Dr. Jaime Schwartz: What It’s Like Transforming From Female To Male With A Top Surgery

If you've ever wondered what the process is like for transgender patients as they align their physical body with their gender identity, this is what my female to male (FTM) patients typically experience during their top surgery.

Top surgery for a transgender male is very similar to a mastectomy, which uses similar breast tissue removal techniques. As with a mastectomy, during the FTM transgender top surgery we remove all breast tissue including glandular tissue, fat tissue, and skin, but the difference is that the goal is to not only remove the breasts but also to masculinize and define the chest.

Transgender patients often come to me after a long and difficult journey of self-discovery. My goal is to help them feel as comfortable, happy, and confident in their appearance as possible. Like this transgender patient of mine, Cameron, said after his top surgery, "I'm content in my skin, I no longer feel dysmorphic about my body." This is the type of result we are looking to create.

Watch Cameron's Journey:

The consultation:

The consultation is the most important step in the patient's journey. We discuss their aesthetic goals and review their medical history to ensure that they are healthy and a good candidate for treatment. After a detailed physical exam, I can then recommend which technique will provide the patient with the most natural-looking results.

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Top surgery techniques:

  • Keyhole incisions are ideal for trans men with small amounts of existing breast tissue. A singular incision around the areola is used to remove breast tissue.
  • Double incisions help treat patients with moderate amounts of breast tissue and allow for the repositioning of the nipple-areola complex without extensive scarring.
  • Inverted-T incisions are best for trans men with significant amounts of breast tissue. An incision is created around the areola, vertically down the lower breast tissue, and across the inframammary fold.

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Masculinizing the chest:

In addition to removing breast tissue, a top surgery may also include reshaping the nipples to create a smaller more oval shape that is more common to males. We can trim, resize and/or reposition the nipple areola complex so that the chest has a more masculine appearance, and depending on what the patient's goals are, liposuction and fat transfer may also be used to remove excess fat and to further sculpt and define the chest.


The downtime for transgender top surgery depends on the techniques used, so each case is a bit different. For top surgery we use sedation known as TIVA (total intravenous anesthesia) to

promote a faster recovery process. TIVA still assures the patient is asleep for the duration of the procedure, but the medications are much less taxing on the body than the breathable gasses used in most general anesthesia.

In addition, I developed a recovery package to help minimize the discomfort of surgery, we inject a long acting numbing medication into the patient to help ease the patient through the initial days of recovery.

After this period, most of our patients require only TYLENOL®. Drains are sometimes used following this procedure to eliminate the buildup of excess fluid. Most patients can return to work after one week, and most are able to resume some exercise after four weeks and full exercise at six weeks.

Some additional considerations:

In order to be eligible, I require the patient to have been on hormones for at least 18 months prior to the top surgery. Often the patient will experience a significant change in their physical appearance with hormones alone. They may grow more body and facial hair, and lose some breast volume.

Also, they must have received a letter of recommendation from a therapist or licensed psychologist.

And they must have been living as their preferred gender identity for at least two years prior to the surgery.

If you are interested in a consultation with me for top surgery, or want to learn more about what we can offer transgender patients, please contact us at the office: dawnr@theroxburyinstitute.com or by phone 424-394-1610. For more information on the practice, please visit our website: www.beverlyhillsbreastinstitute.com

SchwartzPractitioner at the Roxbury Institute and founder of The Beverly Hills Breast Institute, Dr. Jaime Schwartz the highest quality and most comprehensive breast surgery care to men, women and transgender patients, alike.

View Dr. Jaime Schwartz profile and contact information here. 

Images courtesy of Dr. Jaime Schwartz