Top Surgery

TOP SURGERY - FEMALE TO MALE SURGERY IN PORTSMOUTH

To realize one’s own identity fully is one of the primary aims of life. For transgender individuals, this path of self-realization often involves one or more gender confirmation surgeries. Transgender male patients who were assigned female at birth frequently undergo double mastectomy in order to create a more a masculine chest form, a process informally known as top surgery. Board-certified plastic surgeon Dr. Anthony Wilson offers personalized female to male chest reconstruction surgery suitable for every body type.

Meet Dr. Wilson

Anthony Wilson, MD has vast experience performing facial, body, and reconstructive procedures. After receiving an undergraduate degree from Harvard University and completing training with a medical degree from the University of Pennsylvania, Dr. Wilson has continued to improve his technique to ensure the best results possible. Learn More about Anthony Wilson, MD, and why you should choose the Board-Certified plastic surgeon for your next procedure in the Seacoast Region.

ABOUT TOP SURGERY

Top surgery typically involves the removal of most of the patient’s existing breast tissue. In some cases, a nipple graft is also performed in order to reshape the nipples and position them correctly. Though the purpose of top surgery is straightforward, the techniques used to perform this operation vary considerably depending on the patient’s unique anatomy. Female to male surgery on the chest ranges from being a minimally invasive operation to being a complex procedure that requires substantial recovery time. Some of the most common top surgery techniques are outlined below:

  • Liposuction Only
    Liposuction is incorporated into most top surgeries. However, when a patient has very small breasts (with small areolas), it can sometimes be used as a standalone procedure. Removing fatty tissue from small breasts can sculpt more masculine chest contours without creating visible loose skin, provided that the patient has good skin elasticity. This technique is preferred by small-breasted patients because it produces very little scar tissue and requires only about one week of healing time.
  • The “Crescent” Incision

    The crescent incision technique is used on patients with moderately small breasts. When using this technique, Dr. Wilson makes an incision along the underside of each nipple. Through this incision, he can perform liposuction, remove dense breast tissue, and reduce the size of the nipple, if desired.

  • The Inverted T or “Anchor” Incision

    The anchor incision is ideal for patients with average-sized to moderately large breasts. This surgical technique involves the placement of three incisions: A circular incision around each areola, a vertical incision down the underside of each breast, and a horizontal incision within each inframammary fold. This incision pattern facilitates the removal of both breast tissue and loose skin. Furthermore, patients who have anchor pattern top surgery can have their areolas reshaped while preserving nipple sensation (as this method leaves the nipple stalk intact).

  • The Double Incision

    Dr Wilson’s preferred approach to transgender top surgery is the double incision mastectomy. Patients with large enough breasts (or breasts that show a significant degree of ptosis) benefit from this approach. This technique involves the creation of a long incision across the lower border of the pectoral muscles. A substantial amount of skin and breast tissue are then removed from the area below these incisions. Finally, the nipples are detached and reshaped before being grafted back onto the chest. This method is highly effective at changing the contours of the patient’s chest, but patients typically experience some loss of nipple sensation after having this procedure. This approach is often combined with liposuction to provide the best masculinization of the chest.

    When you come in for a consultation, Dr. Wilson will thoroughly examine your chest and let you know which method will create the best results for you.

Liposuction is incorporated into most top surgeries. However, when a patient has very small breasts (with small areolas), it can sometimes be used as a standalone procedure. Removing fatty tissue from small breasts can sculpt more masculine chest contours without creating visible loose skin, provided that the patient has good skin elasticity. This technique is preferred by small-breasted patients because it produces very little scar tissue and requires only about one week of healing time.

The crescent incision technique is used on patients with moderately small breasts. When using this technique, Dr. Wilson makes an incision along the underside of each nipple. Through this incision, he can perform liposuction, remove dense breast tissue, and reduce the size of the nipple, if desired.

The anchor incision is ideal for patients with average-sized to moderately large breasts. This surgical technique involves the placement of three incisions: A circular incision around each areola, a vertical incision down the underside of each breast, and a horizontal incision within each inframammary fold. This incision pattern facilitates the removal of both breast tissue and loose skin. Furthermore, patients who have anchor pattern top surgery can have their areolas reshaped while preserving nipple sensation (as this method leaves the nipple stalk intact).

Dr Wilson’s preferred approach to transgender top surgery is the double incision mastectomy. Patients with large enough breasts (or breasts that show a significant degree of ptosis) benefit from this approach. This technique involves the creation of a long incision across the lower border of the pectoral muscles. A substantial amount of skin and breast tissue are then removed from the area below these incisions. Finally, the nipples are detached and reshaped before being grafted back onto the chest. This method is highly effective at changing the contours of the patient’s chest, but patients typically experience some loss of nipple sensation after having this procedure. This approach is often combined with liposuction to provide the best masculinization of the chest.

When you come in for a consultation, Dr. Wilson will thoroughly examine your chest and let you know which method will create the best results for you.

WHO MAKES A GOOD CANDIDATE FOR TOP SURGERY

Top surgery is recommended for patients with a history of gender dysphoria. If you feel that your current physical shape does not reflect your identity, and this fact causes you great discomfort, female to male surgery can help you feel more at home in your body.

To have top surgery, you will need to be in good overall health and be a current nonsmoker. Smoking greatly increases your risk of surgical complications and can delay healing, so if you smoke, you will need to remain smoke-free for at least three weeks before and after your surgery. Certain medications, like blood thinners, can also interfere with your ability to have surgery. When you come in for a consultation, Dr. Wilson will carefully review your complete medical history, including any medications or supplements you take. He will then work with your primary physician and mental health provider to develop a safe surgical plan for you.  All patients who would like to go through with top surgery must obtain a letter of clearance from their mental health provider.

Many patients are curious as to the role of testosterone in top surgery. Testosterone will greatly improve the aesthetic result of your surgery. Testosterone helps redistribute fat deposits and encourages a male hair growth pattern. There is no requirement, however, for testosterone supplementation. Patients interested in surgery can seek consultation and treatment with or without hormone therapy.

Insurance carriers now frequently cover top surgery. Prior to your consultation with Dr. Wilson we recommend you contact your insurance carrier to discuss the requirements for approval. Many carriers require significant documentation from other health providers prior to any approval.

WHAT TO EXPECT DURING RECOVERY FROM TOP SURGERY

The initial recovery period after having top surgery usually lasts from 10 to 14 days. During this time, you will need to rest at home and avoid vigorous exercise. You will be provided with pain medication to help you manage any discomfort you experience. Enlisting the aid of a caregiver is also recommended; moving your arms will probably be difficult immediately following surgery, so you will need someone to help you perform necessary tasks.  For the first week you will have drains that help prevent fluid collection. These drains will require daily attention and are easily managed at home. In addition to drains you will also have a binder or compression garment that places pressure over the site. For patients that are undergoing double incision mastectomy, there will also be bolster dressings over the nipple sites. These bolster dressings are removed 1 week after surgery.

After two weeks, you will probably feel ready to return to work. However, it’s important to avoid certain forms of exercise and all heavy lifting for four to six weeks after having top surgery. Dr. Wilson will provide you with detailed recovery instructions before your operation in order to help you heal comfortably. Patients who have double incision mastectomy with free nipple grafts will need to avoid getting the nipples wet for three weeks. Nipples will need to be covered with special ointment and Band-Aids for a total of three weeks until this healing process is complete. At the time of consultation our team will provide you with a list of prior patients that are willing to speak of the recovery process. We have found that there is no better source for advice and guidance than someone who has experienced this process.

Note that it is normal for scars to appear thick and bumpy for several months after surgery. You can expect your scars to fade and become smoother over a period of 12 to 18 months. Eventually, they should form subtle lines that are slightly lighter than surrounding skin. Proper wound care can greatly reduce your risk of scarring, so be sure to care for your incisions as directed.

Schedule a Consultation

From Breast Augmentation to Non-Surgical Rhinoplasty and everything in-between, Board-Certified plastic surgeon Anthony Wilson, MD offers a wide range of procedures at his Portsmouth, NH office. If you are interested in booking a procedure, take the next steps by scheduling a consultation today.

ARRANGE A TOP SURGERY CONSULTATION IN PORTSMOUTH

Having the freedom to be who you truly are is a priceless, life-changing feeling. If you’re ready to explore gender confirmation surgery, contact Ivy League educated and trained plastic surgeon Dr. Anthony Wilson at (603) 294-4526 to arrange your personal consultation. His plastic surgery practice, which is conveniently located in downtown Portsmouth, New Hampshire, is built on a foundation of compassionate bespoke care. Dr. Wilson and his team will be happy to support you throughout the transition process and beyond.