At present, you identify either as a transman (FTM) or as gender nonbinary (FTN). You have been experiencing significant gender dysphoria for a while and are very interested in having top surgery to get rid of your breasts. Relevant to this is the fact that you have had a breast reduction in the past.
Is it possible for you now to have top surgery?
If so, will your previous breast reduction affect the results from top surgery?
Let’s look into this.
Reasons for a Breast Reduction Prior to Top Surgery
Even though you (presently) identify as either a transman or as gender nonbinary, there likely was a good reason why you previously had a breast reduction rather than top surgery. The most likely possibilities are:
- At the time of your breast reduction, you were either not aware of any gender issues or had some confusion about it.
- You knew that you needed top surgery at the time but your parents would either only allow you to have a breast reduction or would only pay for a breast reduction.
- You thought at the time that may a breast reduction would resolve your dysphoria rather than the more extensive gender affirming mastectomy. Unfortunately, it did not.
- At the time, your health insurance would cover breast reduction surgery but not top surgery.
Can a Breast Reduction Effectively Address Gender Dysphoria?
In some gender non-binary (FTN) or gender expansive individuals, a breast reduction can either reduce the severity of gender dysphoria or, even alleviate it. This is most commonly true in those individuals who are androgynous. Sometimes they want to feel feminine while at other times, not. Having very small breasts provides them the opportunity for this flexibility.
For those individuals who are transmen, a breast reduction is not a final choice. A flat chest is.
Is FTM or FTN Top Surgery Possible if I Already Have Had a Breast Reduction?
Fortunately, if you have already had a breast reduction but now realize that top surgery is what you really need, you are in luck.
Yes, you can have top surgery after already having had a breast reduction.
The results may not be ideal or exactly what you want, depending on the specifics of your reduction, but at least you can have a chest that better affirms your gender identity.
What Kind of Results Can I Expect?
The results from transforming a breast reduction into a flat chest, with or without nipples, for either an FTM or FTN gender affirmation surgery depends on numerous factors. In fact, each situation is unique because of this.
Some of the issues which will ultimately affect the outcome include:
- Technique employed for the breast reduction
- Length of the resulting scars
- Location of the scars
- Width and quality of the scars
- Position of the nipple-areola complexes
- Size of the nipple-areola complexes
- Skin laxity
- Skin quality including state of elasticity
- Desire for nipple-areola complexes for the top surgery
Patient Example
The following patient of mine is one example of converting a breast reduction into a flat chest for top surgery:
This 19 year old transman had been seeking gender affirming FTM top surgery as a minor. His family would not consent to or pay for the procedure but they would pay for a breast reduction. As a result, at age 16 he decided to proceed with a breast reduction and requested to be taken down to a “B” cup for at least an androgynous look. Unfortunately, he was left far larger, deformed and absolutely not happy with the results (photos A and C).
A). Before FTM top surgery and a few years after a breast reduction
B). Several months following FTM top surgery and a few years after a breast reduction
C). Before FTM top surgery
D). After FTM top surgery
He consulted with me for top surgery, seeking a masculinized flat chest with nipple-areola complexes. Surgery was subsequently performed, transforming his breast reduction into the FTM top surgery results that he was seeking (photos B and D).
Fortunately, in his situation, virtually all the previous scarring from his breast reduction was removed in the process of transformation. (Though the results are only less than 6 months old, he may require a revision for additional improvement on the right side.)
Scheduling Your Top Surgery Consultation
If you are wanting to proceed with gender affirming top surgery and would like to have a consultation with me, Dr. Steven Turkeltaub, you can schedule one by either calling the Arizona Center for Aesthetic Plastic Surgery at (480) 451-3000 or by contacting us via email.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
