Top surgery plays an important role in the transition process and can have significant psychological benefits, in the context of gender dysphoria. Top surgery to address female anatomical breasts entails masculinising the chest through surgical removal of the breast tissue. There are various goals in achieving an appropriately contoured male chest.
Top Surgery: Approach 1 (Double incision and nipple reattachment)
This is often undertaken to address moderate to large sized breast mounds, as excellent contour can be achieved. It also enables complete freedom in repositioning the nipple. With this approach, pre-operative markings are undertaken based on the location of the planned final scar. The final scar is typically located adjacent to the lower border of the pectoralis muscle. This might not necessarily fall in line with the existing female breast fold. It is important that the new scar is not automatically placed in the existing breast crease, as this may in fact result in a more visible scar.
Following administration of anaesthesia, the new nipple areola size is determined and marked. Both nipple areola complexes (NAC) are removed, and are stored appropriately for later grafting. An incision is made in the pre-operatively determined position, taking into account the above scar considerations. From the upper incision, the breast tissue beneath the skin is removed with cautery. Once the breast tissue below this upper skin flap, the upper skin is re-draped in a downward direction.
The excess skin is then determined and removed. The same approach is taken to remove the breast tissue lying below the lower incision. A drain is typically placed in the space under the skin to enable removal of post-operative tissue fluid. The skin flaps are then sutured together. The nipple is then reattached as a graft. It is important that your surgeon has a good understanding of where ideal nipple position is situated in a male chest. There are certain parameters that are followed in positioning the nipple in the most optimal position. Nipple diameter size is also reduced to ensure a result that is consistent with a male nipple areola complex. Once the position is determined and the nipple areola complex is applied as a graft, the graft is secured in place with a special dressing to optimise graft take. A compression garment is also applied to minimise swelling and support the wound.