Top Surgery is reduction and masculinization of the breasts and chest for a person who wants a more masculine chest. This is often an individual who desires gender reassignment.. Breast tissue is removed and the nipple position is usually made smaller and placed in a more masculine anatomic position.
Top surgery allows for a more comfortable chest with improved psychosocial benefits. Clothing fits better, physical activity may be easier. The chest can also be made more masculine with fat grafting or implants to provide a more muscular and sculpted appearance.
There are several methods used and these depend upon the patient’s breast or chest size before surgery. Considerations include the laxity of skin the size of the areola and amount of fat and recent weight gain or weight loss. The most common procedures which are described include the periareola, buttonhole, double incision, and anchor patterns. Personally, I frequently use liposuction along with the double incision for larger breasts and some variation for smaller breasts depending upon the position of the Areola. And the female breast the nipple is often centered on the breast but in the male patient the nipple and Areola is lower and closer to the outside edge of the pectoralis muscle. Because each person is different, it’s important to be realistic about your goals and what is realistically achievable. Shaping the side of the chest may also be needed and can be performed with suctioning along with contouring of the muscle, as noted above to provide the best definition for the chest.
Board certification in plastic surgery and experience is a good starting point. You should feel comfortable with your surgeon and his office staff. They should be open minded regarding gender surgery. It’s important for your surgeon to have an aesthetic eye for body contouring you should be comfortable with the surgical facility that your doctor uses and make sure that it is certified. Although costs for surgery vary it is important that the expense expense be reasonable for your surgeons experience. Does your doctor and his office have an excellent reputation in the community? Are you comfortable that your doctor will have the experience to deal with any problems that may arise as they can with any surgery? Always make an informed decision… take your time.
The world professional association for transgender health (WPATH) promotes the highest medical standards and provide clinical guidance for the best health, psychological and self-fulfillment issues that confront persons with gender concerns. Hormone therapy for top surgery is not required unless you’re seeking coverage through her insurance. Many companies will require one year of HRT. Benefits of HRT for every patient, however , do include heavier chest muscles and more chest hair which can cover some incisions while you are healing. Hormone replacement therapy may be a strong consideration for most patients. WPATH provides the best current standards of care for physicians to assist in the care of transgender, transsexual and nonconforming patients.
I generally use the some sort of compression depending on the method of surgery. This may be a binder, spandex tank top, or something similar. Drains are also used at times but I avoid them whenever possible. These will be removed between three and five days. Most of the sutures used are absorbable and do not need to be removed except those that may be in place around of the Areola. The sutures will be cut or removed between seven and 10 days.
You may bathe the day after surgery but keep the dressings dry. If they get wet, they can be dried with a hairdryer.
Scar therapy is the same as other surgical procedures. Silicon gel and silicon sheets can be used to control scarring. Products such as BioCorneum, Scarguard and others are useful. On occasion we will use a laser treatments to diminish the redness of scars.
You may resume easy activities such as walking on the day of surgery. You will heal quicker and be more comfortable if you are more active beginning the evening of your operation. I will increase your activity over the first of 2 to 6 weeks depending upon how are you were feeling. You should take care not to to avoid it too much of a chest expansion to allow your incisions to heal properly.