What to Know About Top Surgery for Transgender Men

Gender dysphoria is the term that describes a person’s distress due to a difference between their expressed gender and the sex assigned them at birth. Top surgery is a surgical procedure for females transitioning to males that removes breast tissue (subcutaneous mastectomy) in an attempt to create a more masculine physical appearance.

At Desired Beauty, in Bakersfield and the Beverly Hills neighborhood of Los Angeles, California, board-certified cosmetic surgeon Dr. Farzin Kerendian and his staff specialize in helping females transition to their male identities by offering top surgery that comes with quality results and minimal downtime. If you’re looking to make this step yourself, here’s what you need to know.

Why top surgery?

If you’re in the process of transitioning, it’s important to know what does and doesn’t make you feel comfortable in your own body. For some, top surgery is a natural — and important — part of making the transition. 

For others, surgery isn’t necessary for them to feel comfortable with their chosen gender. If you’re considering top surgery, make sure you’re doing it because you want to do it, not because you feel obligated or forced.

Your doctor might also have something to say about the surgery, recommending against it if you have:

Getting ready for top surgery

Masculinizing surgeries are typically not performed until adulthood, so the patient has enough time to consider their transition and is mature enough to give informed consent.

Before you’ll be able to have top surgery, you’re required to meet certain criteria. To start, your doctor evaluates your health to rule out conditions that might contraindicate treatment, such as those stated above. The evaluation might include:

Most surgeons and insurance companies also require a mental health evaluation by an expert transgender health provider. That individual will determine if you meet the World Professional Association of Transgender Health (WPATH) standards of care criteria.

This criteria includes a persistent, well-documented gender dysphoria and the capacity to make a fully informed decision about treatment. You must be of legal age to make health care decisions (18 in the United States) and show a history of successfully managing any significant medical or mental health conditions.

Top surgery results in irreversible physical changes, so you have to give informed consent after thoroughly discussing:

Be aware that even though top surgery may be essential to relieve your gender dysphoria, insurance companies might not cover your surgical procedures since they’re considered cosmetic for the general population.

Top surgery procedure and recovery

Top surgery requires special techniques to reduce and contour your chest wall, position your nipples and areola, and minimize scarring.

If you have small breasts, you may get a subcutaneous nipple-sparing mastectomy. The procedure minimizes scarring, allows for faster healing, and usually preserves sensation in your nipples. 

If you have larger breasts, the surgeon may need to remove your nipples and areolas, which he resizes and grafts back into position for a male chest appearance. It does cause more scarring, as well as a loss of nipple sensation, but the latter can return, albeit months to years, afterward.

After top surgery, you might need additional procedures to correct scarring, the placement of your nipples and areola, or chest contour.

Following surgery, you need to wear a compression garment on your chest for a few weeks. You may also have plastic tubes placed where your breasts were removed to drain fluids that collect after surgery. 

You’ll have to sleep with your torso elevated for the first week and avoid lifting more than 10-15 pounds for several weeks. You’ll likely retain some breast tissue no matter the technique, so you’ll need to discuss continued, routine breast cancer screening.

Research suggests that most transgender men are happy with their top surgery results. In a 2017 study, 48 out of 57 transgender men said they felt comfortable taking their shirts off in front of others.

If you’re considering top surgery to aid your transition, it’s important to go to a doctor who specializes in the procedure. Schedule a consultation with Dr. Kerendrian by calling our location most convenient to you or booking an appointment online today.

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