How To Choose a Top Surgery Procedure
The choice of Top Surgery procedure is largely based on chest size and skin elasticity:
- Small breasts with good skin elasticity – Periareolar or Keyhole.
- Moderately sized chests (B cup) with good skin elasticity – Periareolar, Buttonhole Technique, Double Incision or Inverted-T.
- Large chest or moderately-sized chest with poor elasticity – Buttonhole Technique, Double Incision or Inverted-T.
- Very large chests – Buttonhole Technique, Double Incision.
Note that skin with poor elasticity, often due to years of binding, can limit the surgeon’s choice of procedure and adversely affect post-operative results.
Revision surgery is common: removal of “dog ears”, reduction and/or repositioning of areola, nipple reduction, additional liposuction.
Special note on breast reduction mammoplasty: Some choose a breast reduction instead of a subcutaneous mastectomy, often for insurance reasons. However, note that prior breast reduction surgery may affect your options for top surgery and so should be carefully considered if top surgery is in your future.
The techniques for FTM Top Surgery procedures varies between surgeons. To ensure an optimal outcome, be sure to take the time to discuss with your surgeon the specifics of the methods he or she will be using for your Top Surgery, such as size and placement of areola, nipples and incisions.
Your surgeon will provide you with instructions about post-operative care and healing time. It’s important to follow your surgeon’s recommendations, otherwise you could their nullify policies on surgery revisions and liability. For more information about how to take care of your Top Surgery scars, see the guide to surgery scar care.
The surgical approach used will have been decided during your initial consultation and will depend, in part, on the size of your breasts. The first option available is the “keyhole” procedure, which is often used for people who would wear a size “A” or a small size “B” bra cup. With this approach, Dr. Crabtree will make an incision along the border of your areola, removing breast tissue through that opening. He will not remove extra skin or resize/reposition your nipple and areola, and your nipple sensation will usually be preserved.
A “double incision” top surgery is the approach that is most often used for large chested patients. It involves creating an incision along the lower border of the pectoralis muscle and around the nipple. Through those openings, excess breast tissue is removed and the nipple-areola complex is reshaped and repositioned. In addition, liposuction may be performed as needed. This is a terrific approach because it delivers an excellent masculine contour. However, the primary disadvantage is the fact that nipple sensation is usually lost.
The final approach is the “periareolar” technique, which is recommended for patients with small to medium breasts, large areolas and minimal excess skin. To perform this procedure, Dr. Crabtree will make an incision around the areola. Through that opening, he will remove the excess breast and fatty tissue, along with the remaining skin. He will then suture the area to tighten your skin around your newly positioned areolas.
Your breast masculinization procedure generally takes about three hours depending on the procedures planned and will be performed under general anesthesia administered by a Board-Certified Anesthesiologist or a Board-Certified Nurse Anesthetist at Windward Surgical Facility in Kailua, Hawaii.
- Removal of most of the breast tissue;
- Removal of excess skin;
- Removal of the inframammary fold.
- Reduction and repositioning of the nipple-areolar complex.