Trans Male Procedures:

What is chest masculinization?

This is a surgical procedure that contours the chest to give the individual a masculine appearing chest.  The procedure includes bilateral mastectomies (removing breast tissue), chest contouring (removing extra breast skin and the inframammary fold), and repositioning and decreasing the size of the nipple-areola complex.  Some people refer to this as Top Surgery.

Are there different procedures for chest masculinization?

Yes, there are different types of surgical procedures.  A patient’s breast size, the elasticity of the breast skin, and location and size of the nipple-areola complex will determine the surgical procedure Dr. Silverman will recommend.

What are the different types of procedures for chest masculinization offered by Dr. Silverman?

  1. Keyhole: an incision is made along the bottom of the areola (from the 3 o’clock to 9 o’clock position if looking at a clock). The breast tissue is removed from this incision.  Silverman will offer this procedure to patients with small breasts and small areolas.
  2. Periareolar (concentric circle, purse-string): an incision is made around the border of the areola (if the size of the areola needs to be reduced then the incision is made within the areola) and a second larger circular incision is made. The intervening skin is removed and the breast tissue is removed.  A “purse-string” technique is performed and the resulting incision is around the areola. Dr. Silverman will offer this procedure to patients with small breasts and good skin elasticity.
  3. Button-hole: the nipple-areola complex is maintained on a thin dermal pedicle. This preserves blood supply and some of the nerve fibers. Then 2 horizontal incisions are made and the breast tissue and redundant breast skin are removed.  The 2 incisions are closed to each other and the resulting incision is above where the previous inframammary fold was located.  Based on measurements a circular incision is then made at the location for the areola.  The nipple-areola complex is then pulled thru this new location.   Silverman will offer this procedure to patients with medium to large breasts.
  4. Double incision (free NAC graft): the nipple-areola complex is excised from the breast skin in what is called a free nipple-areola graft. Then 2 horizontal incisions are made and the breast tissue and redundant breast skin are removed.  The 2 incisions are closed to each other and the resulting incision is above where the previous inframammary fold was located.  Based on measurements a circular incision is then made at the location for the areola and the top layer of skin is excised.  The free nipple-areola graft is then secured to this new location. Silverman will offer this procedure to patients with large ptotic breasts.

Why should I have a chest masculinization procedure?

Chest contouring is the most common gender-confirming surgical procedure individuals undergo.  This will establish a more male appearing chest and remove the stigmata of the female chest.

Will my insurance cover a chest masculinization procedure?

Typically, insurance companies will cover these procedures.  Patients may need to meet certain requirements specific to their insurance company prior to authorization of the procedure.

What are my restrictions after the procedure?

Each patient will have a drain under the skin on each side of the chest.  This will be in place for approximately 7-10 days.  The patient will be wrapped with an Ace wrap after the surgery.  Dr. Silverman recommends no heavy lifting for 3 weeks.  Scar management will be discussed during post-operative appointments.