FTM/N Top Surgery FAQ

For questions not answered here, or for a printable version, you may download our PDF, Top Surgery: Your Questions Answered.

  • What techniques of FTM top surgery does Dr Mosser perform?
  • Dr Mosser has expertise in multiple surgery techniques – such as: double incision, periareolar, keyhole, fishmouth, lollipop, buttonhole, inverted t-anchor, and other variations. Your surgery will be personally tailored to your body.

  • How do I know which technique of FTM top surgery I should get?
  • The procedure that’s right for you begins with chest size, but also has a lot to do with the amount of extra skin and chest tissue you have. The Mosser Method is a simple guide to help you answer this question.

    During your consultation, Dr Mosser will evaluate your chest (through photos or in-person) and discuss the best possible options with you, including pros and cons, and taking into account any individualized desires or needs.

  • Why is the Double Incision method the most common style?
  • Most patients have enough breast tissue where another technique would be less advisable. The Double Incision is unparalleled in its ability to achieve the tightest and flattest chest with full customization of areole location relative to the muscle and horizontal scar. It still accounts for more than 80% of  FTM top surgeries performed by Dr. Mosser.

  • If my chest size is between DI and peri, which one should I choose?
  • It is best to discuss this with Dr Mosser individually during a consultation, as there are many other variables that may affect your results other than chest size, such as skin elasticity, scarring, nipple placement and sensation, and other factors.

  • What are other techniques besides DI and periareolar? And are they recommended?
  • Less common techniques include fishmouth, lollipop, buttonhole, and inverted t-anchor. In some ways, these are a variation of the standard DI or peri or both. There are several advantages and disadvantages to each, depending on your body type, chest size, skin elasticity, and other needs regarding scar size, scar placement, areola size, nipple sensation, remaining tissue, etc.

  • How different are the results if I have never been on Testosterone?
  • For the most part there is no difference. People who have been on testosterone for several years may have more chest hair to hide their scars, or may be able to gain significant pectoral muscle, which result a more stereotypically male-looking chest.

  • How will my chest look if I later go on T or gain a lot of muscle?
  • Going on testosterone after surgery will generally not affect the results of your chest surgery. Gaining significant muscle in the pectoral area might hide the scar or create a more masculine appearing chest, but it should also not adversely impact your results.

    FTM chest surgery will give you permanent results. However, significant fluctuations in your weight may impact the appearance of your chest. Gaining weight very quickly or soon after surgery could affect your skin or scarring. In most cases, you would need to gain (or lose) a great deal of weight for the chest contour to change substantially.

    It is always best to discuss any plans for body changes with Dr Mosser before surgery.

  • Does FTM chest masculinization surgery remove 100% of breast tissue?
  • No. A little tissue is always left over to retain the contour of the chest – otherwise your chest would look concave. This is one big difference between FTM Chest Masculinization and a mastectomy due to breast cancer.

  • What is the difference between male chest contouring and a mastectomy?
  • In a mastectomy due to breast cancer, nearly 100% of the tissue is removed. This is not the case with FTM Top Surgery in which more like 93-95% is removed. Moreover, in FTM Chest Masculinization the surgeon is careful to ensure scar placement follows the natural pectoral lines to create an aesthetically natural look, and you get to keep your nipples.

  • What is the difference between chest masculinization a breast reduction?
  • The biggest difference between the two procedures is the amount of skin and tissue removed. Breast reduction can be used to minimize, but not completely eliminate the breasts, and as a result the chest isn’t contoured to appear male.  After a breast reduction there will still be ‘cone shaped’ tissue that looks like breast-shaped tissue, even if they are smaller.

    FTM chest reconstruction removes nearly all underlying fat and tissue (including milk producing ducts and glands) to give the appearance of a masculine-looking chest. In some cases, chest reconstruction surgery also entails nipple resizing and relocation.

  • Can I have FTM Top Surgery after a breast reduction?
  • It is certainly possible. However, this is not usually recommended because it may result in increased scarring.  Also, breast reduction is effective at improving back and neck pain from large breasts, but is not an effective way of treating gender dysphoria.

  • Can I just lose weight to reduce my chest size?
  • Losing weight may result in a decreased chest size; however, you cannot eliminate all chest tissue in this manner. Some people feel more comfortable once they reduce their chest size, while others opt for surgery regardless.

  • Is chest binding an alternative to top surgery?
  • Breast binding is an effective alternative to invasive surgery for some people. For others, breast binding is only a moderately successful, short-term alternative to FTM chest surgery.

    Binding may result in pain, discomfort, or other physical restrictions. If you are are binding, please do so safely.

  • Can I still get FTM top surgery even if I’ve been binding for a very long time?
  • Generally speaking, chest binding will not cause problems with your surgical plan.

    Binding over a long period of time (many years) can alter your skin’s natural elasticity, which may have some minor effects on your final cosmetic results. Dr. Mosser will be able to help you formulate realistic surgical expectations following a consultation.

  • How can I best keep nipple sensation?
  • Changes in nipple sensation vary by technique, which depends on your chest size and other individual factors. If a patient is very attached to a high level of sensitivity to the nipples, it makes sense to consider the Inverted T-Anchor or Buttonhole procedure as alternatives.

  • What is a free nipple graft?
  • Skin grafts are rather miraculous things! We can take a piece of a person’s body, remove it, and put it somewhere else where it will stay and survive.

    What most people misunderstand is that a nipple graft is not simply “pasted on” skin; rather, the nipple attaches to your skin, where it develops new blood vessels that grow into the graft. After only a few weeks, the grafts usually have the strength of non-grafted tissue, and in most cases regain sensation resembling that of your skin.

    For an overview, you can download the FTM Nipple Graft Survival Guide, or read the extended explanation and video about the process of nipple grafting.

  • Do you lose all nipple sensation with a free nipple graft?
  • Definitely not!

    In a Double Incision where a free nipple graft is necessary, sensation is still present, but is diminished from the “hypersensation” of the nipples that is usually present before surgery. Despite diminished nipple sensation following FTM chest surgery, most patients report increased sexual satisfaction.

    Though very uncommon in Dr Mosser’s practice (less than 2%), it is possible to lose all nipple sensation following FTM chest surgery. Patients who smoke or those diagnosed with diabetes or an autoimmune disease run an increased risk of partial or total nipple graft failure.

  • Can I ask for no nipples?
  • Absolutely. Given the spectrum of gender identities of our patients, Dr Mosser always tries to accommodate any individualized requests.

  • Can I get a nipple tattoo / scar tattoo after top surgery?
  • Many patients opt for decorative tattoos to cover or embellish their scars. Some of these patients have agreed to be displayed in our Before and After gallery. As always, this is a very personal choice.

    Although extremely rare in Dr Mosser’s practice (less than 2%), in the case of a nipple graft failure a nipple tattoo reconstruction is an option. An innovative approach is to have a nipple tattoo made that uses optical illusion to create a very realistic 3-D type appearance, even though the skin is still quite flat.

  • Will my scars “out” me as trans?
  • As with everything, this will depend on your situation and circumstances. Generally speaking, most people do not “read” top surgery scars as being specific to gender surgery, unless by coincidence they happen to be familiar with FTM top surgery.

  • Can I get pregnant after having FTM top surgery?
  • If you have a uterus and ovaries, there is always the possibility of getting pregnant. Removing your breasts does not affect this. Since sexual health is of the utmost importance, we recommending talking to your primary care physician or gynecologist to address these questions.

  • Am I at risk for breast cancer after FTM top surgery?
  • Though FTM chest surgery significantly reduces your risk of developing breast cancer, there will still be some breast tissue that remains in the chest wall after surgery. For this reason, you should still routinely check for breast cancer with your primary care physician.

  • Will my breasts grow back after top surgery?
  • No.

  • Is there a difference between all the terms used to refer to FTM top surgery?
  • Top surgery is perhaps the most popular term. Other terms like transgender mastectomy or double mastectomy are used primarily by medical providers.

    We recognize that terms like chest masculinization and FTM are“male-specific” and that patients whose gender is not male or transmasculine may feel excluded by these terms. In this website, we use “FTM top surgery” as a way to differentiate it from “MTF top surgery” or breast augmentation, but we recognize this surgery is not exclusive to transgender men or male-identified patients.