Chest reconstruction surgery, also known as FTM top surgery (female to male top surgery) is a gender-affirming, masculinizing, top surgery that removes breast tissue and forms remaining tissue into a shape that is typically considered to be more masculine.
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There are many different techniques that can be used for chest surgery. The technique used depends on factors like cup size and skin elasticity, as well as the size and position of your nipples. The three most common techniques are described below. Your surgeon will recommend a technique suited to your body shape and goals.
Click through the additional accordion folders below to read more information on each type of technique.
This technique is recommended for people with an A cup-size and lots of chest skin elasticity.
The outcome of this procedure is a small scar on the lower part of the areola and nipples with sensation.
This technique is recommended for people with a B-cup size or a C-cup size in someone with a moderate–to-great-deal-of chest skin elasticity.
An incision is made all around the outside of the areola.
A second circular incision is made a few centimeters away from the first.
The doughnut shaped skin between the two incisions is removed.
Breast tissue is then removed with a scalpel, or with a combination of scalpel and liposuction.
Some trimming of the nipple areola complex may be done but the blood and nerve supply remain intact.
The skin is sutured together around the areola.
Drains (long thin tubing) may be placed in the chest to help drain off excess blood/fluid so that it will not build up under the skin.
The outcome of this procedure is scarring that goes around the nipple/areola complex and nipples with sensation. There may be some puckering around the incision.
This technique is recommended for people with a C-cup size and reduced skin elasticity or a D-cup size.
Large incisions are made horizontally across the chest, usually beneath the nipple.
The skin is peeled back. Breast tissue are removed with a scalpel and liposuction.
Excess chest skin is trimmed.
Incisions are closed, leaving two scars below the pectoral muscle lines.
With the free nipple graft technique, the nipple/areola complex is removed completely, trimmed to a smaller size and grafted to the chest in a higher position.
Two drains (long thin tubing) are placed long each incision to allow blood and fluid to escape.
The outcome is prominent scars (You may be able to grow chest hair to cover the scars. Building your pectoral muscles may make the scars less noticeable. Some people get tattoos over their scars.). There may be possible changes to the pigment or the areola. There can be sensory changes including complete loss of sensation in the nipples.
Your body will want to generate lots of fluid around the surgical site. To prevent this fluid from building up in your chest, it needs to be drained. The surgeon will insert drains for this purpose, and you will be taught how to monitor and empty them. The drains will be removed by the surgeon during a clinic visit 3-7 days following surgery.
It is normal for the incisions on your chest to be red, but this redness should not extend to more than 1 to 2 cm from the incision (if they extend beyond this, seek medical attention). It is also normal to see or feel the knot from the stitches at the end of the incision. These knots can be annoying, but they are nothing to worry about. If they work their way to the surface (usually around 3 weeks) they can be clipped free by a health care provider. Bruising and swelling is expected and is not a cause for concern unless there is an unusually large amount of swelling on one side.
Recovery time varies from person to person, so always follow the advice of your surgeon. Many people feel comfortable within two weeks following chest surgery. You’ll need plenty of rest prior to this time. Expect to limit your arm movement for the first 2-3 weeks. It is common to gradually return to your daily activities over the 4-6 weeks following your surgery. Some activities, such as driving, heavy lifting, exercise, sex, and soaking in hot tubs, may be restricted in the post-operative period. Your surgeon will give you advice about when it is okay to resume these activities.
All surgical procedures involve some risks, including negative reactions to anesthesia, blood loss, blood clots and artery blockages. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise, and respond to them appropriately. They will also inform you about what you can do to minimize your risks.
The list below includes some of the complications associated with chest surgery in particular. It does not replace a thorough consultation with your surgeon.
This is when blood collects in the surgical site, causing pain, swelling and redness. It is the most common complication. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.
This is when clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon. Big seromas may need to be removed through surgery.
