Transgender and non-binary individuals often feel their gender identity is at odds with their biological sex, or their gender assigned at birth.
This feeling of distress or unease is known as gender dysphoria — a debilitating experience that can color every aspect of one’s daily life, often placing individuals at a greater risk for depression, anxiety, substance abuse, interpersonal difficulties, and other challenges. For these reasons, top surgery can feel like a very natural step for transgender patients.
At Silicon Valley Institute for Aesthetics (SVIA), Dr. Jerome Liu and Dr. Tom Liu understand that living in a body that doesn’t feel authentic to your core identity can be physically, emotionally, and psychologically taxing. Our plastic surgeons are passionate about helping patients from San Jose and out-of-town live their best quality of life no matter how they identify. The compassionate team at SVIA is committed to assisting you in your gender transition by listening closely to your concerns, desires, and overall goals.
What is Top Surgery?
Top surgery is a gender-affirming procedure performed for transmen (FTM) and transwomen (MTF) patients who feel their appearance does not match their sense of self. For those who would like to create more harmony between their body and their authentic gender identity, plastic surgery can be a life-changing way to help alleviate feelings of dysphoria. While not all non-binary individuals feel the need or desire to undergo surgery, making the personal decision to align your gender identity with your outward appearance can be immensely rewarding for certain patients. Everyone relates to their body differently, so it’s important to make decisions based on what’s best for your individual needs, health, and life. It’s not uncommon to work with a mental health provider who has experience in transgender health issues during this process.
How is FTM Top Surgery Performed?
Top surgery is designed to remove the breasts and create a more masculine-looking chest. Many transmen, non-binary individuals feel their breasts do not accurately reflect their core identity, prompting them to flatten their chest with binders and compression garments. FTM top surgery can be a transformative way to align one’s physical body with their internal self and gender presentation. Using techniques similar to a bilateral mastectomy and breast reduction, FTM top surgery is performed by removing excess skin, fat, and breast tissue. Incision options may include:
Periareolar
Suitable for patients with a small to medium breast size, this technique involves removing a concentric circle of skin around the areolas, allowing your plastic surgeon to extract tissue and correct skin laxity. The nipples typically remain intact.
“Keyhole” Incision
Resembling the bottom-half of a keyhole, this incision can be ideal for individuals who have good skin tone and little to no laxity. Liposuction is often utilized to remove extra fat, but no excess skin is removed. The “keyhole” technique is most successful for those with relatively small chests.
Double Incision with Nipple Grafts
A double incision approach repositions and resizes the nipples to place them in a more natural-looking, aesthetic location. This technique is usually ideal for those with medium- to larger-sized breasts.
In some cases, liposuction may also be performed to help smooth stubborn fat and create smoother contours. Dr. Jerome Liu or Dr. Tom Liu will let you know what to expect with regard to your unique treatment plan.
How is MTF Breast Augmentation Performed?
Breast augmentation for transwomen, also referred to as “chest feminization” or “top surgery,” is designed to help transwomen and non-binary patients make their gender identity more of a physical reality. This may involve creating the appearance of breasts via saline or silicone implants.
Breast Augmentation with Implants
Achieving a natural breast appearance can be accomplished with a procedure very similar to breast augmentation, although top surgery can differ from a standard breast enlargement in certain ways. Transwomen receiving top surgery will decide on the best type, size, and shape of implant to achieve their desired breast contours. Incisions can be made either along the edges of the areola, within the natural breast crease, or in a fold of the underarm. Once incisions are placed, the implant can be positioned above or below the chest muscles depending on the amount of coverage available for the implant. Dr. Jerome Liu and Dr. Tom Liu will guide you through the breast augmentation process so you’re able to make informed decisions about every aspect of the procedure.
Top Surgery: Patient Resources
Scheduling your breast augmentation or top surgery is a process that involves consulting with your primary care doctor or a mental health professional about your gender dysphoria.
Plastic surgeons and insurance companies typically require a letter of support (or referral) from a mental health provider competent in transgender health affirming the following criteria:
- A well-documented and persistent history of gender dysphoria
- The capacity to make a fully informed decision to consent to surgery
- The patient is at or over the legal age required to make healthcare decisions (18 years old in the U.S.)
- Reasonable control and management of any medical or mental health concerns, should they exist
These requirements are considered the basic standards for care by the World Professional Association of Transgender Health (WPATH). Hormone therapy is not considered a prerequisite for care by WPATH, but criteria may also differ depending on whether you’re pursuing breast augmentation as a transwoman or top surgery as a transman. Your mental health provider, as well as our team, can help you determine the documentation you need to undergo your gender confirmation surgery. It’s strongly encouraged to live as your self-affirmed gender for at least 12 months before pursuing top surgery. Only you can determine whether top surgery is the best course of action to positively improve your confidence and quality of life. That said, the team at SVIA is here for you through every step of your gender transformation. Please don’t hesitate to contact our San Jose office for more information or to schedule a consultation.
