Female to Male

Female to Male

Every transman has his own perspective on what procedures he wants and needs to feel comfortable in his own skin. For some, top surgery is enough for them to feel at ease in their body. Others may choose to also have a phalloplasty.

Top Surgery (Chest Masculinization Surgery)

Female to male top surgery is the procedure to create a masculine chest. Successful top surgery can give you a natural looking, masculine chest. You’ll look better in clothes and feel comfortable taking your shirt off at the beach, pool or in the locker room.

The process involves removing fat and glandular tissue and sculpting a masculine upper chest. The breasts are removed using a combination of surgical excision techniques. The areola complex (nipple area) is repositioned for a more traditionally male appearance. Depending on your age, anatomy, and personal preferences, our surgeons will use one of the following techniques:

  • Periareolar incision (keyhole): This approach is ideal for people with smaller breasts and good skin elasticity. The surgeon removes breast tissue and reshapes the chest through a circular incision around the areolar complex.
  • Double Incision: The double incision approach is performed on the vast majority of patients seeking top surgery. Breast tissue and excess skin are removed through two horizontal, elliptical breast incisions. The final incision line will rest at the lower border of the pectoralis muscle so that scarring is as discrete as possible. The nipples and areolas are typically removed, resized, and grafted back onto the chest in a more masculine position.
  • Buttonhole: This approach is similar to the double incision method, but resizes the nipple areolar complex in a way that preserves nipple sensation.
  • Inverted T: For those with medium to large chests and an abundance of skin, an inverted T incision is used that goes down to the inframammary fold (where the breast and chest meet) and then horizontally across the bottom of the breast.

After their top surgery, patients are able to go home the same day. Recovery times vary depending on the technique chosen, the amount of breast tissue removed, and the patient’s age and general health.

You will be fitted with a compression garment after surgery, which helps to reduce swelling and keep your new shape intact. You will need to sleep on your back for at least the first week, being careful to avoid strenuous exercise or heavy lifting. Most clients find they can return to school or work within about two weeks and resume their normal fitness routine between 4 and 6 weeks post-surgery.

(Watch the above video to learn more about Chest Masculinization Procedures)

Phalloplasty – Female to Male Bottom Surgery

Phalloplasty is the surgical construction of the male genitalia. This is a complex, highly customized procedure that is best performed in stages. However, the impact on a man’s confidence and self-image can be life changing.

During phalloplasty, surgeons use a flap (area of tissue which is moved) from the patient’s own body, typically taken from the forearms or thighs. This tissue is fashioned into an adult penis. The penis may or may not contain a urethra, depending on whether a patient desires the ability to void urine while standing. If not, the penis reconstruction may be “shaft only,” without a urethra, and the patient may void urine while sitting down as they did before surgery. Nerves are joined with the hope of providing tactile and erogenous sensation to the shaft of the penis. Surrounding tissue is used to create the scrotum.

Phalloplasty begins with the removal of the ovaries and uterus. After that, a variety of procedures are possible:

  • Closing off vaginal canal
  • Creating a penile shaft
  • Creating a glans, which can have a circumcised or uncircumcised appearance
  • Lengthening the urethra
  • Creating a scrotum using testicular implants
  • Adding an erectile device

As phalloplasty is highly complex, involving reconstruction of many different structures which all have to work together, it is usually done in steps (staged), rather than all in one surgery. Addition of erectile and scrotal implants usually occurs as the last step, after a healthy phallus and normally functioning urinary tract is created.

For each stage of phalloplasty, recovery can range from being on outpatient (home the same day), to being an inpatient for 1-2 weeks. It may take 4-6 weeks to return to work depending on the stage. A patient should expect the entire process to take approximately 1 year.

(Watch the above video to learn more about the Phalloplasty Procedure)