WHAT IS FTM TOP SURGERY?

FTM top surgery (female-to-male top surgery) is a gender-affirming surgical procedure that removes the breasts and reshapes the chest to create a male-contoured look.

In this reconstructive surgical procedure, Dr. Schwartz removes excess breast tissue, fat, and skin from the chest, and often repositions and reshapes the nipple-areola complex to achieve a natural masculine appearance. The result is a flatter, more defined chest that reflects your gender identity.

Top surgery is highly individualized: No two patients’ chests are the same, so the surgical technique is tailored to your anatomy and desired outcome.

FTM top surgery is typically performed under general anesthesia and usually as an outpatient procedure. It is the most commonly performed gender affirming surgery for trans men, because it can have life-changing benefits.

Many patients report that top surgery dramatically improves their quality of life and self-esteem. In fact, research and countless personal experiences have shown that aligning your chest with your true identity can relieve the distress of gender dysphoria and greatly increase day-to-day confidence.

BENEFITS OF FTM TOP SURGERY

Undergoing FTM top surgery can offer numerous benefits beyond the obvious physical change of having a flatter chest. Some of the key benefits of top surgery include:

• Gender Alignment - By removing breast tissue and creating a male chest contour, top surgery helps align your body with your identity.
• Improved Confidence and Comfort - After top surgery, many trans men describe a surge in self-confidence. You'll feel more comfortable shirtless or wearing the clothes you truly want to wear without needing to hide your chest. Everyday activities – from exercising at the gym to swimming – can feel more natural and freeing.
• Freedom from Binding - Binding can be hot, restrictive, and uncomfortable. Top surgery eliminates the need for constant binding, allowing you to breathe easier and enjoy greater physical freedom in your daily life.
• Physical and Health Benefits - Removing most of the breast tissue significantly reduces the risk of breast cancer in the future. Additionally, relieving the weight and strain of heavy breasts can improve posture and alleviate any back or shoulder discomfort you might have had. The surgical incisions and incision lines are placed strategically (such as along the pectoral muscle line or around the areolas) to be as discreet as possible, and scars tend to fade with time. For most patients, the trade-off of small scars is well worth the tremendous improvement in quality of life.
• High Satisfaction Rates - FTM top surgery has one of the highest satisfaction ratings among gender-affirming procedures. Transgender individuals frequently describe this surgery as “life-changing” or “absolutely worth it.”

Aligning your physical appearance with who you truly are inside can be empowering and emotionally liberating. You’ll have the confidence to move through the world with a chest that reflects your authentic self.

WHO IS A GOOD CANDIDATE FOR FTM TOP SURGERY?

Transgender men, trans masculine, and non-binary individuals who wish to have a flatter, more masculine chest may be eligible for this surgery. Good candidates are those who experience discomfort or dysphoria with their breasts and desire chest masculinization.

Typically, candidates should be in good general health and, in most cases, adults (18 or older) when pursuing surgical transition steps.

At Dr. Schwartz’s Beverly Hills practice, we follow widely accepted guidelines to ensure patients are prepared and supported. Candidates are usually required to meet certain prerequisites before top surgery. These generally include transgender male patients having been on masculinizing hormone therapy (testosterone) for at least 18 months prior to surgery. This is because hormones alone can induce significant physical changes, such as increased muscle mass, body hair growth, a reduction of breast volume, and changes in fat distribution, which may impact surgical planning and outcomes.

Additionally, patients must obtain a letter of support or recommendation from a qualified therapist or psychologist stating that top surgery is an appropriate step. This letter requirement is in line with standard transgender health care protocols (often referred to as WPATH guidelines) to ensure you have psychosocial support.

Dr. Schwartz will discuss all requirements with you during your consultation and make sure you feel informed and ready.

Every person’s journey is different. If you are non-binary or not on hormones, you can still discuss your goals with Dr. Schwartz. The goal is to create the chest appearance you desire, whether that’s a traditionally male-contoured chest or a reduction in chest tissue for a more androgynous look.

During your personal consultation, Dr. Schwartz will review your medical history, listen to your goals and concerns, and perform an exam to determine if you are a suitable candidate. Factors like chest size, skin elasticity, overall health, and smoking status will be considered.

You’ll have the opportunity to ask questions and together design a surgical plan that best fits your needs. We strive to provide a welcoming, supportive environment for all transgender and non-binary patients pursuing chest surgery.

FTM TOP SURGERY TECHNIQUES

There are several surgical approaches that can be used during FTM top surgery, and Dr. Schwartz will choose the surgical technique that best suits your chest size, anatomy, and desired results.

During your consultation, Dr. Schwartz will explain your options in detail and recommend the approach that will provide the most natural-looking, masculine chest contour. Common FTM top surgery techniques include:

Peri-areolar (keyhole) incision

The peri-areolar technique – also known as the “keyhole” top surgery – is typically ideal for patients with smaller chests (often A or small B cup size) and good skin elasticity.

In this procedure, a circular incision is made around the outer border of the areola (the pigmented area around the nipple). Sometimes an additional concentric incision is made a bit further out, and the ring of excess skin between the two circles is removed (this is called a concentric skin excision).

Through the areola incision, the surgeon removes breast tissue (and may use a small amount of liposuction to assist with fat removal and chest contouring). The incisions are then closed in a “purse-string” or drawstring fashion, tightening the remaining skin around the smaller areola.

This technique results in a scar that runs along the edge of the areola, which typically heals well and can be quite discreet.

The keyhole top surgery procedure does not usually involve repositioning the nipple; because the nipple is left attached and mostly untouched, nipple sensation can often be preserved.

Peri-areolar top surgery works best for those with minimal excess skin. If a patient has very good skin elasticity, the skin will contract nicely after tissue removal.

The benefit of peri-areolar top surgery is minimal scarring and maintaining the nipple-areola on its stalk, but it may not be sufficient for larger chests or those with significant sagging, since it has limited ability to remove excess skin.

Double incision

The double incision method (sometimes called a bilateral double incision mastectomy) is one of the most common FTM top surgery techniques, especially for patients with medium to large-sized breasts.

With a double incision top surgery, two horizontal incisions are made across each side of the chest – typically one along the lower border of the pectoral muscle (in the natural fold or crease where the breast meets the chest) and another shorter incision higher on the chest, above the nipple area.

The breast tissue is surgically removed between these incisions, eliminating the bulk of the breast. If needed, Dr. Schwartz may perform liposuction to further sculpt the chest and smooth out the contours, for example, to reduce any fat pockets near the arms or to prevent “dog ear” skin protrusions at the sides.

After removing the excess tissue and skin, the chest skin is brought together and closed, resulting in two scars per side that run horizontally.

The nipple-areola complex is typically removed and then grafted back onto the chest in a higher, more masculine position (this is known as a free nipple graft). Before grafting, the nipples and areolas can be resized and sometimes given a more oval or male-typical shape.

Because the nipples are completely removed and reattached as grafts, they lose their original blood supply and nerve connections. This means that sensation in the nipple-areola area will be greatly reduced or lost.

For many trans men, the trade-off of reduced nipple sensation is acceptable given the desire for a flat chest, but it is something to consider.

The scars from double incisions will be visible across the chest, but Dr. Schwartz places them in a symmetric fashion along the pectoral lines to simulate the look of well-defined pectoral muscles.

Over time, with proper scar care, these scars tend to fade and can be covered by many shirt styles.

Double incision top surgery has enabled countless patients to achieve a dramatic transformation to a masculine chest and is regarded as a standard for larger chest sizes.

Inverted T (anchor) technique

For individuals with a lot of excess skin or larger, pendulous breasts, the inverted T approach (also known as an anchor incision mastectomy) may be recommended.

This method is called “inverted T” because the incisions resemble an anchor or the letter T: it combines the horizontal incisions of a double incision technique with a vertical incision in the middle.

During an inverted T top surgery, Dr. Schwartz makes two horizontal incisions (similar to the double incision placement, along the top and bottom of the chest where the pectoral muscle is) and a short vertical incision that connects them, extending downward from the areola area to meet the lower incision, like the stem of a T.

This approach allows for the removal of a significant amount of skin in addition to the breast tissue, which is crucial for tighter closure and a smooth contour in patients who have poor skin elasticity or a lot of sagging.

One advantage of the inverted T technique is that the nipple-areola complex can often be left attached to a flap of tissue (a pedicle) rather than being completely removed.

In other words, like a more extensive breast reduction, the nipples are not used as free grafts but remain connected to the chest via a strip of tissue that preserves blood supply and nerves.

The nipples can still be resized and repositioned during the process. They are brought out through a new opening in the right location on the reshaped chest, but because they were never fully detached, there is a higher chance of retaining nipple sensation compared to the double incision method.

The trade-off for preserving sensation and blood supply is that a bit more tissue may need to be left behind under the nipple, and the additional vertical scar is present.

For patients who prioritize retaining as much sensation as possible and who don’t mind the extra scarring, the inverted T top surgery can be an excellent option.

The resulting scars form an anchor shape on the chest (around the areola, vertically down, and along the lower chest), but these typically fade over time.

Dr. Schwartz will recommend this approach if it aligns with your chest size and goals – especially if removing excess skin is a big concern.

Buttonhole technique

The buttonhole top surgery technique is a newer variation that, like the inverted T, aims to preserve the nipple-areola attachment and sensation while still allowing removal of excess skin.

The buttonhole approach is somewhat similar to the double incision method in that two incisions are made on each side of the chest, usually horizontally along the top and bottom edges of the pectoral muscle, either in a straight, curved, or diagonal orientation depending on what will best match the male chest contour).

The breast tissue and extra skin are removed as they would be in a typical double incision.

However, instead of taking the nipples off completely as grafts, the nipple-areola complex (NAC) is left attached to a thin dermal pedicle underneath the skin.

Toward the end of the procedure, Dr. Schwartz creates a small “buttonhole” opening in the chest skin at the appropriate location where the nipple should be, and then brings the nipple-areola through that opening from underneath and secures it in place.

Essentially, the nipple is repositioned without ever severing its connection to the body, which helps preserve blood flow and nerve supply.

The areolas can still be reduced in diameter and reshaped during this process before being set into their new position.

The buttonhole technique can be a good choice for patients who are not small-chested enough for keyhole, but who still want to maintain nipple sensation better than the traditional double incision allows.

It avoids the vertical scar of the inverted T, so the scarring pattern is like double incision (two horizontal scars) but with the benefit of no free nipple grafts.

Sensation outcomes with the buttonhole can be better, though it’s not guaranteed.

GENDER AFFIRMATION SURGERY TAILORED TO YOU

No matter which technique is used — keyhole, double incision, inverted T, or buttonhole — Dr. Schwartz takes great care to reshape the chest in a natural silhouette, often with a slight contour or taper toward the sides and a well-positioned nipple-areola complex for an authentic masculine appearance.

Dr. Schwartz may use liposuction to remove additional fat from the chest or underarm area, sculpting a smooth transition and enhancing the pectoral definition.

This can be especially useful for patients who have excess fatty tissue on the sides of the chest or near the armpits, which might otherwise create a bulge.

Liposuction can also help ensure the chest wall is as flat as possible if that is the goal, or conversely, it can aid in shaping a more contoured, masculine slope.

In some cases, a small amount of fat grafting may even be used to correct any contour irregularities or to subtly enhance the pectoral muscle area.

Dr. Schwartz will discuss all these possibilities with you.

The size of your areolas can be adjusted during surgery as well. Many trans men prefer smaller, more oval-shaped areolas, which Dr. Schwartz can create as part of the nipple resizing process.

Every surgical step is planned with your ideal result in mind, whether that means a completely flat chest or one with a bit of natural muscular curvature.

SCHWARTZ RAPID RECOVERY™

One aspect that sets Dr. Jaime Schwartz MD FACS apart is his innovative Schwartz Rapid Recovery™ program.

Undergoing any surgery can be daunting, but Dr. Schwartz has developed a special combination of techniques to make your recovery as quick, smooth, and comfortable as possible.

From anesthesia to post-op care, every detail is optimized so you can heal faster and get back to living your life with minimal downtime.

Key components of Schwartz Rapid Recovery™ include:

Gentle Anesthesia (TIVA)

Instead of traditional general anesthesia with intubation, Dr. Schwartz uses a gentler form of anesthesia called TIVA (Total Intravenous Anesthesia) for top surgery.

This means you will receive medications through an IV that keep you fully asleep and pain-free during the procedure, but without the need for a breathing tube or inhaled anesthetic gases.

You will breathe on your own throughout the surgery.

TIVA has the advantage of wearing off more quickly and cleanly. Many patients wake up feeling clear-headed and experience little to no nausea after surgery. In fact, the medications used in TIVA also have anti-nausea properties.

Thanks to this approach, you can typically go home sooner and feel better immediately after the operation, rather than dealing with the grogginess or sickness that sometimes follows conventional anesthesia.

Long-Lasting Numbing for Pain Relief

Because of these measures, most of Dr. Schwartz’s top surgery patients find their pain is very well controlled. The majority only need over-the-counter pain relievers like acetaminophen (Tylenol®) rather than strong narcotic painkillers.

Less pain means you can move around more easily and recover faster.

Many clients even feel up to going out for dinner the day after surgery, and report that their overall recovery process is far easier than they anticipated.

Comprehensive Post-Op Support

After your top surgery, Dr. Schwartz and his dedicated nursing team will be available to you 24/7.

You will receive detailed instructions on how to care for your incisions, manage any drains (if placed), and use your compression garment.

As part of the Rapid Recovery philosophy, we encourage gentle activity as soon as you are able. Simple movements and short walks help promote circulation and healing.

Dr. Schwartz’s team will check in with you and is just a phone call away if you have any concerns during your healing process.

This round-the-clock support helps ensure you feel cared for and confident every step of the way during recovery.

Overall, Schwartz Rapid Recovery™ means you can expect a smoother experience with quicker return to your daily routine.

Most patients can resume light daily activities very soon after surgery, and many go back to work in about one week (depending on your job and personal healing).

As you and Dr. Schwartz design your treatment plan, he will give you personalized guidance on what to expect in terms of recovery time and how to optimize your healing.

RECOVERY AND AFTERCARE

Recovery from FTM top surgery is a relatively quick process for most patients, especially with Dr. Schwartz’s Rapid Recovery techniques in place.

However, it’s still surgery – your body will need time to heal, and taking care of yourself post-op is crucial for the best outcome.

Here’s an overview of what to expect during the healing process and some aftercare guidelines:

Immediate Post-Op

After the procedure, you will rest in a recovery area until you are awake and stable.

Your chest will be wrapped in a compression bandage or vest, and small drain tubes may be placed at the surgical site (especially common with double incision or anchor techniques) to prevent fluid buildup.

Drains, if used, are typically kept in for a few days up to a week, depending on output.

Thanks to TIVA anesthesia, you should wake up without heavy grogginess or nausea.

Once Dr. Schwartz clears you, you’ll be able to go home the same day with a friend or family member to assist you.

First Week of Healing

The first 1-2 days, you’ll experience some soreness, tightness, and limited arm movement.

Pain is usually mild to moderate. You’ll be wearing a compression garment (a snug surgical binder or vest) around the clock. This compression helps reduce swelling, support the healing tissues, and improve the chest contour as it heals.

It’s important to wear it as directed (often for at least 2-4 weeks).

You should avoid lifting your arms overhead or doing any heavy lifting.

However, do take short walks around your home as you feel able. Gentle movement will aid circulation and help prevent stiffness or blood clots.

Dr. Schwartz’s team will show you how to empty and record your drains (if you have them) and how to care for your incisions.

You’ll likely have a follow-up appointment within the first week to check your incisions, remove or adjust dressings, and possibly remove drains if output is low.

Seeing your new chest for the first time (once bandages are off) can be an emotional moment. Many patients feel a great sense of joy and relief, despite the bruising or swelling that may be present.

2 to 4 Weeks Post-Op

Over the next couple of weeks, your mobility will improve greatly. Swelling and bruising will gradually subside.

By the end of the second week, many patients feel well enough to return to desk work or school, if not sooner. If your job is physical, you may need a bit longer off or light duty, as vigorous activity is still restricted.

Continue wearing your compression vest as instructed; this greatly aids in proper healing and chest shape. You should still avoid strenuous exercise, heavy lifting, or anything that puts strain on your chest muscles.

After 4 Weeks

Around this time, Dr. Schwartz will clear you to slowly resume more activities, including light cardio or lower-body workouts.

Numbness or tingling in the chest or nipples is normal at this stage: Nerves take time to recover.

You may also start scar care at this point, such as silicone gel or sheets, to help your incision lines heal optimally.

Long Term Recovery

By 6 weeks post-op, most patients are cleared for full activity, including weightlifting, vigorous exercise, and other physical activities, as long as healing is on track.

Your chest will continue to settle over the next few months. Any residual swelling will resolve, and the scars will mature.

Initially, scars may appear red or raised, but over 6-12 months they typically soften and lighten in color. Protecting your scars from sun exposure is important for the first year (use SPF or keep them covered) to prevent darkening.

Dr. Schwartz will schedule follow-up visits to monitor your healing and address any questions.

Remember that patience is key; final results can take several months to become fully realized as tissues relax and scars fade.

In the end, you’ll be able to enjoy a permanent, masculinized chest for the rest of your life.

The results of top surgery are permanent. Breast tissue does not grow back, barring extreme hormonal changes or significant weight gain which could add some fat to the area.

For most, this surgery truly is a once-in-a-lifetime step toward living confidently and authentically.

Throughout your recovery, Dr. Schwartz and our staff are here for you.

Ready to talk more? Our clinic is conveniently located off Wilshire and San Vicente in Beverly Hills.

240 S La Cienega Blvd #200
Beverly Hills, CA 90211

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