Transgender Top Surgery offered in Cleveland, OH

Top surgery is a procedure you may be considering if you are interested in surgically transitioning. There are two kinds of top surgery:

• Feminizing top surgery creates natural looking breasts for trans women or nonbinary people. For many transgender women, top surgery can help to create a more feminine shape that matches their gender identity and builds self-confidence.
• Masculinizing top surgery removes unwanted breast tissue via a double mastectomy to create a flatter, more masculine looking chest. This surgery can be combined with pec implants to create a more muscled look.

Although there is more research due to the higher numbers of transgender men opting for surgery, these procedures have had high satisfaction rates for both transfeminine and transmasculine patients. Overall, studies have found that outcomes from these surgeries for transgender men are extremely positive. Transmasculine people who have had top surgery often feel more confident and less anxious than before their surgery and when compared to others that have not had surgery.

While there isn’t much data, research also points to similar improvements in confidence and body image in transfeminine women who have undergone breast augmentation.

With the comfort that is experienced after these surgeries, patients are more physically active and more comfortable engaging in activities with friends and partners. Physical and mental health are consistently improved across studies, surgery types, and populations.

Transmasculine Top Surgery

Surgeries for transmasculine patients are extremely involved. Special techniques are utilized to contour and reduce the chest wall, position the nipples and areola, and minimize scarring.

• If your breast size is small, tissue removal may be minimized. Incisions are made around the borders of the areolae and the surrounding skin. Breast tissue is removed through the incisions and some skin might also be removed. The remaining skin is reattached at the border of the areola.
• If you have larger breasts, the nipple/areola complex may need to be relocated and resized to create the appearance of a male chest. This will create more scarring and potential loss of sensation to the nipple.

Transfeminine Top Surgery

If the patient feels their breast size is not large enough after hormone therapy, a breast augmentation can be performed. This can be done in two ways: direct augmentation with implants, or augmentation broken into two stages.

• Direct augmentation is performed on an outpatient basis and generally takes about one hour. An incision is made either around the areola, or at the location of the future lower breast crease for larger implants. A pocket will be formed under the breast tissue, usually behind the pectoral muscle, to hold the implant. The implant is inserted on one breast and then the other. Symmetry will be checked and positioned, and then the incisions are closed.
• A two-step augmentation procedure will be performed if hormone therapy did not result in enough breast development to hold the implants. First, tissue expanders will be placed where your implants will eventually be. These expanders are then gradually filled with saline solution. Over time, the amount of saline is increased to enlarge the expander. This will continue to stretch the skin and support tissues in order to create space for the implants. When the stretching is complete, the expanders will be removed and replaced with breast implants.

The surgeons at CPSI offer enhancement of a breast to a more feminine breast with natural fat transfer and with breast implants. Natural fat transfer is a great option for trans women who desire a modest increase in volume with a low-maintenance and natural appearance. Natural fat transfer can be combined with breast implants.  Breast enhancement with saline or silicone breast implants is another procedure for more profound increases in breast volume, and can be customized to suit your desired look.

Depending on your individual anatomy, you may be a candidate for several types of breast tissue and skin removal. For trans men with a well-defined breast fold, large areolae, and large breast volume, a double-incision mastectomy involving resizing and reshaping of the areola as well as skin removal may be recommended. For men with small breast mounds, small or mildly enlarged areola, peri-areolar tissue and skin removal may be an option. Liposuction may be added to help refine and add definition to your look.

When you return home, your chest will initially be wrapped in compression bandages. You’ll be able to remove these in a few days and then you’ll need to switch to compression garments, sometimes called binders. These will play an important role in your healing process, as they limit the swelling and bruising. Plus, they hold the surgical areas firmly in place, supporting the intended chest contours. Compression garments should be worn for up to six weeks after your surgery, but a more specific timeline will be discussed with you during your consultation.

This is not an overly painful recovery. You will have prescription pain medication, but many patients feel over-the-counter options can handle the discomfort just fine. If you have a desk job, you’ll be able to return to work in 1-2 weeks. If you have a physically demanding job, you’ll most likely need 4-6 weeks off.

You can return to light activity such as walking almost immediately. Strenuous exercise, particularly anything involving the chest, will need to wait for at least 8 weeks. Weightlifters need to be cautious about heavy chest workouts (avoid them for 3 months) to avoid your incision scars being stretched out.

It is not a difficult recovery. For the first two or three days, you will experience some pain and discomfort, but this is totally manageable. Your chest may feel tight. This is normal as your implants need to settle into place. Your breasts may appear too high initially, but this is also temporary as they settle.

Most patients can return to work in four or five days. Non-impact activity can resume in about a week, with impact exercise available again in about one month. You can return to upper body specific exercises in 6 weeks.