Female to male (FTM) ‘Top’ Surgery, also known as female to male chest masculinisation surgery, is a gender-affirming procedure for transgender men and non-binary individuals seeking a more masculine chest.
As part of the broader process of gender reassignment surgery (female to male), the goal is to remove breast tissue and create a flatter, more traditionally masculine chest contour.
It is considered one of the key procedures in the gender affirmation journey.
Transgender men and non-binary individuals must meet the following criteria to undergo FTM top surgery, a critical step in gender reassignment surgery from female to male:
– A letter from a qualified mental health professional confirming a well-documented diagnosis of gender identity disorder
– Reasonably well-controlled medical or mental health concerns
– Capacity to make a fully informed decision and consent to treatment
– Age 18 years or older
Hormone therapy is not mandatory but if undertaken, it’s recommended to wait at least 6 months before surgery for stabilisation.
The best candidates for FTM ‘top’ surgery are persons who:
– Physically and mentally healthy
– Have realistic expectations
– Accepting of post-surgical scars
– Of stable weight
– Have lived in their affirmed gender identity for at least 12 months
FTM ‘top’ surgery may not be suitable for persons who:
– Not living in affirmed gender identity for at least 12 months
– Have fluctuations in physical or mental health
– Are very overweight or obese (BMI >35) – ideally your BMI should be less than 30 for best results
– Have multiple medical problems
– Are on blood thinning medication
– Are actively smoking
Dr Aggarwal is a well regarded, respected, highly skilled and experienced Specialist Plastic Surgeon. Graduating at the top of his class throughout his training, Dr Aggarwal has completed fellowship training at some of the world’s most prestigious reconstructive and cosmetic plastic surgery institutions in Canada and the USA. He continues to publish research is prestigious plastic surgery journals, and is actively involved in the training of future plastic surgeons.
What sets Dr Aggarwal apart from others is his personal, affable and warm nature. Not only does he pay attention to detail, to producing natural, beautiful results but he ensures that the patient’s journey is just as special as their outcome. Dr Aggarwal looks after patients at one of Sydney’s most prestigious public hospital campuses (POWH/SCH/RHW), and operates privately on Sydney’s North Shore. Dr Aggarwal has treated thousands of patients throughout Sydney and beyond who have achieved outstanding results under his care.
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This surgery is performed under general anaesthesia by Dr Aggarwal in accredited private hospitals. Most patients spend one night in hospital. The approach taken depends on chest size, skin elasticity, and goals for sensation and contour.
Typically used for smaller chest sizes with good skin elasticity.
Incision
– Involves a circular incision around the areola to remove breast tissue.
– Therefore the nipple is attached to the chest, and is maintained on a ‘pedicle’ that allows blood supply and sensation to the nipple
Procedure
– A solution containing adrenaline and local anaesthetic is infiltrated at the start of the procedure in both sides of the chest.
– Breast tissue is removed through an incision around the areola.
– Skin around the nipple is tightened
Typically used for larger chest sizes where potential for nipple sensation is important, and the nipple is therefore maintained on a ‘pedicle’. Incision & procedure:
– Involves an elliptical removal of skin through which the breast tissue is removed.
– The nipple is maintained on a ‘pedicle’ in that it remains connected to the body preserving tissues connected to the nipple to provide blood supply and hopefully future sensation.
– The final scar is cited below the pectoralis major and rises to the side towards the armpit, a second scar is situated around the nipple in its new position
– Some of the tissue is maintained behind the nipple (the pedicle) and therefore may not achieve an absolutely flat contour to the chest. A second revision surgery may therefore be needed to remove this tissue
Typically used for larger chest sizes where the nipple is removed altogether and placed back on the chest in a new position as a ‘graft’. Incision ^ procedure:
– Involves an elliptical removal of skin through which the breast tissue is removed.
– The nipple is removed and harvested as a future skin graft.
– The incisions are closed taking care to position the final scar is cited below the pectoralis major
– The new position of the nipple is determined, the skin in that area removed and the nipple grafted / sewn back together in that position. A small compression dressing is then tied over the graft to increase the chances of vascularisation (the new blood vessels growing into the graft and nourishing it).
– Since all the tissues behind the nipple are removed this procedure aims to produce an absolutely flat contour to the chest.
– In general 1 drain is placed on each side of the chest.
– Whilst in hospital the drain outputs are recorded, but in most patients the drain is left in for a few days
– You will see Dr Aggarwal or his staff in rooms to have the drain removed after discharge from hospital.
Risks of anaesthetic – there are general risks of going under an anaesthetic such as a mild stress on the heart and lungs, risk of reaction to anaesthetic drugs and risk of blotting in the legs. These risks are generally low in patients who are otherwise fit and healthy.
Bleeding (1-2%) – any bleeding is controlled during surgery however unexpected bleeding can occur in the immediate postoperative period. If this occurs it will necessitate a return to theatre to control the bleeding.
Infection (<1%) – this is very rare. However you are given antibiotics during induction (when you are going to sleep), as well as a course of oral antibiotics after your surgery to keep this risk to a minimum.
Seroma (5%) – Gland excision behind the nipple as well as liposuction leaves an empty space where the body can collect fluid after surgery. This space is emptied by a drain placed there. Keeping a chest compression garment on after surgery, as well as reducing movement is also essential to avoiding the risk of a fluid collection. If a fluid collection develops after removal of drains it may need to be removed via a needle through the skin. The fluid is removed as if it accumulates there is a risk of it getting infected.
Nipple compromise – this is possible when the nipple is maintained on a pedicle. Even when the nipple is maintained on a pedicle (still connected to the chest), most of the blood supply coming through the old breast has been removed. This problem is usually treated via the use of dressings, and there is a chance that a part of the nipple may heal abnormally producing a different shape to the nipple.
Abnormal graft healing – this can occur when the nipple is grafted. A graft takes on a new blood supply a the site where it is placed and takes 4 to 6 weeks. Some parts of the graft (often the thicker areas such as the nipple itself) can take longer to heal. It is common for the nipple to lose projection (how much it sticks out) and some of its colour.
Change in nipple sensation – it is common for the nipple to be numb even if it is maintained on a pedicle (can take 9-12 months or longer to recover). In the case of a nipple graft, it will often remain numb.
Chest asymmetry – asymmetry before surgery is very common. Therefore, care is taken during surgery to correct asymmetries as much as possible. However small degrees of asymmetries may still persist with respect to scar quality and position, and nipple shape. Sometimes asymmetries of the ribs or bony skeleton can create the perception of asymmetry not related to the soft tissues.
Hypertrophic or poor scars – How one’s body behaves to scarring is individual and largely genetic. Some types of skin are more prone to hypertrophic or keloid scarring, and some individuals and families are more prone to this. We will routinely advise you on how to improve the quality of scars over time. You should also discuss any history of abnormal scarring with Dr Aggarwal preoperatively.
Dr Aggarwal will place waterproof dressings over the incisions.
If you have not had nipple grafts – You will be able to get all areas wet after 48 hours. However you will not be allowed to swim in a pool or beach for at least 2 weeks after surgery or until all drains are removed (whichever is later).
If you have had nipple grafts – these are covered by special dressings that are not waterproof and therefore you will need to keep the chest dry for the first week, until the dressings are removed. You will not be allowed to swim in a pool or beach until the grafts have healed (approx. 4 to 6 weeks).
You will be given a script for antibiotics by Dr Aggarwal which you must continue for 1 week or until all drains are removed. You will also be given appropriate pain relief medications.
When you go home it is best to have someone look after you as you recover.
While most sedentary activities can be resumed when you go home, you must lay low and not exert yourself. You will also not be allowed to do any heavy lifting or upper body exercises for the first 8 weeks. During this period you will also be required to wear a chest compression garment (a tight vest).
Dr Aggarwal will see regularly after your discharge from hospital.
You can see us at our main practice at Gordon, or at our other locations at Hornsby, Potts Point, Hunters Hill or Camperdown.
Any of the hospitals where Dr Aggarwal works – either at Hunters Hill Private or Sydney Adventist Hospitals.
Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief. The antibiotics need to be continued for a week or until when the drains are out.
Usually not. Sometimes further surgery is needed to remove tissues behind the nipple if a pedicle has been maintained, or to correct small ‘dog ears’.
You may do gentle swimming in a pool or beach once all wounds have healed and all the drains are out.
We suggest it is best to avoid driving for the first week after surgery.
The out of pocket cost for FTM ‘top’ surgery starts at $13500 assuming an appropriate level of health insurance cover but a formalised quote will be provided for surgery after consultation depending on which exact procedure is required. This includes:
Please note that the above prices do not include the initial consult fees.
Know you are in the safest of hands with a Plastic Surgeon who is experienced, highly respected, and appointed at premier Sydney hospitals- including Sydney Adventist, Hunters Hill Private, POWH and RHW.
If sedation or general anaesthetic is required, it is delivered by an accredited anaesthetist
Have your surgery at premier, accredited Sydney private hospitals.
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