Chest Masculinization (FTM)
The goal of FTM (female-to-male) top surgery is to remove breast tissue and contour the remaining skin and fat to create a flat, masculine chest. The specific surgical technique used depends primarily on the size of the breasts and the skin elasticity of the patient. The two most common procedures are Double Incision and Periareolar.
Double Incision Mastectomy
The Double Incision (DI) method is the most common technique, used for individuals with medium to large chests. It involves two horizontal incisions made along the pectoral muscle border. The breast tissue is removed, excess skin is excised, and the nipple-areola complex is removed, resized, and grafted back into a new, masculine position. This technique allows for the most significant tissue removal and chest contouring but results in visible scars along the pectoral lines.
Periareolar and Keyhole Top Surgery
The Periareolar ('peri') and Keyhole techniques are suitable for individuals with very small chests and good skin elasticity. In the peri technique, an incision is made around the border of the areola, and another larger concentric circle is made around that. The breast tissue is removed through this incision, and the skin is cinched together like a drawstring, resulting in a scar only around the areola. The Keyhole technique uses a small incision on the lower border of the areola and does not involve resizing or moving the nipple. These methods have minimal scarring but offer less opportunity for chest contouring.
Breast Augmentation (MTF)
Breast augmentation is the primary top surgery for MTF (male-to-female) individuals. It is typically performed after a patient has been on hormone therapy for at least 12-18 months to allow for maximal natural breast development. If the patient is unsatisfied with the final size, implants can be used to increase volume and improve shape. The surgeon helps the patient choose the implant type (saline or silicone), size, and placement (subglandular or submuscular) to achieve a result that is proportional and natural-looking for their body frame.
Implant Placement and Incisions
For breast augmentation, the incision is typically made in one of three places to minimize visible scarring: in the inframammary fold (the crease under the breast), periareolar (around the areola), or transaxillary (in the armpit). The implant can be placed either subglandular (over the pectoral muscle) or submuscular (under the muscle). Submuscular placement often provides a more natural-looking result, especially in patients with little initial breast tissue, as the muscle helps to hide the edges of the implant.