FTM (Female-to-Male) top surgery is a significant step in the gender-affirming process for many transgender individuals. This surgery involves the removal of breast tissue to create a more masculine chest contour.

Below is a comprehensive guide to FTM top surgery, covering various aspects of the procedure, preparation, recovery, and post-operative care:

1. Understanding FTM Top Surgery

Types of FTM Top Surgery:

• • The technique used depends on the size and shape of the breast, the position and size of the nipple and the quality of the skin.
  • Double Incision with Nipple Grafts: Removes excess skin and breast tissue with nipple grafts. It is the most common method used and results in a curved or linear scar across the lower chest. This is the most common option and involves:

1. • 1. Remove your nipples and areolas and decrease their size.
     2. Make long incisions to access and remove your breasts.
     3. Performing liposuction to remove excess fat.
     4. Removing excess skin, if necessary.
     5. Prevent skin puckering (dog ears) near the incision with special stitches.
     6. Reattach the optimized nipples and areolas to your chest.
   • Peri-Areolar or Keyhole: This procedure produces minimal scarring and is suitable for smaller chests with less excess skin.
     1. Make one circular incision around the border of your areola.
     2. Make a larger circular incision around the first one.
     3. Remove breast tissue and perform liposuction.
     4. Resize and reattach the areola by bringing together the edges of the larger incision

1. • Buttonhole/Inverted-T: Combines aspects of both double incision and peri-areolar techniques.
   • Each technique requires a general anaesthetic and at least one overnight stay.

2. Choosing a Surgeon:

Research:

• • Look for experienced surgeons specialising in transgender procedures. The ideal choice is a board-certified (BAAPS / BAPRAS) plastic and reconstructive surgeon who specialises in transgender procedures. Going to an experienced provider (like Mr Fitton) gives you the best chance of successful surgery.
  • Read reviews and testimonials.
  • Examine before-and-after photos of their previous work.

Consultation:

• • Schedule consultations with potential surgeons.
  • Discuss your goals, expectations, and any concerns.
  • It is very important that you have a realistic attitude of what female-to-male chest reconstruction surgery can achieve, and to be prepared to accept varying degrees of scarring, loss of sensation (especially in your nipples) and irregularity or asymmetry.
  • Enquire about the surgeon’s experience with FTM top surgery.
  • Removal of breast tissue does not eliminate the risk of breast cancer developing in the area. If you are at risk for inherited breast cancer, be sure to inform Mr Fitton.

3. Preparation:

Medical Assessment:

• • Undergo a comprehensive medical evaluation to ensure you are a suitable candidate for surgery.
  • Before surgery, a healthcare provider will evaluate your health to address any medical conditions that might prevent you from having surgery or that could affect the procedure.
  • Discuss any pre-existing health conditions with Mr Fiitton.
  • If necessary, lose weight as a high BMI increases the risks during surgery.

Hormone Therapy:

• • Some surgeons may require hormone therapy before surgery to optimise your results.

Smoking:

• • Smoking can impair healing. Mr Fitton will recommend stopping well in advance of the procedure.

4. Surgery Day:

Anesthesia:

• • FTM top surgery is typically performed under general anaesthesia.

The Procedure:

• • The chosen surgical technique determines the steps involved. Mr Fitton will discuss the best procedure with you at your consultation.
  • Double incision involves removing breast tissue and excess skin and repositioning the nipples.
  • Peri-areolar involves smaller incisions around the areola.
  • Drains, soft tubes connected to a vacuum bottle, are inserted to reduce the risk of a collection of blood in the operative site.
  • The wounds are closed with soluble sutures reinforced with steri-strips, (paper sutures). Further dressings, of a very simple nature, are then applied.
  • The drains are generally removed the following morning.
  • The dressings remain intact for two weeks.
  • If free nipple grafts are used they are held in position with a foam dressing which is sutured in place.
  • A degree of swelling is to be expected along with bruising. This will gradually resolve over the next few weeks.

Duration:

• • Surgery time varies but usually takes between 90 and 120 minutes.

5. Recovery:

Hospital Stay:

• • An overnight stay in the hospital will be required whichever technique is performed.

Pain Management:

• • Medication will be prescribed for pain management.
  • You may experience some discomfort for a few days after surgery, but generally after four to five days your pain will ease and can be managed with over-the-counter acetaminophen and ibuprofen.

Activity Restrictions:

• • Follow post-operative guidelines for strenuous activities.
  • It is imperative not to take to your bed or sit for prolonged periods.
  • Deep vein thrombosis, subsequent pulmonary embolus, and its implications are more common in those patients who do not mobilise.
  • Drinking regular volumes of water is also beneficial.

Compression Garments:

• • Wear compression garments as instructed to reduce swelling and support healing.

Organise leave from work:

• • A period of leave from work or education is necessary to ensure a proper healing process post-surgery.
  • Depending on the complexity of the procedure and the nature of your work, plan for a leave of absence ranging from two to four weeks.