Female to Male Top Surgery: Chest Reconstruction

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Male chest reconstruction is one of the top surgeries for female-to-male sex reassignment. The procedures involve masculinization of the chest by removing the breast tissue and resizing or reshaping the areola and nipples. This method removes the subcutaneous tissue from the inside of the breast along with excess skin.

Surgery Options

  1. Double incision
  2. Inverted-T
  3. Keyhole

Before the surgery

  • Obtain clearance from your therapist for a chest surgery
  • Prepare a pre-op evaluation
  • Maintain a healthy diet at least two weeks prior to the surgery
  • Quit smoking two to six weeks before and after the operation
  • Plan for post-op appointments

Chest reconstruction procedure

Double Incision: This is one of the most common male reconstruction surgeries. It involves incisions above and below the breast to remove the fatty tissue. Scars are inevitable beneath the pectoral muscles. Free nipple grafting is usually combined with this method, where the nipple and areola are removed, resized, reshaped and restored to the chest. The areolas are downsized as female areolas appear larger than male areolas. In the case of your body rejecting nipple grafting, your surgeon will tattoo your nipple back cosmetically or may use further surgical attempts. The procedure severs the nerves on the nipples, but you can hope for some sensation to return.

Inverted-T: This approach is called a transverse inframammary incision, and it includes free nipple areola grafting. Here, the areola is trimmed depending on what you have decided with your surgeon. Your nipple will have a pie-shaped excision which will be reconstituted.

Keyhole: Patients with small breast size choose keyhole incision. A small incision is made in the lower part of the areola to remove the underlying glandular tissue. Removing excessive skin is not necessarily done in this method.

After the surgery

  • Until your first post-op appointment with your surgeon, your chest will be covered with surgical garments.
  • There will be two drains from your dressing to prevent fluid from accumulating in your chest.
  • You will experience itching and pain as your incisions heal, which is normal.
  • Showering should be avoided before your first postoperative appointment. You will be directed to keep your dressing dry for two weeks.
  • Expect soreness for at least a week after the surgery.
  • There will be restrictions on strenuous activities and heavy exercise for two weeks after the surgery.

Risks and Complications

The common risks accompanying a male chest reconstruction surgery are infections on the incision site, blood loss, blood clotting and loss of nipple sensation. The risk of excessive blood loss commonly occurs in double incision approach as it requires cutting a longer length of the skin compared to other methods.

Post-Op Care

  • Smoking and alcohol intake should be totally avoided before and after the surgery.
  • You can expect to resume normal work after a week or two
  • Keep the incision region dry for at least a week
  • Maintain a healthy diet
  • Avoid lifting heavy weights
  • Itching and pain in the incision area are normal after surgery. If the pain continues or gets worse, consult your doctor without delay.

FAQs

If I have big breasts can I still get a masculine flat chest?

A: Yes, your surgeon will choose the type of surgery you will undergo depending on the size of your breasts. For large breasts, the double incision method is suitable.

How dangerous is top surgery?

A: The risks will include excessive blood loss, blood clotting, loss of nipple sensation, anesthesia risks, and hematoma. But the dangers accompanying this surgery will also depend on your medical history, so a thorough discussion with your surgeon will be wise.

Will my breasts grow back after chest reconstruction surgery?

A: Surgeons usually leave some fat for a natural male chest after the surgery. If you have stopped taking testosterone medications or have not removed your ovaries, the feminine pattern would still run as you gain weight. In this case, there is a chance for your breasts to grow back. You can avoid this by following a healthy diet and exercise regime following the surgery.

What is the level of pain after the surgery?

A: If you follow the instructions for postoperative care, you will not be facing extreme pain. Any pain or discomfort will be managed by the prescribed medications from your surgeon.


References:

https://www.healthline.com/health/transgender/top-surgery

https://www.genderconfirmation.com/ftm-chest/

https://www.hey.nhs.uk/patient-leaflet/gender-reassignment-surgery-female-male-breast-surgery/

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