If you’re generally unfamiliar with non-binary or haven’t heard of gender neutral top surgery as a viable option, please read the introduction to non-binary top surgery so you can get the most out of the content below.
FTM/N chest reconstruction surgery, also known as “top surgery,” is a solution for transgender men or non-binary transgender people who wish to achieve a more masculine looking appearance by reducing the size of or removing their breasts.
FTM/N chest reconstruction surgery is usually the first (and sometimes the only) surgical step that transgender men and non-binary transmasculine individuals take on their transformative journey.
Choosing to undergo surgery is a complex process shaped by internal feelings and philosophies as well as by external circumstances such as your overall health, your ability to travel for surgery and your current financial status.
The ultimate goal of surgery is to make you feel more comfortable with your body by better aligning your physical characteristics with your internal sense of self and the self you want to present to the world. The relief surgery provides can enhance both your feelings of self-esteem and body confidence. In our experience, the vast majority of patients are thrilled with their final results and benefit from a huge sense of relief.
As with any major life decision, it’s normal to have some doubt and anxiety. At Cosmedicare, we aim to provide you with in-depth information on FTM/N surgical techniques, recovery, safety and expected results so that you can make an informed choice.
We have designed this section of the website to help you become comfortable with the idea of permanent change and answer important questions such as:
FTM/n chest surgery can certainly enhance your self-esteem and body confidence. It’s also important to maintain realistic expectations throughout the consultation and surgical process. There are trade-offs and potential complications with nearly every surgical procedure.
Unfortunately, scarring is an inevitable consequence of most surgical procedures. Though every patient is different, most are happy to exchange their unwanted breasts for chest scars.
The size, length and color of your scars can be hard to predict and will depend on several factors such as your genetic makeup, our skin’s inherent ability to heal, and your post-surgical care. The extent of your FTM/N chest surgery and the incision patterns used will also impact the size and location of scars.
Your scars will be most visible for about 6 weeks post-surgery, appearing raised and darkened in color. They will gradually fade and flatten over the course of 12-18 months. Our team will provide you detailed instructions on how to reduce their appearance.
Every patient is unique, so it’s not entirely possible to predict your final chest appearance or if you will experience changes in sensation after surgery. It’s also important to remember that additional procedures may be necessary to give you the final results you desire.
It’s impossible to determine exactly what your chest will look like post-surgery, but most patients are extremely satisfied with their results. Ultimately, the final appearance of your chest will depend on a variety of factors such as your body type and level of skin elasticity (tightness), as well as the techniques used during your chest reconstruction surgery.
You should maintain realistic expectations when considering FTM/N chest surgery. Your results probably won’t be “perfect,” and you shouldn’t anticipate buff, traditionally masculine-looking results if that doesn’t match your body type to begin with. During your personal consultation, we will work with you to form realistic post-surgical expectations.
Additionally, you will have the opportunity to experience our 3D before and after photos to help gauge your expectations of masculine transformation. Like cisgender men, not all transmen and non-binary transmasculine people have identical chests. You should keep this in mind when viewing before and after photos. Choosing patients with a similar body type to your own will help you form realistic expectations.
Your final chest appearance will be highly dependent on the surgical technique that you and your surgeon choose during your consultation. Some patients choose breast reduction, which reduces the size of the breasts. If you choose this route, your chest will appear much flatter in clothing, but it will still retain a somewhat feminine appearance. Chest reconstruction completely removes all breast material and results in a much more masculine-looking chest.
Ultimately, the best procedure for you will depend on your cosmetic goals and personal preferences. Some patients first choose breast reduction and eventually choose chest reconstruction later to enhance their final results. While this surgical route is entirely possible, it is important to note that it may lead to more severe scarring.
The FTM/N Top Surgery Keyhole Method is a procedure for chest reconstruction that involves a small incision along the areolar border, through which the breast tissue is carefully removed by the surgeon. This procedure is desirable because it involves very minimal scarring. However, only about 5% of the population are good candidates for this procedure because it requires the patient to have minimal breast tissue and tight chest skin.
Once the breast tissue is removed the surgeon places often places a drain and then closes the incision. The drain is usually in place for about seven days after surgery and is then removed. After the procedure, the patient may experience significant numbness of the chest. Sensation usually returns with time, often ultimately feeling the same as before surgery.
This procedure is a good fit for patients who have more skin than would be appropriate for the Keyhole surgery but still minimal excess skin.
It involves a relatively minimal skin incision and after the breast tissue has been removed, the surgeon performs a stitch called a “purse string” stitch to bring the outer circle down to the diameter of the inner circle. Sometimes, this has the downside of creating a pleating affect, oftentimes called a sunburst or a ripple pattern around the area left because of the mismatch between a large circle and a small circle. Most of the time, these ripples diminish or disappear completely in the weeks and months that follow surgery.
While most patients have a considerable decrease in sensation immediately after surgery, the majority recover most or all sensation. This is one of the great advantages of this procedure.
This is one of the procedures that has a higher revision rate because of the challenges involved, particularly in creating perfectly uniform thickness across the entire chest which can be a challenge even for the most capable of surgeons.
The Fishmouth technique removes unwanted breast tissue and results in a flat chest. Because the horizontal scars that radiate out from the areola create a non-anatomic layout of scars, this procedure is more commonly chosen by non-binary transgender individuals. After the Fishmouth technique is used the scars are around the areola and extend out horizontally inward and outward from the areola itself.
One of the advantages of the Fishmouth procedure technique is that, much like the Inverted T or Buttonhole, there is a better chance of maintaining increased sensation density of the nipple areola region. Another advantage is the enhanced ability to obtain a considerable degree of flatness and tightness to the chest that can be flatter than with the Inverted T approach.
For patients who wish to have a male appearing chest with an incision that is in the lower border of the muscle, this is not the procedure for them. Our surgeons perform this procedure most often for patients who are gender nonconforming and therefore do not wish to have either a male or a female appearing chest.
This method is best for when the priority is not flatness, but attempting to maintain erotic sensation to the nipple/areola region is. However, it is still important to remember that retention of sensation is not guaranteed. The tissue that is attached to the nipple and areola keeps its blood supply and a very thin sheet of that tissue is maintained intact. This tissue, referred to as a pedicle, goes all the way down to the lowest part of the breast area and keeps blood supplied to the nipple and areola. While we hope nerves are also traveling within this pedicle, we won’t know until after the procedure is complete how much nipple sensation is conserved. After the creation of the pedicle, the rest of the skin is folded around the pedicle and the excess is removed. What’s left over is the incision around the areola which comes from the areola down to the lower breast, and then a curved incision across the lower breast area.
The Buttonhole procedure is similar in every way except that not as much skin is removed and therefore the small vertical incision can be omitted from the Buttonhole procedure.
The double incision is ideal for very large chests or for those with a significant degree of sagging, the incisions runs in a U-shaped pattern just below the pectoral muscles to help reconstruct male chest contours and appropriately positioned nipples. This pattern results in two visible scars across the lower chest areas.
Ultimately, the best procedure for you will depend on your body type, cosmetic goals, and personal preferences. Your surgeon will discuss options to best suit you but you can read our guide to find out more about the techniques for chest construction surgery and how these compare to one another.
FTM/N chest surgery is a major surgical procedure. It will take time for your chest to heal and settle into its new position. It may take up to a year before the final results of your procedure are evident. In some instances, it may be necessary to undergo additional procedures to correct asymmetry or a complication resulting from surgery. This may result in a longer recovery time.
Because most people designated female at birth have less exposure to testosterone, weight training is highly recommended, both before and especially after surgery for a more masculine appearance. Following surgery there will be less fat on the surface of the muscle and it will be much easier to see well-developed muscle definition.
Ideally, in the months leading up to your surgery, you should initiate a healthy exercise routine, focusing on chest exercises. Cutting out fatty foods and increasing your protein intake will help you build muscle mass to enhance your post-surgery results.
Following surgery, you will need to take at least four weeks to recover. During this recovery period, you should avoid heavy lifting and rigorous cardiovascular exercise. Once at least a month has passed, you can gradually resume your normal exercise routine, but it will continue to be restricted for an additional eight weeks until you’ve reached a full recovery.
Bodybuilders who have undergone a double incision FTM chest surgery should avoid heavy chest workouts for even longer, up to three months, to avoid stretching the incision scars. Your surgeon will be able to provide you with a more personalized timeline during your consultation.
FTM/N chest surgery will give you permanent results. However, significant fluctuations in your weight may impact the appearance of your chest. In most cases, you would need to gain a great deal of weight for the chest contour to change substantially. The best way to ensure long lasting results is to implement a balanced diet and exercise routine.
If you have additional questions after reading and considering the information, please don’t hesitate to contact our team – we’d be happy to go through any further details with you over the phone, or arrange a personal consultation.
When you are able to return to work will depend on your role and how physical your day to day work in. Most patients feel up to resuming sedentary work and light physical activity within 7 to 9 days.
You'll need enough time off work for both surgery and recovery. Our team will provide you with a doctor’s note regarding your activity restrictions. The note will not include any information regarding the nature of your procedure. Your employer is not required to know what type of procedure you have undergone.
Depending on your type of procedure your mobility will usually be limited for the first several days, but it is recommended that you start walking as soon as possible. Normal showering will be restricted until the dressings over your incisions and drains (if you have them) are removed. This usually happens within 3 to 7 days.
3 weeks after surgery you can begin to lift up to 20 lbs and do cardio exercise like running / cycling / elliptical training. At 6 weeks there is no weight limit limitation - unless your procedure included a horizontal incision across each side of the chest.
Any physical activity that may cause your heart rate to increase or for you break out in a sweat should be avoided for at least three weeks. Heavy lifting and chest exercises should be avoided for at least 5 to 6 weeks.
If your procedure included a horizontal incision across each side of the chest (double incision, buttonhole, inverted T, fish mouth), then you should avoid elbow-over-shoulder arm positions for up to 6 months after surgery, because this can put a vertical strain on the scars and make them thicker or much wider.
You can do the vast majority of things in your life without putting your arms above your shoulders, except putting things on high shelves or doing certain sports / physical fitness activities.
If you currently smoke, avoiding tobacco use for at least 3-6 weeks before and after surgery is one of the easiest ways to improve your body’s healing response. In advance of your procedure eating a nutritious diet that contains adequate protein, zinc and vitamin C, all of which have been clinically proven to accelerate healing, is a simple step you can take to help minimise scarring.
Following surgery, it is important to keep your scars out of the sun for at least one year. Over-the-counter topical treatments like Scarguard and Bio-Oil have been shown to speed up wound healing and improve the appearance scars. Using silicon sheeting or compression tape is also effective way to treat scars because they prevent the build-up of collagen that can cause scarring.
It is normal for your chest to be red and sore after FTM/N chest surgery. However if the redness extends 1-2 cm beyond the incision line, or if your skin is very warm or tender or you have a fever measured with a thermometer, you should contact us as soon as possible as infection is extremely rare, but these can be signs of an infection.
If at any time during your recovery you feel a sudden shortness of breath, dizziness, chest pain, or tender, swollen legs, you should get emergency help. These may be signs of a medical emergency.
We understand that procedures like this are a deeply personal decision—and one that comes with many questions. At Cosmedicare, we believe in open, honest communication every step of the way. Thats’s why we’ve tailored FAQs for straightforward answers, helping you feel informed, confident, and fully supported.
When you wake up from surgery, it’s normal to experience some discomfort, swelling and bruising. Your chest will be wrapped in gauze dressings and a compression vest for support. You will need to take medication during your recovery which we will provide. You will also have already gotten a dose of antibiotics during surgery, which will decrease your risk of a post-surgical infection. Depending on the amount of tissue removed, your surgeon might also place temporary surgical drains to collect excess fluid build-up.
You will be required to wear a special surgical bra and/or a compression vest for a few weeks to minimize swelling and to help the skin tighten. Most patients are able to return home, or to a recovery center the same day as their surgery. You will need the help of a friend or family member during the first few days of your recovery. A home care nurse may also be necessary for the first three days to monitor your progress, check your dressings and empty the drain reservoirs if you happen to have drains in place (this is highly unlikely).
Your surgeon will review your healing and final results. We’ll provide expert advice on maintaining your outcome and any additional care. At 3 weeks after surgery you can lift up to 20 lbs and do cardio exercise like running / cycling / elliptical training. At 6 weeks there is no weight limit limitation unless your procedure included a horizontal incision across each side of the chest. At your follow-up appointment our goal is to ensure that your results—and your confidence—continue to flourish.
Our team of expert surgeons provide personalised, safe surgical treatments across a full range of procedures. Every experience is tailored to your individual needs.
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