FTM Top Surgery After Breast Reduction | Dr. Javad Sajan

Gender affirming surgery has existed for decades. However, only within the last twenty years or so have FTM top surgery been offered and performed openly. Additionally, few surgeons were well-versed in the intricacies of top surgery and the gender non-conforming community, leading to misunderstandings and less-than-stellar transgender surgery options. Thankfully, top surgery is more commonplace and more surgeons worldwide perform the procedure. Dr. Javad Sajan of Allure Esthetic Plastic Surgery is one of the most sought-after plastic surgeons for top surgery in the United States. Allure Esthetic Plastic Surgery provides the best FTM top surgery after breast reduction.

FTM top surgery is a procedure that removes extra skin, gland, and breast tissue to create a more masculine or flat chest. A breast reduction will often remove skin and tissue to make the breasts smaller but maintain the look and shape of the breasts. Both procedures can be life-changing for patients. Due to the inaccessibility of top surgery for many decades, many gender non-conforming people underwent a breast reduction instead of FTM top surgery.

It is possible to have a top surgery after a breast reduction, but it does come with unique challenges not present in a standard top surgery. However, patients who underwent a breast reduction for whatever reason can later seek out the benefits of top surgery.

Many patients who underwent breast reduction did so because they did not know top surgery was an option or because they could not find a surgeon to perform it. Additionally, insurance coverage for FTM top surgery did not become widespread or mandated in many states until the 2010s. Therefore, even if a patient knew about the surgery and found a surgeon to perform it, financial restraints may have prevented them from getting top surgery.

Also, it is fairly common for people to begin their transgender transition later in life. The patient may have had a breast reduction to address back pain or other chronic issues caused by larger breasts, but later desire a gender affirming procedure like top surgery.

Performing FTM top surgery after breast reduction does pose some unique challenges. While every patient and case is different, Dr. Sajan considers many common factors and challenges associated with top surgery after breast reduction.

• Scar Tissue: Previous surgery will leave behind scar tissue. To achieve a good result, Dr. Sajan needs to remove all of this scar tissue which can make the surgery longer than a traditional top surgery. Not removing all of the scar tissue can lead to irregularities in the look or shape of the chest.
• Visible Scarring: A breast reduction surgery involves some of the most extensive incisions and scarring of any breast surgery. It most frequently involves an anchor-shaped scar. This can be beneficial because it allows Dr. Sajan to use the old incisions—fully or partially—to access the area. But, this can also pose challenges because some of the scarring may be outside of the traditional top surgery treatment area. Thus, Dr. Sajan will have to accommodate his surgical technique to fully address these scars. He aims to replace the extensive breast reduction scarring with double incision top surgery scars.
• Dog Ears: The term “dog ears” refers to when excess skin or tissue is left behind and causes protrusions from the side of the chest that can resemble dog ears. Patients who had previous breast reduction surgery are sometimes at a higher risk of developing dog ears. Therefore, occasionally, Dr. Sajan will need to extend the incision slightly to prevent dog ears.
• Nipple Placement: Like top surgery, a breast reduction often uses a free nipple graft to move the nipple upward on the chest. However, a breast reduction may place the nipple higher on the chest than is typical on a top surgery patient. While this is perfectly fine for a breast reduction patient, it does mean that Dr. Sajan often needs to move the nipple down instead of up during top surgery.
• Thick Scarring: There is an increased risk of thick scarring—including keloids—with this surgery due to the prior surgery. If a patient is already prone to thick scars, they should weigh this and discuss options with Dr. Sajan.

All surgeries—including top surgery after a breast reduction—come with benefits and risks that Dr. Sajan and patients need to consider before going forward with surgery. These will vary for each patient, but some will apply to most patients.

Possible benefits include:

• Creation of a masculine or flat chest
• Less scarring on the chest
• Reduction in gender dysphoria
• No longer need to bind the chest
• Ability to wear traditionally male clothing easier
• May result in fewer instances of misgendering
• Improvement in overall mental health and well-being
• Natural looking results
• Masculine nipple appearance and placement
• Ability to customize the surgery such as having no nipples
• Performed by a top plastic surgeon specializing in FTM top surgery

Risks associated with an FTM top surgery after breast reduction are similar to those of a traditional top surgery. However, as previously mentioned, there are some increased risks associated with this type of top surgery. Possible risks include:

• Extensive or thick scarring
• Infection
• Prolonged or severe side effects such as bruising or swelling
• Complications associated with general anesthesia
• Total loss of nipple sensation
• Asymmetry
• Bleeding
• Fluid collection

If possible, having the patient’s surgical records from their breast reduction helps Dr. Sajan plan a better surgery and tends to result in more successful outcomes.

Patients recovering from top surgery after breast reduction tend to be fairly comfortable. However, unlike his other top surgery patients, Dr. Sajan does place drains for these patients. They may also have a slightly longer recovery. Generally, though, patients can return to work and more everyday activities in about two weeks. Dr. Sajan will continue to restrict heavy lifting and strenuous exercise for about six to eight weeks.

Can I Keep My Nipples With An FTM Top Surgery After Breast Reduction?

Yes, even if a free nipple graft was performed during the breast reduction surgery, it is possible to have another one. However, it is more likely that sensation will not return to the nipples. If Dr. Sajan has access to the breast reduction surgery records, this can help him better plan nipple removal and placement.

Will My Breast Reduction Scars Still Be Visible?

No, Dr. Sajan works to remove breast reduction scars from the chest. Only in rare cases is this not fully possible.

How Soon After A Breast Reduction Can I Have Transgender Top Surgery?

Patients should be at least one year out from their breast reduction surgery because this is when major healing, swelling, and skin retraction ceases. However, based on a patient’s medical history, it may take longer for this to occur.

Is A Keyhole Top Surgery Still Possible?

Unfortunately, in most cases, it is not possible to perform a keyhole top surgery. This is because—for the best results—the scar tissue and scars need to be fully removed which is not possible to achieve through a minimal keyhole incision.

How Much Is Top Surgery After Breast Reduction?

The starting cost of FTM top surgery is $8,500. However, patients seeking top surgery after breast reduction can expect it to cost more due to the increased surgery time and complicated nature of the procedure. Patients will receive a personalized price quote at their consultation.

Insurance will often still cover FTM top surgery after a breast reduction, though it is on a case-by-case basis. Allure Esthetic works with outside financing companies Care Credit, Alphaeon Credit, and United Medical Credit to offer affordable financing as well.

Dr. Javad Sajan is a Seattle plastic surgeon who specializes in gender affirming surgery including FTM top surgery, facial feminization, and body masculinization. He customizes the surgery to match the patient’s unique situation and needs. Dr. Sajan and Allure Esthetic know that top surgery saves lives and aim to provide full, quality service to transgender and gender-nonconforming patients from around the world. This includes following WPATH’s standards of care. Allure Esthetic Plastic Surgery offers the best top surgery after breast reduction.

To learn more and schedule a consultation, call us at 206-209-0988. Patients can also reach out online via chat, contact form, and Price Simulator.