Performing top surgery for the transgender community is one of Dr. Larson’s greatest passions. It’s an incredible procedure that transforms bodies and changes lives.
I am pleased to offer all forms of top surgery including keyhole, circumarolar, double incision, low-lateral incision, liposuction alone, liposuction assisted and free nipple grafting. The type of surgery chosen is customized and tailored to the individual patient. Whenever possible, I try to keep the nipple alive on its own blood supply.
To qualify for surgery, you should be in good physical health and at least 18 years of age. I am happy to discuss surgery with younger patients but will not perform the operation until they are legally able to sign their own surgical consent form. We follow WPATH guidelines; for more about that, click here. If surgery is to be done through insurance, typically it is required that you have lived consistently as your identified gender for at least 1 year and a letter of endorsement from your mental health professional is necessary. Informed consent is always required.
Patients currently using nicotine are not candidates for surgery. Blood testing for nicotine is frequently performed if there is any doubt. Using nicotine in any form (smoking, vaping, patches, chew, gum, lozenges, etc) is extremely detrimental to wound healing and can seriously impact your surgical result in a very negative fashion. You must be off nicotine for at least 6 weeks prior to the surgery and promise to remain off it for at least 6 weeks after to qualify.
We accept a wide range of insurance plans at Larson Plastic Surgery. Each insurance policy is different; therefore, I can’t say for certain if your insurance provider will provide coverage for the operation. They will frequently provide coverage for the office consultation. Arizona Medicaid plans and AHCCCs do not cover the surgery. My best advice is to look at the fine print of your policy or call your insurance company and ask. Occasionally, your insurance will cover part of the operation, the mastectomy (or removal of breast tissue) without covering the nipple reconstruction.
Testosterone is not a requirement for FTM top surgery. If you are planning on using testosterone at some point, however, I recommend that you begin prior to your operation and use it, ideally, at least a year prior to your surgery. Testosterone causes significant shifts in body fat and muscle. If testosterone is begun after surgery, or if these changes are not complete at the time of surgery, the chest can occasionally turn out less than ideal as this shift happens.
We all know that a body mass index and a weight close to ideal body weight is the best idea for our health, leading to a longer life with fewer problems. Having surgery at, or near your ideal body weight is “ideal!” For many of us, that is just not a realistic expectation. To calculate your BMI, click here. Surgery is safest when the BMI is between 24-36. I recommend that you have your surgery when your body is at the weight you plan on maintaining for the foreseeable future. If you gain or lose a lot of weight after surgery, the way your chest looks will change also, and not always for the better. If you are very heavy, consider weight lost assistance or weight loss surgery. Heavier patients will need to choose if they want a flat chest or if they would like a chest contoured to be more in line with the size of their body and abdomen. It is very helpful if you bring a picture (or several) of someone with a weight and frame like yours, that has a chest that you find aesthetically appealing. This will help us to zero in together on your individual goals. This does not have to be a post-op trans result, any chest you like with a body like yours will do.
The obvious answer is, as good as I can make you look. I recognize that gender appearance exists along a spectrum from pure feminine to pure masculine. The better you can visualize your ideal chest and communicate it to me (ahem, pictures), the better chance I will be able to give you what you want. I have a great deal of control over final chest contour and post-operative nipple size and position, so think about how you would like your chest to be. Please look at post-operative pictures on the internet. The scars are permanent although they fade with time. Not all healing goes as planned. Sometimes there can be wound healing complications, asymmetries, contour deformities and/or partial or complete nipple loss that complicate the result. Many of these complications can be fixed, but they require additional surgery.
Nipple location and size is frequently up to you. Some patients prefer no nipples. When nipples are replaced as free nipple grafts, they will be permanently numb and unable to become erect and there is no chance of breast feeding. When nipples can be preserved on their own blood supply, it limits size and location choice a bit but may lead to a nipple that has sensation and erectile function, and in some cases, discharge. If you have any questions about this, ask me when we determine what procedure is right for you.
Most top surgeries, in order to avoid a “scooped out” chest appearance, will need to leave some breast tissue behind. In this way, the operation should be thought of more as a breast reduction than a true mastectomy. There will still be a risk for breast cancer, although diminished somewhat following the operation. Weekly breast self-examination should still be performed, and you should inform your primary doctor that you are still at risk of breast cancer to keep it on their radar. If you have a strong family history of breast cancer, please let me know. You might require genetic testing (BRCA) to determine your risk and help us to choose the right operation for you.
Most patients will end up with JP drainage tubes, one from each side, for a week or two after the operation. They need to be emptied daily and their output recorded in mL.
I hate dog ears just as much as you. I do my best to avoid them. I also hate scars, and so I might leave a little dog ear at the end of the incision to “shrink” some before I finally remove it. This will help minimize your final scar length. Sometimes preventing large dog ears will involve extra cost to include liposuction or to extend the incision off the breast and into the armpits. Sometimes it is simply not possible to completely remove a dog ear at the time of the first operation. Typically I let you heal and then finish the dog ear removal in the office (or if it is still very large, in the operating room.)
This is totally variable from patient to patient. 2 weeks off of work is typically a safe bet. This can be longer if things don’t go as planned and there are open wound. You can usually shower 48 hours after surgery. You can’t get into a pool or spa for 5 weeks from you surgery, or 5 weeks from when your last open area has closed up (in the event of delayed healing.) You should have someone around to stay with you the night of your surgery to help you out. I also recommend a post-operative compression vest. You can shop for one at this link . Follow the website instructions on fitment (I am no expert in these vests, every body is different.)
I recommend silicone scar treatment. Ask me for our scar care handout at your post-operative appointment.
Complications are pretty rare when the perioperative regimen is followed and the patient is healthy and close to ideal body weight. The most common complications are partial nipple loss and post-operative hematoma. Other potential complications include, but are not limited to, asymmetry, pain, contour deformity (bulges or dents), scarring, nipple malposition, complete nipple loss and loss of nipple sensation. Remember, this is going to be a huge change to your body and your self-image. In many patients, the reaction is instantly positive. Still, some people have a hard time adjusting to the new shape and size of their post-surgical chest.
I am happy to welcome out of town patients. We can arrange for phone or video consultation. We can also arrange a night in a nursing care facility after your surgery if you would like.
Plan to be in town for at least one week following your surgery.
Our bodies need building blocks to heal. I recommend eating a healthy, balanced diet that includes 100g of protein daily and a multivitamin for 2 weeks before and 4 weeks after your surgery to optimize your healing. We have a sample diet for you in the office. If you would like a copy, just ask us when you are here.
Please read through the excellent literature available here.
Everyone would like a concrete number. Sadly, I just can’t give you one here. A good portion of the cost is decided by how long the procedure will take. We have to pay by time for the anesthesiologist and the use of the operating room. That time is determined by your size, choice of procedure and any special details or add-ons (like liposuction.) The best I can do is say most surgeries fall into a range between $7,200 to $8,000. Sometimes more, if you want pec implants, liposuction, etc. Sometimes less. If the surgery is being done through your insurance, typically you will only be responsible for your co-pay (unless there are add-ons such as liposuction). You will have to contact your insurance to find out how much your co-pay will be. A complete price quote will be provided to you after your consultation.
We do offer Care Credit and Alphaeon financing. We also accept major credit cards, cash, personal check, and cashier’s check. We do not offer payment plans through the office. My advice, if you do not qualify for credit, is to open a savings account for your procedure and put a little away each month. Payment is due in full at least 2 weeks prior to your scheduled operation.
This is a question that I answer all of the time. Everyone wants to have the shortest scars possible. I get that. Unfortunately, sometimes chest masculinization requires bigger scars to get the job done right. Every top surgery must be custom designed to achieve the best result, while taking into account the unique anatomy of the patient. Every body is different and requires a different solution. A peri-areolar or “keyhole” approach is possible if you have A or small B cup breasts, smaller nipples and good skin elasticity. This is the only approach than can lead to “invisible scars” (they are still there, but very hard to see). This procedure also has a high complication rate from bleeding or contour deformity. The skinnier you are, the harder it is to make a masculine chest at the time of surgery….. working out often solves that though but it takes time so be patient!!. A larger nipple on a smaller breast can have a concentric circle technique, although I’m not wild about this one because the areola tends to enlarge with time. Larger B cup breasts with smaller nipple/areola qualify for low lateral incision technique if they have good skin elasticity. This results in a scar about half as long as a double incision technique without the need for nipple grafting. We need to talk about this one to make sure you are a good candidate. Finally there is the double incision surgery. This can be done with or without free nipple grafting or with a pedicled nipple. Nipple grafting is necessary if you want to keep your nipples, but they will be numb after surgery probably forever (less than 5% get sensation back.) This surgery is custom tailored to you. Many people want flat scars. Whenever possible, I do that. Every person is unique. Sagging breasts, breasts that come close together in the middle of the chest and especially larger breasts often require curved scars. We can talk about the scars you want and what I can do to make that happen (PLEASE BRING PICTURES OF SCARS YOU LIKE, ON SOMEONE WITH A BODY LIKE YOURS, TO YOUR CONSULTATION!) If you have a “side boob” or excess lateral skin and fat in your armpit, that can also compromise your result and lead to “dog ears” or bulges. Many times, we can do liposuction to fix that. We can talk about it at your consultation.
Binding is very bad for the breast skin. It cuts down on blood supply and causes premature aging and often stretch marks. I totally understand why you do it. I just want to warn you that, over time, it will result in a degradation of the quality of the skin. This can compromise your final post-operative result. Before surgery, try to stop binding for at least a month. Hold onto your binder though, because it can be useful for post-operative compression. I like patients to use compression for 4 weeks after surgery to make sure they have the best scars possible. This can be done with an ACE wrap, compression vest or an old binder.
In certain situations, we can provide top surgery to patients under 18. We understand the importance of gender consistent physical appearance during the teenage years and have decided to offer this surgery to select patients who meet the criteria. The cut off is 14 years of age. These patients must demonstrate excellent psychological maturity. Both parents need to be willing to give consent for the procedure. We will also need a letter from a mental health professional and your primary care physician attesting to the need for surgery, the appropriateness of the surgery for you and your ability to cope with the stress of surgery. We also highly recommend that you have been on testosterone for at least one year to help ensure an excellent outcome. We will need to meet both parents in person to describe the procedure to obtain their consent with your birth certificate and their identification.