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What Happens to My Nipples During FTM/FTN Top Surgery?
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Female-to-male (FTM) and female-to-non-binary (FTN) top surgery is a transformative, gender-affirming procedure that aligns a person’s physical appearance with their specific gender identity. Depending on one’s preferences, it can involve the removal of either the vast majority of breast tissue through a mastectomy or most of the breast with an aggressive breast reduction. There are several options available for the nipple-areola complexes (“nipples”), which also include their permanent removal.
Nipple Options During FTM/FTN Top Surgery
A majority of FTM and FTN patients desire a masculine chest with preservation of their nipples, though some do not want them at all. Some FTN individuals want less of a masculinized chest appearance with or without nipples. There are other possibilities that are also impacted by the gender-affirming procedure.
- Keyhole Mastectomy: The keyhole technique is suitable for those with smaller breasts and good skin elasticity. This approach involves making incisions in the lower half of the areolas through which breast tissue is removed. The nipples remain attached to the surrounding tissue that includes a blood supply. There is no change in their size (aside from being less stretched out), shape or location.
- Periareolar/Concentric Circle Mastectomy: This technique is similar to the keyhole mastectomy, but it involves excising a “donut” of skin around the entire areola to reduce its size. There can be a slight shape change if desired, but no real substantial repositioning on the chest.
- Double Incision Free Nipple Graft Mastectomy: The double incision technique is the most common one used in gender-affirming top surgery. Skin and breast tissue are removed, and the nipples are detached but then placed back as skin grafts in a more desirable location and of a more ideal size.
- Double Incision Mastectomy Without Nipple-Areola Complexes: This technique is the same as the double incision-free nipple graft mastectomy, except the nipple-areola complexes are permanently removed and not reattached.
Factors Affecting Nipple-Areola Complex Appearance and Healing
With the keyhole and concentric circle/periareolar techniques, the nipple-areola complexes retain a blood supply along with some nerve fiber attachments. Consequently, they will be smaller and retain most of their pre-existing characteristics. This may be good in some situations but will not be a great solution if the nipples themselves are very broad and too feminine in configuration. Overprojection can be easily treated.
The free nipple graft approach provides far more flexibility regarding the size, shape, location and appearance of the nipple-areola complex. It also allows for more de-feminization of the nipple appearance. However, with the free nipple graft, there is no guarantee that the nipple will revascularize to provide for long-term projection. Several factors play a role here.
Tactile sensation (ability to feel touch or pressure) may return to some degree over time. Some individuals who have had the free nipple graft approach have had substantial sensation and even “sensuality” return with time, though this is not the norm. Regardless, whether or not sensation is present long term is a non-issue for the overwhelming majority of FTN and FTM top surgery individuals.
Postoperative Care and Recovery
To help maximize the aesthetic results regarding your nipples, it is critically important to follow your plastic surgeon’s instructions. This includes activity restrictions, appropriate nutritional intake and avoidance of smoking cigarettes and marijuana and vaping for at least one month prior to surgery until at least one month post-surgery (though your surgeon may have different recommendations).
There are also factors out of your control, however, that can impact the ultimate outcome.
A silicone scar gel or tape is started around 3–4 weeks after surgery, which can help you obtain a more desirable scar. Full maturation of the scar and nipple appearance can take up to a year or even longer.
Finding Your Phoenix, AZ, Top Surgery Specialist
FTM/FTN top surgery is an extremely positive life-changing procedure for those with gender dysphoria. Dr. Steven H. Turkeltaub and his staff are strongly committed to supporting you during this part of your gender journey.
Dr. Turkeltaub is board certified by the American Board of Plastic Surgery and has over 35 years of experience performing gender-affirming top surgery. If you have any questions about FTM or FTN top surgery or would like to schedule a consultation with him, please call us at (480) 451-3000 or contact us online.