Top Surgery (Transmasculine)

In San Jose, CA

Top Surgery (Transmasculine) Introduction

Top surgery is a broad term used to describe different types of procedures for patients who experience gender dysphoria or gender incongruence and wish to either feminize their chest (e.g. Breast Augmentation or Fat Transfer) or masculinize their chest (e.g. Mastectomy). Whether the transition is from male to female (MTF), female to male (FTM), or non-binary (N), the surgical technique is always individualized to meet your personal aesthetic goals. 

Transmasculine top surgery involves removing breast tissue (a.k.a. Mastectomy) from each breast to give the chest a more masculine look. At CA Aesthetics in Los Gatos, CA, Dr. Li is a Transmasculine top surgery expert. For more information, contact us or book an appointment online. At the time of your consultation, Dr. Li will analyze your chest in detail and discuss the techniques that are best suited for you.

transmasculine person | CA Aesthetics by Dr. Li

What is Transmasculine Top Surgery?

Transmasculine top surgery, also known as Female-to-Male (FTM) top surgery, is a gender-affirming procedure designed to remove breast tissue and contour the chest as a way to create a more masculine appearance for transgender men or individuals who’ve been assigned female at birth. Ultimately, the goal is to remove breast tissues and flatten the chest. The technique that is best suited for you depends on the amount of breast tissue that you have and the condition of your skin.

When the chest fullness is minimal and there is also minimal stretching of the skin, liposuction can be used to flatten the chest. Dr. Li also sometimes advises Renuvion to help tighten the skin post-liposuction. However, liposuction by itself is rarely the best treatment option because most patients do not meet the above criteria, and there is sometimes glandular breast tissue underneath the nipple-areolar complex that cannot be liposuctioned and needs to be surgically removed. If tissue needs to be removed to flatten the chest, then a peri-areolar or keyhole incision tissue can be made at the bottom of your areola. The scar associated with this incision hides very well once healed.

For most patients, there will either be moderate to significant fullness involving their chest with excess or stretched-out skin. As such, the double incision technique is most suitable to flatten the chest. This technique is by far the most common technique among surgeons who performed transgender top surgery. In the standard technique, a crescent pattern is designed at the bottom of the breast to remove a large segment of skin and tissue (see diagram). The nipple-areolar complex is also removed completely from your chest and can be placed back as a graft based on the choice of the patient. The result after surgery is horizontal scars that span across the lower chest and circular scars where the nipple-areolar complexes were grafted back.

By in large, the double incision technique provides the greatest ability to flatten and tighten the chest and re-position and resize the nipple-areolar complexes.

trans- what

What is Dr. Li’s modified double incision technique?

Even though the double incision technique is the most common technique among surgeons who perform transgender top surgery, Dr. Li performs two different versions of this technique which leads to better results.

In the nipple-sparing double incision technique, a smaller crescent pattern is designed, primarily at the lateral and lower portion of the chest, and the nipple-areolar complex is not removed (see diagram). The result after surgery is curvilinear scars involving the lower lateral chest. The advantage of this technique is that the nipple-areolar complex does not need to be grafted back and as such there is a greater possibility that normal sensation can be preserved in the nipple. The disadvantage of this technique is that it only works for select patients with moderate fullness and skin excess involving their chest and with nipple-areolar complexes that are not positioned too low on the chest already, as this technique pulls it even lower and more lateral.

In Dr. Li’s preferred and unique muscle border double incision technique, an L-shaped pattern is designed, following the border of the pectoralis muscle (see diagram). The pectoralis muscle is a large broad muscle that is responsible for a significant part of the muscle definition involving the upper chest. The result after surgery is L-shaped scars that outline the border of the paired muscles on each side. The advantage of this technique is that the final scars in many ways highlight the muscles and become even better with more muscle growth after surgery. Dr. Li also prefers the scarring created by his muscle border double incision technique over the traditional double incision technique, in which scars usually extend far onto the lateral chest and/or can create soft tissue prominences called “dog ears”. By angling the scar upward and lateral, Dr. Li’s technique does not create any “dog ears”. In Dr. Li’s muscle border double incision technique, the nipple-areolar complex is also completely removed from the chest and placed back later as a graft. Dr. Li also re-positions the patient into an upright position to decide the new location of the nipple-areolar complexes. In inexperienced hands, the nipple-areolar can be positioned too medial or central and/or created too large on the chest, which creates an odd appearance to the result.

What is Nipple-Areolar Complex Grafting?

In nipple-areolar complex (NAC) grafting, a circular incision is made around the existing NAC, and then it is carefully removed from the chest. The NAC that is removed can be smaller and more circular than the original. When all wounds are closed after completion of the mastectomy, the patient is sat up on the operating room table to determine the best location for the new NAC. A matching piece of skin is then removed from the chest, and the NAC is sutured to its new location.

Because the NAC is completely removed, both blood vessels and nerve endings are also fully detached. However, over time, new blood vessels and nerve endings from the chest grow into the NAC, in a process that takes approximately 2-3 weeks for partial healing, and 6-8 weeks for more complete healing. A special compression dressing is applied over the chest to help the graft heal. Even after 8 weeks, the NAC will continue to change, with fading of scars and return of normal pigmentation.

Why is Nipple-Areolar Complex Grafting necessary?

Often, pre-existing nipple-areolar complexes (NACs) are larger and lower on the chest. Removing the NAC and placing it back as a graft is often the most effective technique of re-sizing and re-locating so that it has a more masculine appearance. Also, if the NAC is not removed as a graft, tissue directly underneath may have to be preserved and this may result in excess and undesired fullness and bulk.

Who are the best candidates for Transmasculine Top Surgery?

The ideal candidate for a Transmasculine top surgery would be someone in good health who maintains a good diet and exercise regime. Patients who are looking to undergo this transformative surgery are looking to change their external characteristics, specifically the chest area, in order for them to be in line with their internal sense of self. 

We also ask all of our patients to have realistic expectations of the overall outcomes. There is no reason to continue feeling uncomfortable in your skin or feel that your body does not express who you truly are. If you are looking into either form of top surgery discussed above, we encourage you to come in for a consultation and discuss your options. We look forward to meeting you!

What are the benefits of Transmasculine Top Surgery?

Transmasculine top surgery in San Jose and the surrounding Bay Area offers a range of benefits for transgender men or individuals assigned to females at birth who desire a more masculine chest appearance. These benefits include:

  • Can return home the same day of surgery
  • Able to resume normal activities within four weeks 
  • Scars are camouflaged in natural areas
  • Removes unwanted breast tissue
  • Reveals muscle definition
  • Boosts your self-esteem
  • Helps you achieve gender congruence
man with curly hair and wired glasses smiling | CA Aesthetics by Dr. Li

Top Surgery (Transmasculine) First Step

What’s the first step?

The first step in getting Transmasculine top surgery in San Jose and the greater Bay Area is to have a consultation with Dr. Li at CA Aesthetics in Los Gatos, CA. At the time of your consultation, Dr. Li will analyze your chest in detail and discuss the techniques that are best suited for your personal goals. However, a helpful way to consider where your anatomy stands is to consider the lower pole arc of your breast. The lower pole arc is the distance between the nipple and the bottom of your breast. 

Generally, if this distance is short, this usually means you have less skin excess, less breast tissue, and less droopiness as well. These anatomic features may make it possible for you to have liposuction or peri-areolar or keyhole techniques to masculinize your chest. On the other hand, a longer lower pole arc distance usually means that you have more skin excess, more breast tissue, and more droopiness, which usually requires double incision type techniques. 

While minimizing scarring is always of utmost concern, attempting to use peri-areolar or keyhole techniques when double incision type techniques should be used instead will often lead to irregular bulges of excess skin, inadequate flattening of the chest, and a greater likelihood of dissatisfaction with the surgical result.

Transmasculine Top Surgery recovery

After you are released from our care, you will be able to return home the same day. We recommend having a family member or friend available to drive you home. Maximum discomfort will occur in the first few days after surgery and gradually improve. You will be provided a compression garment to wear – it is recommended that you wear this for six weeks to help shape your chest and minimize swelling. 

You may experience temporary bruising, swelling, numbness, or a burning sensation involving your chest and over areas you had liposuction; bruising and swelling take several weeks to improve; numbness takes a couple of months to normalize. You will not allowed to lift more than 10lbs for 4 weeks as a safety precaution. Scars may be red and firm for approximately 6 months before they soften and fade

Top Surgery (Transmasculine) Cost

How much does Transmasculine Top Surgery cost in San Jose, CA?

The cost of Transmasculine top surgery in San Jose, Los Gatos, and the Bay area will vary on numerous factors, but can best be determined by coming in for your consultation with Dr. Li. After your surgical plan is created, our Patient Coordinator will be able to provide you with a detailed quotation.


Why choose Dr. Li?

Dr. Eric Li at CA Aesthetics in Los Gatos, CA is a highly experienced and double board-certified plastic surgeon with affiliations to prestigious organizations like the American Board of Plastic Surgery (ABPS), the Royal College of Physicians and Surgeons of Canada (RCPSC), and American Society of Plastic Surgeons (ASPS). With his extensive training and expertise, Dr. Li specializes in chest contouring procedures, offering personalized treatment plans tailored to each patient’s unique goals and anatomy. Patients choose Dr. Eric Li for his commitment to safety, attention to detail, and dedication to achieving natural-looking and beautiful results.

Top Surgery (Transmasculine) FAQ’S

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Schedule a Consultation

To schedule your consultation for Transmasculine top surgery at CA Aesthetics in Los Gatos, CA, please visit our contact page or call our office directly. Our compassionate and experienced team is here to support you every step of the way, from the initial consultation to post-operative care. If you’re in San Jose or the greater Bay Area, don’t hesitate to reach out to us to schedule your consultation and take the first step toward achieving the masculine chest contour you desire.

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