Gender affirming mastectomy or chest masculinizing “Top” surgery

Masculinizing “Top” surgery will shape the skin and tissue of your chest to match the contour of a male chest.

There are many factors that Dr. Kim will discuss with you during your consultation. These factors include your current shape and size, body type, skin type, and nipple size and position. Dr. Kim is a proponent of “double incision” surgery with free nipple grafts. Most transmasculine patients with larger breasts are good candidates for a “double incision” chest surgery with free nipple grafts, where the lower scars are hidden under the lower border of the pectoralis muscle in the male chest. Depending on your chest dimensions, the nipple and areola are resized, and new nipple positions are chosen to look more masculine. Patients with smaller breasts may also be candidates for either a periareolar incision or subcutaneous mastectomy (“keyhole”).

Dr. Esther Kim performs this procedure in the Division of Plastic Surgery at UCSF. During your consultation, Dr. Kim will discuss which options are available and your expected postoperative result.

Dr. Kim can also use liposuction to help contour and create better definition in specific areas of the male chest. Please let Dr. Kim know if you are interested in this procedure. This added procedure is not usually covered by insurance.

Gender-affirming chest surgery options

At UCSF, we perform three types of gender-affirming chest surgery:

1. “Double incision mastectomy” with or without free nipple grafts
2. Periareolar mastectomy
3. Inverted-T Breast Reduction

	Double Incision	Periareolar	Inverted-T Breast Reduction
Characteristics of a Good Match	Medium to large breasts Excess skin Low skin elasticity Ptosis	Small breasts Minimal excess skin High skin elasticity Nipple in appropriate position	Ideal for those who want to preserve some breast tissue Ideal for patients who do not want a flat chest
Pros	Allows for removal of excess skin  Easier to contour the chest Ability to resize and re-position the nipple	Minimally visible scar that is hidden around the areola May preserve sensation to the nipple	Smaller breasts achieved without a completely flat chest May preserve nipple sensation
Cons	Larger, more visible scars Possible loss of nipple sensation	Contour deformity Possible need for second procedure to resize the nipple	Outcome may not meet expectation Limits options to perform a double-incision mastectomy in the future

Prepare for your initial consultation

At UCSF, we want you to have the best possible result from your surgery with the greatest satisfaction. UCSF criteria for surgery are based on the World Professional Association for Transgender Health SOC (Standards of Cre) 7th Edition and are required by most insurance companies.

Before scheduling your initial consultation, please send the following:

• Your insurance card and identification
• Our surgeon requires that your BMI (body mass index) is less than 32 before scheduling your consultation. 
  • These requirements are set by our surgeon, who has determined these criteria based on medical considerations and surgical risks
• If you are over 40 years old, the results of a mammogram performed within the past year

Referral documentation

Please fax or mail your documentation to us. 

UCSF Gender Affirming Health Program
1725 Montgomery St.
Suite 250
San Francisco, CA 94111

Tel: 415-885-7770
Fax: 415-353-3399
Email: [email protected]

​Please include your legal name, chosen name (if different), and date of birth with all communication.

Prepare for the operation

• Meet all necessary criteria for surgical treatment
• You may be asked to obtain additional medical or mental health clearance letters, which must be faxed to the office before your operation can be scheduled
• A pharmacy and pharmacy plan to obtain postoperative medications
• Schedule an appointment or phone appointment with the anesthesia PREPARE preoperative evaluation clinic

Two weeks before the operation

• Make sure you eat a healthy balanced diet, get plenty of rest, and stay active
• If you are a smoker, you should absolutely quit smoking two weeks before and six weeks after surgery to avoid poor wound healing and complications
• PREPARE clinic will tell you which medications to stop taking and which to take
• Make sure you have transportation to and from UCSF for your operation (most patients go home the next day after surgery)

The night before surgery

• Shower with antibacterial soap and hibiclens (chlorhexidine) scrub (available at most drugstores)
• Make sure your home is well stocked with light food, beverages, and items that you will need are within reach without needing to lift your hands above your head or bend over
• Make sure you pack your surgical garment or vest to bring with you to the hospital on the morning of surgery

 

 

Post-surgical supplies

• Compressive surgical garment or vest (if not available, ACE wraps will be provided)
• Silicone sheets or scar gel for after-surgery care

Recovery: what to expect

Mild soreness, swelling, and bruising are normal. Pain is usually mild after top surgery and is well controlled with Tylenol. You may experience numbness or decreased sensation of the chest or armpits, but this should improve over several months. Expect scars to fade over 12-24 months, though not completely. You should avoid lifting heavier than 5 lbs for 6 weeks after surgery.

• Your chest will be covered in a compressive surgical garment or vest over bandages. This must be kept on at all times, including while sleeping, until your first postoperative appointment
• You will also have two drains coming out of your dressing. These drains and the compressive dressings are meant to prevent fluid from building up underneath your chest
• As your incisions heal, you can expect some itching and shooting pains. This is normal healing
• Plan to sleep on your back with several pillows to elevate the head of your bed. This is to lessen the amount of swelling you experience, which may worsen in the first few days after surgery before getting better. Plan to sleep on your back for the first 6 weeks after surgery while your chest heals
• Don’t shower or get the dressings wet until you are seen at your first postoperative appointment. You will not be allowed to shower or get dressings wet for 2 weeks to protect the nipple grafts
• Drains are usually removed at the first postoperative appointment. A compression vest is worn on the second postoperative appointment
• You will be sore and will need to rest for about a week after surgery. During this time, you may need someone to help you at home. We do want you to walk around the evening after surgery to prevent blood clots from forming in your legs
• Avoid strenuous activity or lifting more than 5 pounds for two weeks after surgery
• Scar care:
  • You can improve the appearance of your scars by using silicone sheets or scar gel on your incision, beginning two weeks after surgery. Your surgeon can advise you on which brands and sizes to purchase
  • Scars can be made more noticeable by sun exposure for up to one year after surgery. Make sure the scars are either covered, or apply a strong sunscreen to your scars

More information

Please visit our UCSF Gender Affirming Surgical Care Box folder to access this information in PDF format and to view an educational module on Gender-Affirming Chest Augmentation.

Access the GASC Box Folder