You have just had an FTM top surgery, and you are looking in the mirror for the first time. What do you see?
The mirror moment after surgery tells a story years in the making. The results do not just depend on your plastic surgeon’s skill — they are shaped by months of preparation, your unique anatomy, and how you will handle the recovery process in the weeks ahead.
Will your job demand heavy lifting or long hours at a desk? Do you sleep on your stomach or your back? These details which can be overlooked can impact your recovery. Tissue elasticity, chest wall anatomy and surgical technique are important factors in discussing your FTM surgery.
Modern techniques have revolutionized what’s possible. Plastic surgeons can preserve sensation while minimizing scarring through strategic incision placement. Maximizing these advances in female-to-male chest surgery requires understanding how your unique anatomy responds to surgical intervention. With this understanding, a customized plan can be developed to optimize your outcomes and help you attain your goals.
Dr. Adrian Lo is known for his expertise in FTM surgery and also in his comprehensive understanding of his patient’s needs — especially of the LGBTQIA+ community. Receive personalized care for your FTM top surgery. Visit his Philadelphia office today.
Types of FTM Top Surgery Procedures
Deciding to pursue FTM top surgery is a deeply personal and empowering choice, so it is important to understand the details of this life-changing procedure.
Not all chest reconstruction surgeries are the same. The best option for you will depend on your unique anatomy, tissue characteristics, and the aesthetic results you are aiming for. Each technique has its own set of benefits, designed to suit different body types and personal goals.
The beauty of FTM top surgery is that it is highly customizable, ensuring the approach is tailored to your specific needs and preferences.
Double Incision Method
Double incision top surgery remains the most common approach for patients with larger amounts of breast and chest tissue. This technique involves a horizontal incision at the lower part of the chest or inframammary crease. This allows maximum breast tissue removal and chest contouring of the skin. The second incision is circumferential around the nipple/areola to reduce the areolar size and to reposition the areola. This double incision technique uses a free nipple graft which can have issues with healing and loss of nipple sensitivity.
Dr. Lo has pioneered a new technique that preserves the nipple feeling and blood supply to eliminate the problems with the nipple healing in the double incision technique. It is a version of the No Vertical Scar Breast Reduction technique that Dr. Lo has modified for his FTM patients.
Dr. Lo recommends his novel surgical technique for patients with significant breast volume seeking maximum breast tissue elimination and refined chest sculpting.
Subcutaneous Mastectomy/Periareolar Approach
Designed for patients with mild to moderate breast tissue, the periareolar technique involves an incision on the lower part of the areola. This method allows breast tissue removal while minimizing visible scarring. There is also a small reduction in the size of the areola and the nipple/areolar ends up in a better position.
Patients with smaller breast volume and minimal excess skin are candidates for this surgical approach. Dr. Lo uses this technique frequently for his FTM patients with mild to moderate breast tissue to meet their aesthetic goals.
Keyhole Technique
Keyhole top surgery offers another option for patients with moderate breast size. The surgical incisions are completely around the areola with a vertical incision that extends from the areola to the lower breast crease or inframammary crease. This approach allows removal of larger breasts and removal of excess skin. However, this results in a vertical scar that may be more visible than one may like. This surgical approach is the least often used by Dr. Lo for his FTM patients.
Related: Boob Job Scars: What You Can Expect
Pre-Surgery Requirements and Preparation
Preparing for FTM top surgery is a journey that requires careful attention to both medical and psychological readiness for you to achieve the best possible surgical outcomes.
Medical Clearance
A medical evaluation is one of the top surgery requirements before proceeding with chest reconstruction.
This comprehensive assessment includes in-depth review of medical history and possible blood tests.
Lifestyle Adjustments
Getting your body ready for surgery means making some important lifestyle changes to set yourself up for the best possible recovery.
Focus on eating a balanced diet, staying active with regular exercise, and managing your medications. If you smoke, the only option is to quit — tobacco can slow down healing and increase the chances of complications after surgery. All nicotine products must be stopped including vaping with nicotine and marijuana or THC.
Mental Health Considerations
Recognizing the psychological dimensions of gender-affirming surgery is essential. The journey extends beyond physical transformation, encompassing emotional readiness and psychological preparation.
Psychological Evaluation Process
Before surgery, a thorough psychological assessment ensures you are emotionally ready for the process. This evaluation looks at your mental health history, your experiences with gender dysphoria, and what you expect from the surgery. Counseling with a health professional such as a psychologist or psychiatrist who supports your goals is vital to the success of your surgery.
The goal is to provide well-rounded support to guide you through this life-changing experience.
Support System Planning
Having a solid emotional support network is very important when preparing for surgery.
Surrounding yourself with family and friends can make all the difference, offering comfort and guidance when you need it most and helping you through all the ups and downs of the journey.
Honest communication and understanding from those around you can create a safe space for your healing and personal growth.
Financing Your FTM Surgery
As part of your preparation, it can be important to explore your FTM surgery insurance coverage options. Many insurance companies may not cover FTM surgery. For this type of surgery, financing options are often available to make this surgery affordable.
The Surgery Process
The success of FTM top surgery requires careful pre-operative planning and ongoing dialogue between patient and plastic surgeon. A typical surgical plan for FTM top surgery involves evaluating your current breast and chest measurements and potential for excess skin before marking your incisions.
Anesthesia Administration
FTM surgery is performed under general anesthesia with monitoring by a board-certified anesthesiologist.
Surgical Techniques
Your surgical plan is designed for you to create results that look both natural and harmonious.
Typically during the procedure, 100-800 grams of breast tissue per side are removed to give you a flat chest you desire. The nipple-areola complex is placed in a better position harmonious with your new look.
Dr. Lo is an award-winning plastic surgeon with specialized techniques that can help you achieve the best results.
Post-Operative Recovery Timeline
Recovery from FTM top surgery happens in stages that require patience and proper care.
The first week centers on managing swelling and early healing, while weeks 2 through 6 focus on slowly returning to normal activities. Most patients can resume light office work after 7 to 10 days, but heavy lifting is restricted for 4 to 6 weeks. Athletes should plan for 2 months of top surgery recovery before returning to intense chest exercises.
Immediate Recovery Period
The first 24-48 hours after surgery is an important part of your recovery journey. Early ambulation and maintaining fluid intake is important for optimal healing. Surgical pain is usually mild and is managed by over-the-counter pain medications and occasionally prescription medications.
Drains may be used to prevent fluid buildup after surgery to give you a better result. The drains are typically removed in 3 to 5 days.
You will wear specialized compression vests for 20 hours a day to reduce swelling and to support tissue adherence. Compression garments are usually worn for 4 to 6 weeks.
Long-term Results
Final surgical outcomes evolve over 6 to 12 months as healing continues.
- Sensation improves gradually with most patients reporting normal feeling returning around 6 months and full sensation returning by 12 to 18 months.
- Chest contour continues to refine over 12 months as residual swelling resolves and your skin contracts.
- Scars typically fade with time over 12 to 18 months.
Results and Scar Quality
Scars quality will depend on various factors from the surgical technique to your genetic make-up.
Your genetics, skin type, and commitment to post-operative care will influence how your scars evolve and fade over time.
Scar Management Techniques
Effective scar management begins 3-4 weeks post-surgery, once incisions are fully healed.
Treatment protocols typically include:
- Medical-grade silicone sheets worn 12-23 hours daily for 3-6 months
- Specialized scar creams
- Gentle massage using circular motions for 5-10 minutes twice daily to improve collagen remodeling
- Professional treatments like laser treatments or microneedling
- UV protection to prevent hyperpigmentation
Patients should maintain regular follow-up appointments at 1, 3, 6, and 12 months post-surgery to monitor healing and optimize the results.
Explore Your FTM Surgery Options with Board Certified Plastic Surgeon Dr. Adrian Lo
Dr. Adrian Lo is dedicated to delivering personalized, compassionate care for transgender individuals seeking FTM chest reconstruction. Our approach towards FTM top surgery is rooted in understanding your personal goals and providing support throughout your journey.
Your path to living as your authentic self is deeply personal. Schedule a confidential consultation today to take the next step toward embracing the best version of yourself.