At its best, cosmetic surgery is a means of achieving the vision of your most authentic self. For those who desire gender reassignment (or as some prefer, gender confirmation) surgery, this transformation can be especially poignant, leading to the psychological and social well-being so integral to a happy, productive life. I am proud to support members of the transgender community on their journey to becoming their true selves.
Whether considering Male to Female (MTF) or Female to Male (FTM) transformation, the first step taken should be to find a cosmetic surgeon with extensive experience in this field. Once that due diligence is taken care of, the next step is to meet with the surgeon and to make sure the individual is the right fit for you to take you through this highly emotional, very individual journey. Ideally, the surgeon will understand your vision for yourself and will work with you to develop a plan for reaching your personal goals.
For individuals seeking gender reassignment, the first step often taken is “top surgery,” a complex surgical procedure requiring a physician with a seasoned track record in breast surgery. Look for a surgeon experienced in a wide range of breast-related procedures to offer recommendations based on the latest, most groundbreaking techniques. You should expect a custom-tailored recovery plan unique to you, and a realistic expectation of a quick, healthy recovery.
Top Surgery and Recovery: What to Expect
Top surgery provides those seeking a FTM transition with a traditionally masculine physique through chest reconstruction and contouring. This involves breast tissue removal (bilateral mastectomy) or reduction and reshaping of the nipples/areolas, and may include liposuction for tailoring on both sides. Based on your anatomy, skin elasticity and specific aesthetic goals, there are two types of incisions from which I choose for my patients. Both of these are “nipple-sparing” in order to preserve sensation and reduce scarring. In reshaping and resizing the nipple/areola complex, the doctor’s primary goal is to accomplish a more masculine position and appearance. The average length of the entire procedure is one to two hours.
For transgender men with smaller A or B cup chest measurements, I often recommend an incision that traces the outline of the areola. In this case, the removal of breast tissue is completed with a combination of liposuction and direct excision. This procedure usually will take an hour. Recovery is 48 hours, and then the patient can return to work. For transgender men with B, C or larger chest measurements, or in cases where loose, excess skin is present, I may choose a more in-depth method of tissue and excess skin removal via scalpel, creating incisions at the breast fold and around the areola.
Pain medication will be prescribed for soreness, however, FTM top surgery patients should expect to heal at a quick, healthy pace, based on advanced and efficient surgical techniques. In most cases, a drain will be placed on each breast to collect excess fluid after surgery. These will usually be removed after the first week, but note a drainless procedure can be performed in others. Lots of rest and downtime is advisable for the first few days, after which transgender men can expect to be back in action. Workouts, weight lifting and physical labor can be resumed in around two to three weeks.
Many transgender women do not have sufficient levels of natural breast tissue to rely on hormone therapy alone in order to create their desired breast volume. For those MTF transition patients seeking a fully feminine, shapely silhouette, I recommend the use of breast augmentation, a procedure to increase breast volume and enhance the overall breast appearance.
The surgical site should be kept as compact as possible, with incisions made that are perfectly matched to the size of the implant, for a fit that is snug and sustainable, as well as highly conducive to healing. The small surgical site also predicts a lower risk of infection. The total time in surgery is typically around 45 minutes.Your surgeon should take a holistic approach when it comes to aftercare — the right surgical technique often results in the patient not requiring pain medication post-surgery outside of the same over-the-counter remedies taken for everyday aches and pains.
In my practice, breast augmentation patients typically resume normal activities within around 48 hours, including childcare, showering and reasonable job duties. Sutures dissolve over time, and surgical tape is removed after about seven days. It is this level of rapid recovery that you should look for in a practice, as not all are created equal, with some surgical techniques resulting in healing that drags on for as long as six months.
Another consideration is the type of implant used; the majority of my augmentation patients choose the latest breakthrough in breast augmentation innovation, the “Gummy Bear” implant, so called due to its natural-feeling texture. With over 100 shapes and sizes available to complement any physique, the Gummy Bear offers proven stability and versatility that is revolutionizing breast augmentation and beyond.
Completing Your Transformation
Not to be overlooked is consideration of the overall transformation, not limited to top surgery. After all, to be “feminine” or “masculine” involves far more than having or not having breasts. There are an array of treatments that support long-term aesthetic goals and facilitate a holistic approach to transitioning. For example, transgender men may find that contouring and body shaping through liposuction or CoolSculpting, and the use of Kybella to dissolve fat under the chin, upper breasts and underarm areas, as well as the abdomen, help them to better realize their desired masculine physique.
Many transgender women expect to undergo laser hair removal, particularly in the facial area, but there are a wealth of additional treatments to help achieve a soft, feminine appearance. From dermal fillers such as Volbella or Vollure for fuller lips, to Profound, a non-surgical treatment for tightening of the face and neck, arms, knees, and abdomen, to tried-and-true Botox to smooth away harsh lines, there are a multitude of non-surgical treatments to create complete transformation.
One of my MTF patients, Marsha, sums up this transformative experience better than I could: “As a transgender woman, life drawing model, LGBTQ advocate and a medical professional, choosing a reputable provider with quality references and results is imperative. Choosing a provider who is accepting, caring and sincere seems even more important. My surgeon and his caring, highly trained team prepared me for the physical aspects of surgery, and their kindness and support helped me psychologically. Besides the physical change (which is fantastic), the emotional effect has changed me completely, as my inner self now sees an outward manifestation of my true identity.”
info: Dr. Peter Capizzi s a double board-certified cosmetic surgeon who is based in Charlotte, N.C. He completed his training at Mayo Clinic. Visit capizzimd.com to learn more.