The primary goal of masculinizing mastectomy (FTM top surgery) is to create a masculine chest appearance for patients transitioning genders (trans men), as well as for neutral or non-binary individuals. This transformation involves three main surgical steps performed in one procedure:
- Nearly total mastectomy.
- Reconstruction of the areola and nipple.
- Liposuction above and around the chest area.
- (Optional) Fat grafting to enhance the pectoralis major muscle.
Who Is This Surgery For?
In 90% of cases, this surgery is performed on patients undergoing hormone therapy (testosterone) as part of their FTM transition. It is typically one of the final steps in their journey.
After the procedure, binders will no longer be necessary. About 10% of patients are neutral or non-binary individuals who choose not to use hormones but want to reduce or eliminate their breast tissue to align with their gender identity.
Surgical Techniques
We aim to achieve the best results with minimally visible scars. For this reason, we avoid techniques like the inverted “T” or “flying saucer” incision, which can leave noticeable marks. Instead, we focus on techniques that maximize tissue removal while creating discreet scars.
The Two Main Techniques for Masculinizing Mastectomy
1. Horizontal Mastectomy (Double Incision)
This is the most commonly used technique for medium to large breasts. It allows for the removal of a significant amount of skin and glandular tissue, resulting in a flat, masculine chest with small areolas.
How It’s Performed:
- A large horizontal ellipse of skin is marked at the base of the breast, encompassing the areola and nipple.
- The entire glandular tissue and skin within this area are removed, allowing for significant volume reduction.
- Additional glandular tissue is removed from the upper chest to ensure a flat contour.
- Drains are typically used for this surgery, and the removed tissue can weigh up to 1.5 kg per side.
Areola and Nipple Reconstruction:
- After flattening the chest, the areola is carefully positioned for a masculine appearance, typically 10 to 13 cm from the midline, depending on the chest width.
- The areola is reduced to a diameter of 15 to 25 mm, and any excess nipple tissue is also minimized.
- A special dressing called a Brown dressing is used to protect the graft during healing.
Note: This technique results in a 100% loss of sensitivity in the nipple and areola. While a few patients have reported partial recovery after several months, this is not guaranteed.
2. Periareolar Mastectomy
This technique is best suited for patients with small breasts. The key advantage is that the nipple and areola remain attached to the skin throughout the procedure, preserving sensation in 95% of cases.
How It’s Performed:
- An incision is made around the areola to remove excess glandular tissue and skin.
- After reducing the breast size, the areola is resized to a diameter of 25 mm, with optional nipple reduction.
- A circular “round block” suture technique is used to flatten the chest and close the incision.
Liposuction for a Refined Result
Liposuction is often recommended to address fat deposits above or around the chest and to smooth any remaining tissue near the armpit. This is optional but enhances the overall results.
Fat Grafting for Pectoral Enhancement
For patients seeking a more muscular appearance, lipoaspirated fat can be injected into the pectoralis major muscle for greater chest definition. This option is particularly popular among patients who are already physically active.
Recovery and Post-Operative Care
- First Session of Physical Therapy: Includes lymphatic drainage, laser/LED therapy, and physiotherapy taping, performed in the hospital.
- Timeline for Recovery:
- Discharge occurs the day after surgery, with the first follow-up appointment three days later.
- Light activities like walking can resume after 15 days.
- Daily activities such as driving and working are allowed after one month.
- Intense physical exercise is permitted after 2-3 months.
- Compression Garment: Must be worn for two months to manage swelling and support healing.
- Pain Management: Patients generally report no significant pain, even when liposuction is performed.
Common Questions
- When Are Drains Removed?
Drains are typically removed during the first follow-up visit, which is pain-free. - Will I Have External Stitches?
Most sutures are absorbable and internal, except for those around the areola in horizontal mastectomy cases. These stitches are removed after 10-14 days. - Will I Need Frequent Dressing Changes?
No. We use special dressings or Dermabond Prineo surgical tape, which eliminates the need for frequent dressing changes.
Why Choose Dr. Alexandre Charão?
Dr. Alexandre Charão is a leading plastic surgeon in Rio de Janeiro with extensive experience in FTM top surgery. Patients from around the world choose his clinic for its advanced techniques, excellent results, and attentive post-operative care.
Key benefits include:
- A multi-disciplinary team of doctors, nurses, and physiotherapists.
- Minimally visible scars.
- Comprehensive six-month follow-up, including a WhatsApp group for direct support.
How to Schedule Your Procedure
Brazilian plastic surgery is renowned worldwide, thanks to pioneers like Dr. Ivo Pitanguy. At Dr. Alexandre Charão’s clinic, we build on this legacy with modern techniques, exceptional patient care, and affordable costs.
To book your consultation, contact our team today. Once confirmed, you’ll receive a secure link for payment, and your appointment will be scheduled promptly.
Dr. Alexandre Charão sees patients in Rio de Janeiro and Petrópolis. For more information, feel free to get in touch.
