Female to Male (FTM) Top SurgeryDelray Beach, FL

FTM Top Surgery is a group of chest masculinization surgery procedures derived from subcutaneous mastectomy (breast removal.) For many transgender men, Top Surgery is one of the biggest events of their gender transition, fulfilling a long held desire for both physical and emotional freedom.

More than cosmetic surgery, Top Surgery is considered a medically required procedure to reduce dysphoria in trans men and has been proven effective:

  • In follow-up studies, transgender men who have undergone mastectomy report very low rates of complication and high rates of satisfaction. 1-6
  • Chest reconstruction surgery in combination with hormone therapy has been shown to be more effective in alleviating gender dysphoria than hormones alone. 7
  • Quality of life is higher among transgender men who have undergone chest reconstruction than those who have not. 8, 9

FTM Top Surgery involves a subcutaneous mastectomy, or removal of breasts, followed by male chest contouring. Depending on the procedure and needs of the patient, Top Surgery can also include additional liposuction, nipple/areola resizing and repositioning and free nipple grafts.

FTM Top Surgery is a 3-4 hour surgery that is done under general anesthesia. It is usually an outpatient procedure.

Types of FTM Top Surgery Procedures

Double Incision with Nipple Grafts

Transgender Top Surgery or Double Incision Surgery

Double Incision may be the most common form of FTM Top Surgery. Touted as the most effective option for those with medium and large sized chests, Double Incision uses horizontal incisions that result in two scars just below the pectoral muscles. (These scars often become less noticeable with time, chest hair growth and/or pectoral muscle development.) Dr. Drew Schnitt specializes in double incision Top Surgery technique.

Nipple grafts are the most common way to incorporate nipples and areolas with Double Incision Top Surgery. The native nipples and areolas are removed, resized then grafted in the appropriate male anatomical position.

The benefits of Double Incision Top Surgery are better results for medium and large chests. An additional benefit is to achieve a more accurate repositioning and resizing of the nipple/areola complex.

Post-operative results can possibly include puckering along the edges of the scar, as well as potential excess skin left at the end of the incision, commonly referred to as “dog ears”, which can be resolved with a revision surgery.

While many will have excellent results from the Double Incision method, the larger scars and partial or complete loss of nipple/areola sensation are worth consideration. Post-operative results can include puckering along the edges of the scar, as well as excess skin left at the end of the incision, commonly referred to as “dog ears”, which can be resolved with a revision surgery.

Keyhole & Peri-Areolar Methods

The procedures are distinct but a similar goal: to remove breast tissue through small incisions. They are ideal in patients with small to medium chest sizes and result in a masculine chest with minimal scarring. This is especially true with Keyhole, which uses a semi-circular incision at the base of the areola.

In Peri-areolar Top Surgery, the incision goes right around the areola, and a second larger circular incision is made around this. The resulting “ring” of tissue is removed and the edges of the larger incision are brought up to the edges of the areola, like a drawstring bag.

Depending on the needs of the patient, nipple reduction is often performed with Keyhole and Peri-Areolar, and areola reduction is also typically performed with Peri-Areolar, sometimes as a revision surgery.

The benefits of Keyhole and Peri-Areolar Top Surgery are smaller incisions, less scarring, intact nipple stalk to preserve sensation, and that post-operative drains are often not required.

Despite these benefits, the potential downsides of Keyhole and Peri-Areolar also need to be considered: nipple/areola size and placement may not be ideal; the chest may not be completely flat; insufficient skin retraction; pleating/puckering around areola with Peri-Areolar; approximately 40% chance of revision.

Inverted-T Top Surgery

Another procedure that is similar to Double Incision but designed to preserve nipple sensation is Inverted-T. The important distinction between these methods is that Inverted-T doesn’t use nipple grafts. Instead, the nipple-areola complex is reduced in size and repositioned without severing the nipple stalk and nerve, offering better sensation compared to Double Incision Top Surgery.

Cost of FTM Top Surgery

The cost of FTM Top Surgery with Dr. Drew Schnitt, for Keyhole, Peri-areolar, Double Incision with nipple grafts, or Inverted-T procedures, price starting at $5995.

After a complete consultation with Dr. Drew Schnitt exact pricing will be provided.

Easy Top Surgery Financing options available for qualified applicants & may add additional costs. Dr. Drew Schnitt accepts Care Credit and United Medical Credit financing. Dr. Drew Schnitt does not accept insurance for Top Surgery.

Top Surgery Revisions

Dr. Drew Schnitt also performs Top Surgery revisions to correct results of a previous Top Surgery performed by another doctor. It is important to select your surgeon with the right credentials and board certifications. Ensure your surgeon is board certified by the American Board of Plastic Surgery and in good standing with the American Society of Plastic Surgeons (ASPS).

With Keyhole patients, nipple reduction is the most common revision. Peri-Areolar revisions include nipple and/or areola reduction, liposuction, scar revisions. “Dog ears” are often reported after Double Incision and are probably the most common cause of revision in Double Incision patients.

Top Surgery Recovery

You will be provided with specific instructions for Top Surgery recovery and post-op care.

Please note that you will require a friend or family member to pick you up from the surgery center and stay with you for a minimum of 24 hours. You will need to stay in the South Florida area for at least a week. Most patients are clear to leave after their follow-up appointment with Dr. Drew Schnitt.

You may experience some pain following surgery, however medication can be provided to reduce discomfort. Non-opioid alternatives are recommended and available.

A surgical chest binder is usually worn for 3-6 weeks after Peri-Areolar and Double Incision Top Surgery to prevent swelling, fluid buildup, help tighten the tissues and help reduce scarring.

To get the best results, it’s very important to avoid heavy lifting, exercising and raising your arms over your head for a period of 4-6 weeks following Top Surgery. Additional details will be provided during your consultation with Dr. Drew Schnitt.

Requirements

  • Dr. Drew Schnitt is a member of WPATH and follows the WPATH Standards of Care. You will need to supply a letter from a qualified mental health professional recommending Top Surgery.
  • Hormone therapy is not required, however patients who are on HRT will need to provide a support letter from the prescribing physician.
  • Dr. Drew Schnitt will operate on those under 18 years of age, with parental consent.

Footnotes:

1. Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232.

2. Spack NP. Management of transgenderism. JAMA. 2013;309(5):478–484.

3. Gijs L, Brewaeys A. Surgical treatment of gender dysphoria in adults and adolescents: Recent developments, effectiveness, and challenges. Annu Rev Sex Res. 2007;18(1):178–224.

4. Lawrence AA. Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery. Arch Sex Behav. 2006;35(6):717–727.

5. Richards C, Barrett J. The case for bilateral mastectomy and male chest contouring for the female-to-male transsexual. Ann R Coll Surg Engl. 2013;95(2):93.

6. Berry MG, Curtis R, Davies D. Female-to-male transgender chest reconstruction: A large consecutive, single-surgeon experience. J Plast Reconstr Aesthet Surg. 2012;65(6):711–719.

7. Davis SA, Colton Meier S. Effects of Testosterone Treatment and Chest Reconstruction Surgery on Mental Health and Sexuality in Female-To-Male Transgender People. Int J Sex Health. 2014;26(2):113–128.

8. Newfield E, Hart S, Dibble S, Kohler L. Female-to-male transgender quality of life. Qual Life Res. 2006;15(9):1447–1457.

9. Wierckx K, Van Caenegem E, Elaut E, et al. Quality of life and sexual health after sex reassignment surgery in transsexual men. J Sex Med. 2011;8(12):3379–3388.