We use the term “chest reconstruction top surgery” at the Gender Confirmation Center as a broad term to describe what others may refer to as top surgery, chest masculinization surgery, or double mastectomy, in an effort to use a term that is affirming and acceptable to a broad audience. Top surgery is the most popular term used in and around the community.

No.

Though chest reconstruction 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.

You can get pregnant after chest reconstruction top surgery, although you will not be able to chest/breastfeed unless you only had a reduction. Having chest reconstruction top surgery otherwise has no effect on your fertility and reproductive capacity.

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.

Many patients opt for decorative tattoos to cover or embellish their scars. Some of our patients have agreed to be displayed in our Before and After gallery. As always, this is a very personal choice. Although extremely rare in our 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.

Absolutely. we always try to accommodate any individual requests.

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 chest reconstruction top surgery, most patients report increased sexual satisfaction. Though very uncommon in our practice (less than 2%), it is possible to lose all nipple sensation following chest reconstruction top surgery. Patients who smoke or those diagnosed with diabetes or an autoimmune disease run an increased risk of partial or total nipple graft failure.

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. 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 Nipple Graft Survival Guide, or read the extended explanation and video about the process of nipple grafting.

Changes in nipple sensation vary by technique, which depends on your chest size and other individual factors. If you are very attached to keeping nipple sensation, it makes sense to consider the Inverted T-Anchor or Buttonhole procedure as alternatives.