Chest masculinization-
Top surgery
Is Chest Masculinization right for you?
Chest masculinization or chest reconstruction is often known as “top surgery.” It’s a surgery for people with breast tissue who would like to change the shape of their chest to achieve a more masculine appearance. This involves the removal of breast tissue and skin, and then typically followed by liposuction to help achieve the desired chest contour.
There are many different techniques described to perform chest masculinization.
The two most common techniques used in our office are “Double incision” and “Periareolar” mastectomy.
At Banff Plastic Surgery, we believe in doing the right thing (surgery or not) for the right patient at the right time for the right reason.
You can click on each heading below for more information.
The approach used will depend on your pre-operative breast size and assessment by the surgeon during your consultation.
Double incision/bilateral mastectomy is typically selected for patients with C cup size and low skin elasticity, or people with D cup size and higher. This involves making two horizontal incisions across the chest, below the areola. Breast tissue, fatty tissue and excess skin are removed. The nipple and areola are removed completely, trimmed, and re-attached (known as “free nipple graft”). Drains might be left in the chest during the healing process to allow blood/fluid to escape and the tissue to heal in place. This approach leaves two long horizontal scars on the chest.
Periareolar incision is possible for people with a small breast size and moderate skin elasticity. The surgeon makes an incision around the entire outside of the areola, leaving it attached to the body. This avoids the long scars on the chest and avoids use of a free nipple graft. Breast tissue is removed, and the areola and chest skin may both be trimmed down. The nipple and areola are repositioned. This approach leaves a scar around the areola.
Dr. Todd will provide specific instructions on how to prepare, what to expect after surgery, potential concerns to watch for and when to return for a follow-up appointment.
Top surgery is for people who would like their chest to look and feel closer to the way they desire. The goal of the procedure is to flatten the chest by removing breast tissue and skin. A good candidate for top surgery is close to their ideal body weight, is healthy and has realistic expectations for the outcome of their procedure.
The WPATH (World Professional Association for Transgender Health) Standards of Care uses these guidelines for top surgery:
- persistent, well-documented gender dysphoria
- a capacity to make a fully informed decision and to consent to treatment
- age of majority in a given country
- if significant medical or mental health concerns are present, they must be reasonably well-controlled
Transgender and nonbinary people may choose top surgery to address gender dysphoria or discomfort and psychological stress that goes with the unwanted tissue on the chest. The goal of top surgery is to allow you feel more comfortable in your own skin.
If you have more questions about top surgery, we invite you to visit Banff Plastic Surgery for a consultation with Dr. Todd. Our dedicated and compassionate staff is here for you every step of the way. Call us today at 403-762-2055 to learn more or schedule an appointment.
Being in the optimal physical and mental health is essential in the successful outcome of a top surgery. Dr. Todd can answer any questions you might have about the procedure, how to prepare and what to expect after surgery.
Smokers must quit smoking several weeks before surgery because nicotine can interfere with blood supply and healing.
After surgery, it’s important to give your body time to heal. It usually takes about 1-2 weeks to get back to normal activities and 3-4 weeks to get back to sporting activities (jogging etc). If you work in an office, you may be able to return to work in about two weeks. If you do any lifting, it may take 3-4 weeks to get back to normal. Heavy labour may take 6 weeks.
Chest Masculinization – Top Surgery FAQ
What are the potential risks associated with top surgery?
As with all surgery, top surgery comes with side effects and risks. These are:
• Breast cancer screening being less effective.
• Inability to lactate or chestfeed.
• Numbness or increased sensitivity in your nipples, areolas or chest (there’s a higher degree of sensation loss with double incision).
• Partial or full nipple graft failure (where the nipple tissue dies and falls off).
• Changes in symmetry and colour of nipples and areolas.
• Scarring (largest and most noticeable with double incision surgery).
• Skin irregularities, like bulges or puckering.
• Some aesthetic problems can be addressed with revision surgery or other treatments, like tattooing or laser.
General surgical risks:
• Risks of General Anesthetic
• Blood clots in your legs or lungs
• Injury to surrounding organs, nerves or blood vessels
• Hematoma (a collection of blood) or seroma (a collection of fluid)
• Infection or abscess
• Wound opening or delayed healing
• Chronic pain
• Scarring
• Feeling dissatisfied with the outcome
• Feelings of regret about surgery
What is the recovery from top surgery like?
The surgery is performed on an out-patient basis at Banff Mineral Springs Hospital and it lasts about 3 hours. You will have a dressing and a chest binder in place following surgery. Your chest may be swollen, bruised, tender and sensitive. We recommend taking 1-2 weeks off work and 3-4 weeks off athletic activities. Heavy lifting and chest exercises should be avoided for up to 6 weeks.
Do you use drains?
We use drains for our top surgery procedures.
The Jackson-Pratt drain is a tube equipped with a bulb that provides a constant suction. It is inserted, usually from a small incision below the surgical area, and it is used to:
1. Prevent the accumulation of fluid in the wound and reduce the risk of infection.
2. Allow you to measure the amount of fluid draining from the wound.
The nursing team will provide instructions on drain care before you leave hospital. The drain will be removed around 4-7 days after surgery. Removal of the drains tends to be well tolerated and relatively painless.
How do I know which type of top surgery procedure to choose?
The two most common techniques used in our office are “Double incision” and “Periareolar” mastectomy. To determine which approach will be used, it is necessary to have a consultation with the surgeon. Pre-operative breast size, skin elasticity and overall health will be taken into consideration.
Do you have specific training in gender-affirming surgeries?
Dr. Todd gained experience in gender affirming surgery during a year long fellowship at the Maclean Centre in Toronto.
We're Worth the Trip
To learn more about our practice or the services we offer, contact Banff Plastic Surgery today at 403-762-2055.
Address
#217, 304 Old Canmore Road
Canmore, Alberta T1W 0L5