Transmasculine Top Surgery (Subcutaneous Mastectomy)
During female-to-male or transmasculine top surgery, we remove breast tissue, fat, and skin to flatten and contour the appearance of the chest, and reduce and reposition the nipples, making it appear more masculine or non-binary. Our goal is to minimize the appearance of incision lines and achieve a natural-looking chest. As board-certified plastic surgeons, we are experts at handling delicate breast tissues, skin, fat, and muscular tissues to achieve noticeable yet realistic results.
Before your procedure, we’ll meet to discuss your surgical goals and medical history. We’ll also review your anatomy, take photographs and measurements, and will recommend a treatment option based on your breast size, nipple and areola size and location, and chest wall width.
We perform transmasculine top surgery under general anesthesia administered by an anesthesiologist. The entire procedure usually takes two to three hours and you can go home afterward. Please make sure you have somebody to drive you home, as you will not be able to operate a vehicle after anesthesia. We perform transmasculine top surgery as outpatient procedures at our accredited Northern Arizona SurgiCenter in Flagstaff.
Transgender men and nonbinary people with smaller chests may be eligible for a nipple-sparing subcutaneous mastectomy. With this approach, we will make discreet incisions around the areola to access and remove the breast tissue. This option produces minimal scarring, heals faster, and usually maintains nipple sensation.
Patients with a larger chest may need a free nipple graft. During a free nipple graft, we’ll excise the nipple and areolas, resize them, and place them into a natural position. This approach usually involves more obvious incision lines and scarring and may cause loss of nipple sensation. Some patients opt to remove their nipples and areolas and have them tattooed.
Following transmasculine top surgery, you will wear an upper-body compression wrap for a few weeks. This garment applies gentle pressure to reduce swelling and promote healing. Everyone heals at their own pace, and you need to take it easy. Walking and light activity is fine to resume as soon as you feel able to, but avoid upper body activity, strenuous or high-impact exercise, and lifting more than 10 pounds for four weeks. Sleep upright for the first week after surgery to help minimize swelling. You can shower 48 hours after surgery, but please do not submerge your body in water for at least four weeks while swimming or bathing to reduce the risk of infection.
While most of the breast tissue is removed during subcutaneous mastectomies, some can remain in the chest and around the nipples. It’s important to talk to your doctor about routine breast cancer screening even after your transmasculine top surgery.
Medical Review: This procedural information has been medically reviewed by plastic and reconstructive surgeon, Brian A. Cripe, M.D.