FTM Top Surgery

Among transgender men, FTM Top Surgery is the most popular type of Gender Reassignment Surgery. More than cosmetic surgery, FTM Top Surgery and other GRS procedures are medically required.

FTM Top Surgery is a type of chest masculinization derived from subcutaneous mastectomy that uses specific techniques to create male contours. All types of FTM Chest Surgery involve incisions and removal of breast tissue. FTM Top Surgery may also include removal of excess skin, repositioning of areola and nipple, reduction of areola and/or nipple, or free nipple grafts.

Dr. King performs Top Surgery at St. Mary’s Hospital in Madison, Wisconsin. Surgery typically takes about three hours, under general anesthesia (you are asleep). When you awake, you are in a secure binder, with drains in place. Then you go to the recovery area for the remainder of the time in the hospital. Dr. King keeps his patients overnight for pain control and blood pressure control. If there are any concerns, this allows Dr. King the ability to come into the hospital and check on you.

Types of FTM Top Surgery

Dr. Clifford King offers four different FTM Top Surgery procedures in Wisconsin. He usually performs the procedure at St. Mary’s Surgery and Care Center in Madison.

Double Incision with Free Nipple Grafts

Double Incision FTM Top SurgeryWith Double Incision Top Surgery, horizontal incisions are made along the top and bottom of the chest muscles and breast tissue, as well as the nipple and areola, are removed. The top and bottom incisions are brought together and sutured, with the resulting scar line running under the pectoral muscles, following the natural contour. Smaller areolas and nipples, created from native areola tissue, are grafted on.

Double Incision Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Pros & Cons: Double Incision Top Surgery produces excellent male contour with areolas and nipples appropriately sized and positioned. However, patients should not expect sensation to return in the areola or nipple because the nerves are cut when the original areola and nipple are removed.

Who’s a Good Match: Trans men with medium to large chests and low skin elasticity, and without concern for areola/nipple sensitivity.

Recovery: Top Surgery Recovery – Double Incision

View Before & After Photos of Double Incision Top Surgery

Inverted-T Top Surgery, aka. T-Anchor

With Inverted-T Top Surgery,  horizontal incisions are made along the top and bottom of the chest muscles as with Double Incision. Breast tissue is removed but the areola and nipple are not removed. Instead, an additional vertical incision is made on each side, from the areola down to the incision below the chest muscles. This extra incision allows the areola and nipple to be reduced and repositioned appropriately without severing nerves, thus largely preserving sensation.

Inverted-T Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Pros & Cons: Inverted-T Top Surgery produces excellent male contour with areolas and nipples appropriately sized, positioned and having sensation. However, patients need to be comfortable with having the two extra vertical incisions.

Who’s a Good Match: Trans men with medium to large chests and low skin elasticity, who would like to retain areola and nipple sensation.

Recovery: Top Surgery Recovery – Inverted-T

Peri-areolar Top Surgery

Peri-Areolar FTM Top SurgeryWith Peri-Areolar Top Surgery, two circular incisions are made around the areolas. Breast tissue and the “donut” ring of tissue between two two incisions is removed. The areolas and nipples may be resized. Next, the chest skin is pulled together toward the areolas and sutured around the edges (similar to a drawstring purse.) Like Inverted-T, the areola and nipple are not removed, but resized and repositioned, resulting in largely retained sensation.

Peri-areolar Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Pros & Cons: Peri-Areolar Top Surgery produces excellent male contour with areolas and nipples appropriately sized, positioned and having sensation. Additionally, scarring is minimal as incisions follow the natural outline of the areolas. However, revisions are often required, such as additional liposuction.

Who’s a Good Match: Trans men with medium to small chests and good skin elasticity, who would like to retain areola and nipple sensation.

Recovery: Top Surgery Recovery – Peri-Areolar

Keyhole Top Surgery

Keyhole FTM Top SurgeryWith Keyhole Top Surgery, semi-circular incisions are made at the base of the areolas. Breast tissue is removed. The nipples may be resized. Because the areola and nipple are not removed, sensation is largely retained.

Keyhole Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Pros & Cons: Keyhole Top Surgery produces excellent male contour, with areola and nipple sensation. Additionally, scarring is minimal as incisions follow the natural outline of the areolas. However, revisions are often required, such as additional liposuction and areola/nipple reduction.

Who’s a Good Match: Trans men with small chests and good skin elasticity, who would like to retain areola and nipple sensation.

Recovery: Top Surgery Recovery – Keyhole

View Before & After Photos of Keyhole Top Surgery

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