Female-to-Male (FTM)

Transgender Top Surgery

Transgender patients on the journey to aligning their physical body with their gender identity may consider aesthetic surgery to help them feel more like their authentic self. Top surgery (breast tissue removal) can provide a trans man with the masculine, defined chest he desires to better represent his gender identity. Dr. Schwartz understands that the journey to self-discovery for a transgender patient can be a long and sometimes difficult one. At the Beverly Hills Breast Institute, we treat all of our patients with the sensitivity and care they deserve, and we aim to help them feel comfortable, happy, and confident in their own skin.

What FTM Top Surgery Can Do for You

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Dr. Schwartz’s primary focus in breast tissue removal is to ensure that the chest maintains a natural contour. This can be achieved by also using liposuction or fat grafting around the chest to create definition where it is needed.
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By removing the breast tissue and surrounding glands, Dr. Schwartz can sculpt a more masculine chest appearance. He can build out pectoral definition and remove the soft, feminine look that is caused by breast tissue.
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The nipple-areola complex plays an important role in creating the appearance of a male chest. Areolas that are too circular, too large, or poorly placed can lead to an unattractive or unnatural chest appearance. Our reconstruction techniques will create an areola appearance fitting for men.

Dr. Schwartz’s Experience With Breast Tissue Removal

Dr. Schwartz is one of the foremost leaders in breast surgeries in the United States. One of his specialties is in mastectomy, which uses techniques similar to breast tissue removal surgery for FTM patients. His technique can sometimes be minimally invasive and can result in less postoperative scarring depending on the amount of tissue you have and what your goals are.

FTM Top Surgery Techniques

Incision Options

Keyhole incisions are ideal for trans men with small amounts of existing breast tissue. A singular incision around the areola is used to remove breast tissue.

Double incisions help treat patients with moderate amounts of breast tissue and allow for the repositioning of the nipple-areola complex without extensive scarring.

Inverted-T incisions are best for trans men with significant amounts of breast tissue. An incision is created around the areola, vertically down the lower breast tissue, and across the inframammary fold.

Nipple-Areola Complex Reconstruction

• We can reposition the nipple-areola complexes on the chest to have a natural positioning and projection.

• We can trim and resize the areolas to have a more masculine shape and size.

• We can resize and reshape overly large nipples to appear more natural with your new chest contour.

Liposuction

• Liposuction is used to remove excess fat from the chest that cannot easily be removed through direct excision.

• With liposuction, we can better contour along the chest to ensure we achieve the masculine definition you desire.

• We use the same incisions used for tissue removal to perform liposuction, which prevents any additional, unnecessary scarring.

Fat Grafting

• Fat grafting for top surgery involves using patient-harvested fat to build out and sculpt the chest.

• Fat grafting may be used during your surgery to help improve the shape and definition of your chest.

FTM Top Surgery Details

Consultation With Dr. Schwartz

Your consultation with Dr. Schwartz is the most important step in your journey. You and Dr. Schwartz will discuss your aesthetic goals and review your medical history to ensure that you are healthy and a good candidate for treatment. After a detailed physical exam, Dr. Schwartz can recommend which technique will provide you with the most natural-looking results.

Recovery

Dr. Schwartz has developed a recovery package to help minimize the discomfort of surgery. He uses twilight sedation known as TIVA to promote a faster recovery period and offers long-acting numbing medications to help ease you through the initial days of recovery. After this period, most of our patients require only TYLENOL®. Drains are sometimes used following this procedure to eliminate the buildup of excess fluid. Most patients can return to work after one week, and you may be able to resume some exercise after four weeks and full exercise at six weeks.

Scars

Dr. Schwartz is a leading scar expert who has published journal articles on this subject and has been the principal investigator for an FDA clinical trial studying breast scars and their healing and improvement. He has developed and utilizes many modalities to relieve tension on the incisions, which reduces the visibility of scars, and he combines scar reduction techniques during the recovery process. While some scarring is likely to develop, it is likely to fade over time.

Pain

Dr. Schwartz uses a number of pain-minimizing techniques before and after surgery. During surgery, we utilize twilight sedation (TIVA), which eliminates surgical pain but doesn’t have the unwanted side effects of general anesthesia. Once your surgery is complete, we inject a long-acting numbing medication that helps reduce pain for three to four days following your procedure.

Dr. Jaime Schwartz’s Results

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In the Media

Frequently Asked Questions

Transgender top surgery can only be performed on patients who have undergone the following steps:
  • On hormones for at least 18 months prior to consultation
  • Received a letter of recommendation from a therapist or licensed psychologist
  • Lived as their preferred gender identity for at least two years prior to their surgery
While there's always a risk of losing nipple sensation, Dr. Schwartz often has success in preserving it. However, this is not important to all patients, so if this is a concern, you should discuss it during your consultation with Dr. Schwartz.
Dr. Schwartz may remove all forms of breast tissue, including glandular tissue, fat tissue, and skin, if needed to achieve your desired goals.