Top surgery, also known as transgender mastectomy, is a surgical procedure that involves removing breast tissue to create a more masculine or androgynous chest. The removal of breast tissue can help contour the chest to create an appearance that more aligns with your gender identity. Commonly, this procedure includes nipple and areola resizing and repositioning if desired or free nipple grafts. This procedure can help trans men and non-binary patients become more comfortable in their own bodies and improve social and psychological functioning. During your consultation, Dr. Stiller will evaluate your chest and help assist in making a decision that is right for you.  

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Bilateral Mastectomy with free nipple grafts

A double-incision mastectomy is a good choice for patients with a medium to large chest. During the procedure, an incision is made above and below the breast tissue to open the skin. Liposuction will be performed as well to help contour the chest. The breast tissue is removed and the skin is closed, leaving two horizontal scars. Each nipple is removed. The nipple-areolar complex is downsized and placed as a graft in the anatomically correct position. 

Peri-areolar subcutaneous mastectomy

The peri-areolar, or keyhole, incision is ideal for patients with a smaller amount of breast tissue, usually A or small B cup. The procedure consists of removal of breast tissue through a small incision around the nipple-areola complex. The nipple stays intact with the breast and are not repositioned. This technique results in significantly reduced scarring. 

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Mastectomy with dermal pedicle flap

The dermal pedicle flap consists of the full thickness of the skin and is attached by tissue where it receives its blood supply. An incision is made on each side of the chest along the lower pectoral muscle fold. The nipple areolar complex is then downsized and placed in a new opening. The ideal candidate is a large-breasted, or ptotic, individual. 

Anchor incision mastectomy

An incision is made around the areola and continues down the midline of the breast. The incision continues across the inframammary crease. This procedure allows for reshaping and sculpting of the entire breast. The ideal candidate for this procedure is one with overly large or ptotic breast tissue as other procedures will result in excess skin around the breast. 

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Recovery

The recovery for top surgery varies from patient to patient however, most patients do very well. After your surgery, you will have a drain placed on each side of your chest and have a compression garment on, which you will wear for 4 more weeks. You will follow up in 1 week to have your drains removed, if fluid is less than 30 cc's in a 24 hours period, and bandages removed. At this appointment, we will make sure your nipples are alive and healthy if you had free nipple grafts. New bandages will be placed which are to be kept on for 5 days. At the 5 day mark, you can remove them and continue with an antibiotic ointment. Patients can usually began chest exercises around the 4 week mark but encouraged not to lift arms above shoulders for about 6 weeks.

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