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Female to Male Plastic Surgery

The Removal of Breast Tissue

Often one of the first surgical steps for individuals transitioning from female to male is the removal of unwanted breast tissue to create a more masculine chest. In the medical community, this is known as mastectomy; in the transgender community, it is commonly referred to as “top surgery”. There are a number of surgical techniques that may be utilized to accomplish the tissue removal.

Bilateral Mastectomy

The most common technique that is utilized is called a “bilateral mastectomy with free nipple grafts”. This technique allows the removal of essentially all of the breast tissue and excess skin and allows for the proper placement and downsizing of the nipples. This technique is utilized most frequently because the majority of patients present with a combination of excess skin and a naturally low nipple position.

This technique leaves a scar on each side of the chest. The surgeons at American Institute for Plastic Surgery make every effort to make the scar less apparent by placing the scar along the lower border of the pectoral muscle fold. The nipple-areolar complex is downsized and placed as a graft in the appropriate location. A special medical dressing stays on the nipple graft for one week.

Mastectomy Combined with Liposuction

For patients with lateral chest fatty tissue, our plastic surgeons recommend a mastectomy combined with liposuction of the lateral chest. This technique can reduce the need for lateral chest revisions in patients with excessive lateral chest tissue.

Peri-areolar Subcutaneous Mastectomy / Keyhole Incision

The peri-areolar, or ‘keyhole’, technique consists of breast tissue removal through a small incision around the nipple. This technique carries the advantage of significantly reduced scarring. However, a relatively small number of patients are actually good candidates for this technique. The suitable candidate for this type of mastectomy is typically the young, slim patient with a small amount of breast tissue, no excess skin, and a nipple position that is suitable and does not require repositioning. An assessment of which technique will be best for you will be discussed during your examination.

Some patients have inquired about the possibility of using a ‘pedicled technique’ to preserve sensation to the nipple. However, many patients do not maintain sensation with this technique. We generally do not recommend this technique for FTM patients because it requires leaving a fair amount of breast tissue and does not result in an optimal male chest appearance.

The Recovery Process

No Drains! The physicians at American Institute for Plastic Surgery have developed a meticulous surgical technique to reattach the skin flap to the chest wall, thus, eliminating the need for uncomfortable drain tubes. This technique has been used by the doctors at AI4PS for several years with phenomenal results for our patients. Following the mastectomy, post operative discomfort can be moderate to mild, but will be lessened with prescribed pain medication. Bruising may persist 2-3 weeks. Scars are permanent, but should fade over time (this can take up to one year). Do not tan or expose scars to prolonged sunlight for one year.

Patients should avoid using their arms during the first week following a mastectomy surgery. The means no driving, lifting, or even reaching. At one week normal daily activities may be resumed; vigorous exercise and weight lifting can be resumed at 6-8 weeks post-surgery.

Medical Insurance

Many insurance companies still consider Mastectomy for Gender Dysphoria to be a cosmetic procedure and, therefore, not covered by medical insurance. However, there are some large scale employers who have insurance policies that cover transgender procedures. The first step is to contact your employer’s HR department or call your insurance company benefit line and ask if they cover transgender procedures or if you have a policy ‘exclusion’. If they confirm that you do have coverage for these procedures make sure to inquire as to their requirements to qualify. American Institute for Plastic Surgery has physicians who are ‘In Network’ with many insurance plans. Contact your insurance company or our office for more details.


Despite our efforts to coordinate with Medicare, we have been unable to communicate with any Medicare representatives who can guarantee approval and reimbursement for transgender surgery. In addition, no one offered contractual agreements with us to provide service. In our test cases with Medicare coverage, there continue to be denials of our claims. Until we receive confirmations of coverage and proof of reimbursement, the language suggests only a lifting of the ban. As a result, we cannot accept Medicare for transgender surgery at this time with such uncertainty still in effect.

Out of Town Patients

Our physicians at American Institute for Plastic Surgery are well known throughout the United States and abroad for their work in cosmetic surgery. We routinely work with patients who travel great distances to have surgery with our physicians. We would be happy to provide you with information so that you can make just one trip to the Dallas area for your surgery if you prefer.

Mastectomy Photo Gallery

The following image gallery depicts pictures of our patients who have received mastectomy at the American Institute for Plastic Surgery. To see the pictures in better detail, please click on any individual image. If you are interested in undergoing a mastectomy procedure, please contact us today. Our facility is located in Plano, Texas, a part of the Dallas/Ft. Worth metroplex.

For more information on our Female to Male surgeries, please visit our transgender site, The International Center for Transgender Care.

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Individual results may vary.