FTM and FTN Top Surgery Recovery Like?

To help minimize any post-operative bruising, swelling and discomfort, a supportive and snug 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 several 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 ten days 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 and up to eight to ten weeks.

The results of top 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.

The final outcome of FTM or FTN breast surgery can be truly life-changing for individuals transitioning from female to male or female to non-binary or other more neutral chest aesthetics.

Real Patient Experience: Early Recuperation from Keyhole FTM Top Surgery

Generalizations can be made about the expected early recuperation from the keyhole approach for 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 patient, in their 20s, 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. After 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 chest 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 another more month in order to fully resume without any restrictions.

Does Insurance Cover FTM and FTN Transgender Top Surgery?

Many major insurance companies do offer at least some insurance benefits for FTM and FTN 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 that 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 top surgery.
  3. Evidence of your capacity to make a fully informed decision and to consent to 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. As of March 31, 2023, all patients in Arizona seeking gender affirming surgical procedures are required to be at least 18 years of age before they can undergo this surgery (See our blog on the topic: Arizona Passes Law Prohibiting Gender Affirming Surgery on Minors.)

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

If you want to pursue FTM or FTN 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 third-party financing through CareCredit and Alphaeon, though you will have to meet their credit standards.

How Much Does FTM or FTN Top Surgery Cost?

The cost of FTM or FTN top surgery depends 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
  • Miscellaneous items like medications; possibly post-operative garments
  • Regional area cost factors, etc.

Given all this, it is impossible to state a precise cost that you can expect for your top surgery. The website RealSelf does provide a national range of costs but it is inclusive of revisions and ancillary procedures as well as the full gender affirming breast surgical procedures resulting in it not being too helpful. Their numbers indicate a range from around $1600 up to $14,000.

In order to provide a custom quote, Dr. Turkeltaub will need to meet with you for an in-person consultation at our practice. At that 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 or FTN breast surgery expenses manageable for almost any budget.

Ancillary Procedures Offered to Our FTM and Gender Non-Binary Patients

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

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

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

A common path chosen by those looking to alter the contours of their body is liposuction, which can reduce stubborn, “feminine appearing” fat deposits around the hips, thighs, abdomen and buttocks. This surgery, which we offer, is done as an outpatient procedure 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, resulting in a more masculine aesthetic.

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

Additional FTM and FTN 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 no. In the past, discontinuing testosterone at least a few weeks prior to surgery and restarting it a few weeks post-surgery was a common recommendation and practice. This is generally no longer the case though there are exceptions such as individuals who have an abnormally high hematocrit (blood count). This is usually an untoward consequence of taking testosterone that occurs in some individuals and can lead to blood clots.
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 with this. 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 will I need to have my drains for?
Most of our patients having their top surgery using this technique will have their drains in place for around 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 or more.
Can I get top surgery with no nipples?
Absolutely! Patients not wanting to have nipple-areola complexes on their chest can choose this option for their double incision top surgery procedure. During your consultation, Dr. Turkeltaub will ask about your aesthetic goals for the procedure, as he customizes a top surgery plan for each individual patient.

Top Surgery Patient Testimonials*


*Individual Results May Vary

Hand Written Notes

Interested in FTM or FTN Breast Surgery?

If you are considering FTM or FTN top surgery, Dr. Turkeltaub would be happy to assist you in your gender affirming surgery process. Please contact our practice online or by phone today to schedule a consultation.

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