FTM Top Surgery (Female-to-Male Chest Masculinisation Surgery)

Overview
FTM top surgery removes breast tissue and reshapes the chest to create a masculine contour. It is a key component of gender-affirming surgery for trans men and some non-binary individuals, aligning physical appearance with gender identity. The approach is tailored to chest size, skin elasticity, and individual aesthetic goals.

Who It’s For

  • Transgender men or non-binary individuals seeking masculine chest contour

  • Stable gender identity and realistic expectations

  • Good physical health and stable weight

  • Non-smokers (or willing to cease pre- and post-operatively to reduce complication risk)

Procedure
Technique selection depends on breast size and skin quality:

  • Double Incision Mastectomy:

    • For moderate to large chests with excess skin

    • Horizontal incisions placed along the lower pectoral border

    • Removal of breast tissue and skin; nipples are resized and grafted in a masculinised position

  • Periareolar or Keyhole Technique:

    • For small chests with good skin elasticity

    • Incisions made around the areola; tissue removed via liposuction or direct excision

    • Minimal scarring and preservation of natural nipple attachment

  • Surgery performed under general anaesthesia; duration 2–4 hours

Recovery

  • Outpatient or one-night stay

  • Compression garment worn continuously for 4–6 weeks to reduce swelling and support chest contour

  • Drain tubes (if used) removed after several days

  • Return to light activity within 1–2 weeks; avoid heavy lifting or chest exercise for 6 weeks

  • Swelling and tightness gradually subside over several months

Results and Scarring

  • Masculine, contoured chest with improved body congruence

  • Scars positioned along the natural pectoral line or areolar border; fade gradually over time

  • Sensation changes around nipple area are common and may be partial or permanent

  • Final contour visible after 3–6 months

Risks

  • Bleeding, infection, or delayed healing

  • Fluid collection (seroma or hematoma)

  • Nipple graft loss or pigment changes

  • Asymmetry or contour irregularities

  • Hypertrophic or widened scarring

Long-Term Considerations
Results are permanent, though weight fluctuation and ageing can alter contour. Scar management, compression, and sun protection improve healing quality. Many patients report improved self-image, comfort, and quality of life following recovery.