Among transgender men, FTM Top Surgery is the most popular type of Gender Reassignment Surgery. More than cosmetic surgery, FTM Top Surgery and other GRS procedures are medically required.
‍
FTM Top Surgery is a type of chest masculinization derived from subcutaneous mastectomy that uses specific techniques to create male contours. All types of FTM Chest Surgery involve incisions and removal of breast tissue. FTM Top Surgery may also include removal of excess skin, repositioning of areola and nipple, reduction of areola and/or nipple, or free nipple grafts.
‍
Surgery typically takes about three hours, under general anesthesia (you are asleep). When you awake, you are in a secure binder, with drains in place. Then you go to the recovery area for the remainder of the time in the hospital. Dr. Gillespie keeps provides special nerve blocks for pain control and blood pressure control. If there are any concerns, this allows Dr. Gillespie the ability to come into the hospital and check on you.

Double Incision with Free Nipple Grafts
‍With Double Incision Top Surgery, horizontal incisions are made along the top and bottom of the chest muscles and breast tissue, as well as the nipple and areola, are removed. The top and bottom incisions are brought together and sutured, with the resulting scar line running under the pectoral muscles, following the natural contour. Smaller areolas and nipples, created from native areola tissue, are grafted on.
‍
Double Incision Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Inverted-T Top Surgery, aka. T-Anchor
With Inverted-T Top Surgery,  horizontal incisions are made along the top and bottom of the chest muscles as with Double Incision. Breast tissue is removed but the areola and nipple are not removed. Instead, an additional vertical incision is made on each side, from the areola down to the incision below the chest muscles. This extra incision allows the areola and nipple to be reduced and repositioned appropriately without severing nerves, thus largely preserving sensation.
‍
Inverted-T Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Peri-areolar Top Surgery
With Peri-Areolar Top Surgery, two circular incisions are made around the areolas. Breast tissue and the “donut” ring of tissue between two two incisions is removed. The areolas and nipples may be resized. Next, the chest skin is pulled together toward the areolas and sutured around the edges (similar to a drawstring purse.) Like Inverted-T, the areola and nipple are not removed, but resized and repositioned, resulting in largely retained sensation.
‍
Peri-areolar Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Keyhole Top Surgery
With Keyhole Top Surgery, semi-circular incisions are made at the base of the areolas. Breast tissue is removed. The nipples may be resized. Because the areola and nipple are not removed, sensation is largely retained.
‍
Keyhole Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.