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How to Talk to Your Surgeon About FTM, FTN or MTF Top Surgery

July 22, 2024

A Guide to Top Surgery

Discovering your true self and then transforming your appearance so that it aligns with your chosen gender identity is a challenging, stressful and emotional journey for most. Surgical transitioning is a very significant and deeply personal step for most transgender individuals. 

Whether you’re considering female-to-male (FTM), female-to-nonbinary (FTN) or male-to-female (MTF) top surgery, having an open and honest conversation with your surgeon is vital for achieving the best possible outcome. 

The following offers tips for open and honest communication during your consultation to ensure you are well-informed, empowered and supported throughout the process.

What Is Top Surgery and How Does it Work?

FTM, FTN and MTF top surgery are procedures that surgically alter the appearance of the chest in order to align with an individual’s gender identity and his/their/her preferences and perceptions as to what that is. With female-to-nonbinary (FTN) there is a defeminization of the chest with a broad spectrum of physical outcomes that can extend all the way to complete masculinization.  

FTM Top Surgery

For a more masculine appearance, the plastic surgeon will create a flat chest by removing breast tissue and skin along with needed contouring. Various techniques can be used, depending on a variety of factors, including the double incision-free nipple graft, concentric circle and keyhole methods.

FTN Top Surgery

The same techniques that are used for FTM top surgery can be employed for FTN top surgery, though with a wider variability of customization. In addition, there are other options, such as breast reductions, that are sometimes sought after by gender-fluid, androgynous and other individuals.

MTF Top Surgery

Creating a more feminine chest involves augmentation to reshape and add volume to the breasts. MTF top surgery is typically performed using saline or silicone implants, though fat grafting can also be an option.

Preparing for Your Top Surgery Consultation

Select a plastic surgeon who has extensive experience in gender affirming top surgery (along with good results) and who is board certified by the American Board of Plastic Surgery. Before meeting him/her/them, take some time to consider your questions. Being well-informed and clear about your goals can help make your consultation more productive. The following tips should help:

Research the Procedure

• Understand the different surgical techniques and their implications.
• Read about the recovery process, potential risks, and expected outcomes.
• Look at before-and-after photos to have realistic expectations.

Clarify Your Desired Results

• Think about what you are hoping to achieve with top surgery.
• Consider your aesthetic preferences and how you envision your post top surgery body.

Know and Share Your Medical History

• Prepare a detailed medical history, including previous surgeries, medical conditions, allergies and current medications.
• Include any information about any current hormone therapy you are receiving.
• Provide accurate information regarding smoking cigarettes and marijuana, vaping and alcohol consumption.
• If you are on a special/restricted diet, such as being a vegetarian or vegan, make sure that it is disclosed. 

Key Topics to Discuss with Your Surgeon

Transition Goals

Start by discussing your overall transition goals. Explain why you want top surgery and what you are hoping to achieve. Be honest about your expectations regarding the outcome.

• FTM/FTN Top Surgery: Explain your desired chest appearance: flat (FTM and FTN) or with some breast projection persisting (such as gender fluid or androgynous in FTN). Do you want nipples or no nipples? If you want nipples, try to provide generalities about nipple size and placement on the chest. 
• MTF Top Surgery: Discuss your preferred breast size, shape and the type of implants that you are/may be considering (saline or silicone). 

Surgical Techniques

Your plastic surgeon should provide you with surgical recommendations based on your anatomy and preferences. Different surgical techniques can lead to varying results, scarring and recovery. If there are choices, find out what they are and their pros and cons.

• FTM Top Surgery: Common techniques include the double incision-free nipple graft, concentric circle and keyhole methods. In some situations, a gender-affirming breast reduction might be most appropriate.
• MTF Top Surgery: Discuss placement options (submuscular vs. subglandular), as well as incision sites (inframammary, periareolar or transaxillary).

Surgeon’s Experience and Qualifications

You should make sure that your plastic surgeon has a good track record in performing gender-affirming top surgery procedures. Check out before-and-after photos and overall patient reviews. Finally, you want to make sure that your plastic surgeon is board-certified by the American Board of Plastic Surgery.  

Risks and Complications

Every surgical procedure carries risks and less-than-desirable outcomes. Your plastic surgeon should review these risks and issues with you in detail, including relative frequency. Make sure that you understand it all.

Top Surgery Recovery Process

Understanding the recovery process is essential for planning your post-surgery life. Your plastic surgeon likely will go over this with you. Of course, there may be unique issues with your situation that you may need to ask about. Some considerations:

• What can I expect in the immediate postoperative period, including discomfort?
• What kind of support will I need during recovery?
• What are the restrictions on my physical activities and for how long?
• How can I best help the healing process?

Cost and Financing for Top Surgery

Top surgery can be expensive and it’s important to ask about the costs involved and any financing options available:

• What is the total cost of top surgery including surgeon’s fees, anesthesia and facility charges? This is relevant whether you are paying for the surgery out of pocket or going through your insurance. 
• Are there any additional costs I should be aware of?
• Do you offer financing options?

Your Responsibilities in Gender-Affirming Top Surgery

You may do all your research and have an excellent plastic surgeon performing your surgery and caring for you postoperatively. However, you absolutely play an important role in your ultimate results—either positive or negative.

• Respect your surgeon’s expertise and consider the recommendations carefully.

• Adhere strictly to the pre-operative instructions to prepare your body for surgery.
• Follow all post-operative care guidelines. 
• If you are not sure about something, ask.
• Don’t make independent decisions about your care without checking with your surgeon. You can sabotage your surgery and results.

Your Phoenix, Arizona Top Surgery Expert

FTM, FTN and MTF top surgery is a collaborative process. At the Arizona Center for Breast Surgery, Dr. Turkeltaub’s expertise, combined with your clear communication and compliance, can help you achieve the best possible results.

If you would like to schedule your consultation with Dr. Steven H. Turkeltaub, who is board certified by the American Board of Plastic Surgery, please call our office at (480) 451-3000 or contact us by email.