Female to Male Procedures and Non-binary Top Surgery

Every transgender patient requires an individualized approach to their medical care, and we know that there is no “one-size-fits-all” model for a patient’s transition. As a result, a double board-certified plastic and reconstructive surgeon Dr. Sidhbh Gallagher provides various procedures for her FTM (female to male procedures) and Non- binary patients.

For ideal results, you can look through the Gallagher Plastic Surgery picture gallery or bring in photos yourself. Just be sure that it is representative of your goals. 

Chest Masculinization/ Top Surgery

The most common requested top surgery a more natural-looking masculine chest. With Dr. Gallagher’s expertise, she will choose and discuss with you the best procedure for your specific body type. 

Drain free Double Incision Top Surgery with free nipple graft or Masculoplasty®

What is it?

This type of top surgery is the most common for transgender men. All the extra breast skin and tissue are removed during this procedure to create a natural male look. The nipples are also resized, reshaped, and repositioned, which involves removing the nipples and replacing them. Most patients will have two scars, which are then placed in the natural creases underneath the pectoral muscles. Patients who have larger breasts or breasts close together may need a single incision across the breast.

The procedure

For the female-to-male procedures, the patient is asleep, and it takes about two to three hours. During the procedures, the nipples come off, and breast tissue is removed. When everything is finally closed up, the masculinized nipples will be repositioned on the chest. The nipple is then reattached with a special dressing (a bolster) which will be sewn into place.

The patient is then placed in a binder to assist with swelling. Then will then come back a week later, and the bolsters will be removed. There will be two weeks needed of antibiotic ointment and band-aids to the chest, up until the nipples are fully healed.

What happens after the female-to-male procedures?

Most patients will leave the hospital approximately two hours after the female-to-male procedures. However, in some cases, the patients will need to stay overnight (especially if they have sleep apnea). For patients from out of town coming in for their surgery, we want to ensure they remain in the area for the first 24 hours after surgery.

How painful is it?

We use a lot of innovative techniques to reduce the patient’s pain. First, we can perform the surgery safely with no drains. Secondly, we will use a lot of numbing medication. As a result, many of our patients rate their pain at no worse than 4 on a scale of 10 for the first few days.

Will I be able to feel my nipples?

At first, you will not be able to feel your nipples; however, approximately 80% of patients will get the sensation back — although they may not be as sensitive as they were. 

What is the recovery like?

Most people will back to work within one to two weeks, depending on their type of work. However, you will not be able to do any vigorous upper body workouts for six weeks. The binder comes off in about one week.

What about scars?

Dr. Gallagher sees patients back at the six-week point to check on scars. Then, depending on how the body is healing, there may be another treatment that she recommends.

High Body Mass Index Patients

To be as inclusive as possible, we do not have a cut-off BMI requirement for patients interested in top surgery. Dr. Gallagher is an expert in providing top surgery to patients with a higher BMI and ensuring safe and natural results. Masculoplasty – Dr. Gallagher’s drain-free technique called Masculplasty is a proven method for patients with a higher BMI. With your safety in mind, we do everything we can to accommodate all body types.

Six Weeks After Masculoplasty

Frequently, patients with higher BMIs will have a scar that goes all the way across the chest and to the sides to avoid unnatural-looking lumps (or “dog-ears”).

When we take out significant amounts of tissue, some patients may need a longer recovery, so staying a few extra days in the area can be a good idea.

Patients that have a BMI of over 50 will need to have an overnight stay. Also, all patients with sleep apnea should bring their CPAP machine to their surgery.

Key-Hole Top Surgery

What is it?

These female-to-male procedures are for patients with smaller breasts who don’t want scars. A small (about 1 inch) incision is hidden in each nipple, and the breast tissue is removed through this process. Liposuction may also be used. 

If the nipples are larger, then another surgery will be needed to masculinize them. This surgery will not eliminate extra skin, so the patient has to have a small chest. It also relies on the elasticity of the chest skin for shrinking down. To achieve optimal results, wearing a binder is necessary and needs to stay on for six weeks following the surgery.

The procedure

This procedure takes approximately two to three hours and is generally done as an outpatient.

What happens after?

The patient will wear a binder every day, 24/7, or as often as they can six weeks following surgery. 

The stitches will dissolve on their own.

How painful is it?

We use various techniques to reduce the patient’s pain. First, we safely perform the surgery with no drains. Then, we use all kinds of numbing medications. As a result, many patients rate their pain at no worse than 4 out of 10 for the first few days.

What is the recovery like?

Many patients will be back to work in one to two weeks, depending on their work and what it entails.

Other options

For alternative options, it is possible to leave smaller breasts alone or to not replace the nipples. It all depends on the patient’s desired results.

Female- to- Male Procedures: FTM Top Surgery Revisions

We welcome patients who had their previous surgeries elsewhere. We can help patients with many issues to realign the appearance of their chest better with their overall transition goals.

• Scar revisions – The most significant predictor of how a patient will heal in the future is how their scars have recovered in the past. However, we can achieve improvements by removing scars – especially for “train-track scars.”
• Nipples in the wrong place – This result can be tricky to fix, but we can move one or both nipples if necessary for some patients. In cases where the nipple is a long way off, we can remove it and graft it back to a more appropriate location.
• Nipples too big– Dr. Gallagher is skilled at masculinizing the nipple.
• Nipples in general – Nipples aren’t for everyone and can be removed and replace with a short scar.
• Loose skin – Patients will need to wait a minimum of six months so that the appearance of the chest can continue to improve after surgery. This fact is especially true for keyhole procedures. However, extra skin is a straightforward process.
• Chest unevenness– In some patients, there can be a “sunken in” look on one or both sides of the chest. Sometimes, it is possible to fill in one or both sides with the patient’s own fat. 
• Dog Ear excision– For some patients, breast tissue can extend around the sides and back. As a result, they can be left behind with lumps after their first surgery. These can be easily removed.
• Too much tissue left behind– This issue can be pretty common. It occurs when the patient has had a breast reduction during the first surgery instead of top surgery. However, it can be easily converted into a masculinizing top surgery. At times, we see patients who have undergone keyhole surgery but have too much tissue remaining. As a result, a patient can do well with a revision via a small incision or a conversion to a double incision. That way, we can achieve a better appearance.
  

Top Surgery with Gallagher Plastic Surgery: What to Expect

Consultation

Depending on the season, Dr. Gallagher’s team can schedule consults within a couple of weeks. Consultation fees will be put towards the cost of surgery if and when you decide to do it. 

The first consult is usually through a virtual platform. We will gather some information before then about your health. We will then talk about this in the first part of the consult, and then they will discuss surgery and your goals. If you feel nervous about the consult – don’t worry – they keep everything friendly and casual. If you are a minor, your parent must be there for our consults. 

What’s next?

After they have the consult, they will contact you via email with a quote and information about financing, insurance, and scheduling. 

Depending on the season, the waitlist can sometimes only be a few weeks.

Next, a date will be set, and the patient will need to consult with their general practitioner for any necessary health checks.

Minors and Top Surgery

Dr. Gallagher is proud to offer top surgery to minors with the consent of their parents. Also, we will require the recommendation of the patient’s counselor or mental health professional.

When they evaluate a patient, they always think about the risk versus benefit and know that it could be a disservice to the patient to wait until 18 to have surgery. Every case is evaluated with the patient and their family.

Non-binary AFAB Top Surgery

Every patient is different when it comes to what is affirming for them. As a result, Dr. Gallagher offers a variety of choices. Folks can choose from several techniques to get the desired result.  

With “masculinizing” top surgeries, patients may want a size or position of a nipple that is atypical for a male binary chest.

Other “alternative” top surgery options are as follows:

Nipple Free Top Surgery

With any top surgery option, a patient can opt for going without nipples. This choice makes surgery and recovery simpler as the patient doesn’t have to look after fresh nipple grafts.

“Non-flat” Top Surgery

This type of top surgery has the same scars as regular double incision top surgery. It is generally designed to be located underneath the pec muscles; however, they do leave “mounds.” According to what the patient prefers, these have many different sizes and can be done with or without nipples.

Breast Reduction Type Top Surgery

In alignment with the patient’s preference, Dr.Gallagher can perform a breast reduction. As a result, they can design a smaller but “feminine” shaped breast. Genderfluid patients may choose this option to make the binding process more straightforward.

Breast reduction is generally performed with an anchor-shaped scar.

Female-to-Male Procedures: FTM Bottom Surgery options- Metoidioplasty

What is it?

Metoidioplasty procedure uses the patient’s clitoris. The clitoris has been enlarged after the usage of testosterone. It can then be made into a small penis, with the labia being reformatted to create a scrotum. For a later surgery, testicular implants can be placed.

Is this procedure right for me?

This procedure can be done as a clitoral release. This release involves the patient urinating from the same place as before, or a urethral lengthening can be performed. In essence, the goal is that the patient will be able to urinate in a standing-up position. In general, the penis made from the clitoris will not be big enough to be used for penetration. The surgery is most ideally done when the full effects of testosterone have taken place — approximately two years of taking testosterone before surgery.

What is the recovery like?

When a patient needs to have their urinary stream changed, it is a more significant surgery. However, a simple clitoral release does not require much downtime at all. On the other hand, urethral lengthening is usually a more complicated surgery. The most known way to make the urethra longer is by using part of the patient’s vagina. As a result, that patient will need to have a hysterectomy first, and then undergo the removal of the vagina during the metoidioplasty. This procedure requires a stay in hospital and a catheter for the recovery process. 

Phalloplasty

What is it?

To create a bigger penis skin and tissue, it needs to be brought in from somewhere else in the body. It will generally entail the use of a “flap”. This tissue will be removed from the body completely, and the blood vessels (and occasionally, the nerves) are connected underneath a microscope (called microsurgery). 

Various phalloplasty options are available. Some patients will have the penis created and keep their anatomy the same to urinate from below. The more complex procedure is to try to lengthen the urethra so that the patient can urinate from the new penis. This option will likely require a few different surgeries. As the vaginal tissue is used for creating the urethra, a hysterectomy will be needed. Overall, when everything is healed, a patient can have a penile prosthesis placed into the new penis. As a result, the patient can have penetrative sex. 

For a metoidioplasty, the labia will be formed into a scrotum, and then testicular implants will be placed. For the most part, the tissue used to create a new penis will be taken from the forearm, thigh, or back.

Is this procedure right for me?

Phalloplasty is major surgery and can have several potential complications. The patient should expect scars on other parts of their body and anticipate a long recovery time with catheters and tubes. 

What is the recovery like?

Most patients will need to take off approximately six weeks from work. Also, a few surgeries will be needed according to the patient’s goals.

Body Masculinization/ Contouring

Dr. Gallagher uses various techniques to provide a more masculine and muscular look to the patient’s chest, abdomen, buttocks, or hips.

Depending on the patient’s preference, it can include liposuction, fat grafting, and lifts. These methods can be used as an individualized approach to provide a more affirming appearance.

Transmasculine / AFAB Non-binary Body Contouring

Some patients experience extreme dysphoria from “feminine” curves in the torso.

It is possible to permanently alter the shape of the torso and/or thighs to create a more masculine appearance. This process can be done during top surgery or at a later date.

This type of procedure is most successful for patients with a BMI of around 22 to 32. Also, liposuction can be used to target specific areas.