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For many female-to-male (FTM) transgender patients, their bodies can be a constant cause of gender dysphoria and distress. Some may choose to seek out gender affirming surgery that seeks to alter their body to better match their gender identity. This can include many surgical and non-surgical procedures. The most common procedure among many FTM patients is top surgery. Female-to-male top surgery (more correctly stated as gender affirming top surgery) is one of Dr. Sajan’s top procedures. He aims to achieve every patient’s goals and offers many different types of top surgery to better serve his patients. Dr. Javad Sajan at Allure Esthetic Plastic Surgery performs some of the best FTM top surgery in the world.

Understanding FTM Top Surgery

Female-to-male top surgery, or FTM top surgery, is a procedure that removes the traditionally female breasts and creates a masculine or flat chest. While referred to as “female to male” top surgery, many non-binary and gender non-conforming patients also undergo the surgery. Due to the diversity in identity, size, and goals of Dr. Sajan’s patients, Dr. Sajan offers many different types of FTM top surgery.

The way a patient’s incisions sit on their chest is extremely important. Traditionally, patients did not have much control over the shape or size of their top surgery scars. However, Dr. Sajan allows patients to choose the shape they like and allows them as much freedom in determining the outcome of their chest as possible. This approach is unique to Dr. Sajan and Allure Esthetic, making them one of the top destinations for top surgery in the world. Although Dr. Sajan does not guarantee and any particular scar shapes, he does his best to achieve the vision of the patient.

Along with this, Dr. Sajan also offers Scar Protocol. Scar Protocol is a five-phase scar cream system that his FTM patients go on following surgery. It helps their scar fade and promotes less visible scars over time. Lessening the look of top surgery scars is important to many of his patients.

Masculine vs. Flat Chest: What’s The Difference?

As previously mentioned, the two results that Dr. Sajan can create during top surgery are a masculine chest and a flat chest. What is the difference between these two results? A flat chest and masculine chest are often seen as one and the same. However, that is not entirely the case.

A masculine chest involves sculpting breast tissue for the look of cut, muscular pecs. Generally, this approach is favored by athletic and active individuals who want to work on improving the look of their chest after surgery. A masculine chest result from FTM top surgery puts them on the track for a chiseled, masculine looking chest.

A flat chest focuses on removing the breast tissue and leaving behind a flat chest. Unlike the masculine chest, breast tissue is removed to create a flat look proportionate to the patient’s body type. This technique is popular among non-binary patients and those who desire a gender neutral look.

Dr. Sajan can create a great result with either a masculine or flat chest and sees multiple FTM top surgery patients every week. He understands that not every patient wants the same result and caters his approach to fit the individual patient, their body, and their goals.

Top Surgery Specialist, Dr. Javad Sajan

Dr. Javad Sajan of Allure Esthetic Plastic Surgery performs multiple FTM top surgeries per week and hundreds every year. Patients have come from out of state and even out of the country for top surgery with Dr. Sajan. To best accommodate his transgender patients, Dr. Sajan does accept many insurances for top surgery. Additionally, he works with outside financing companies such as Care Credit.

Dr. Sajan has years of experience in gender affirming and plastic surgery. He is an advocate of the LGBT community and has vast experiencing working with transgender surgery patients. This is why he offers some of the most diverse and varied options for FTM top surgery incisions and techniques.

Types of FTM Top Surgery Incisions

Dr. Sajan can achieve many shapes of FTM top surgery incisions. While the traditional double incision technique remains the best way to achieve a masculine chest, Dr. Sajan has made many advancements on the technique to create scars that better match his patient’s goals. Below are a few types of FTM top surgery incisions and techniques.


U-shaped FTM top surgery incisions follow the natural curve of the breasts and tend to result in two U-shaped incisions on the chest. This technique was one of the first and most traditional techniques. Some patients may opt for U-shaped incisions if they want some tissue left over. This also tends to offer the best results for larger patients or those with additional extra skin in the area.

A few advantages of this incision include:

  • Suitable for most body types and sizes
  • Reliable
  • Works well for non-binary patients not wanting to look too masculine or feminine
  • Customizable and versatile surgery


A pec incision is located in roughly the same place as the U-shaped incisions but follows a contour similar to that of a masculine pectoral muscle. This technique is ideal for fit people who want to look especially cut or muscular. It enhances masculine contours and often involves sculpting the chest.

Benefits of this technique include:

  • Often results in a more sculpted look
  • Focuses on a more masculine look
  • Can suit most body types


Straight incisions have become more popular among FTM patients because it does not mimic or follow the original breasts. This technique features sharp angles which can complement nearly any body type. Straight incisions are not always possible depending on the amount of tissue that needs to be removed. However, for patients who prefer the look of straight incisions, Dr. Sajan does his best to make the incisions as straight as possible.

Advantages of this technique include:


Benefits of the keyhole top surgery technique include:

  • Small incisions
  • Nipple removal unnecessary
  • Less invasive
  • Usually results in a flat versus masculine chest (this may be a drawback for some patients)

Inverted T/Anchor:

Similar to the double incision method, the inverted T, or anchor, top surgery technique involves making two incisions on either side of the chest. However, in addition to these incisions, an incision around the areola and down the chest connects to the horizontal incision. This maintains blood supply to the nipple. Therefore, the nipples can be resized and repositioned without removing and grafting the nipples back onto the chest.

Benefits of the inverted T method include:

  • Nipple not removed
  • Blood supply to nipple not interrupted
  • Nipple sensation likely to remain the same as before
  • Less risk of losing the nipple post-surgery
  • Potentially less overall risk than the traditional top surgery technique for some patients

Determining the Right Incision for Top Surgery

A top surgery journey will look different for every patient. Normally, patients often have a vision of what they want their chest to look like. This may or may not align with the right technique to achieve the best result and their goals. There are two main considerations to make when determining the right incision for your Seattle top surgery.

First, the size of your body and chest. Patients with a larger chest will not likely be candidates for a keyhole top surgery. Additionally, patients with little breast tissue may not be able to achieve a more masculine look. Dr. Sajan does his best to achieve the desired results regardless of body type.

Secondly, some patients want to look more masculine, while other patients may desire a flat, non-gendered look. Both of these can be achieved via top surgery but often require different techniques. A double incision chest reconstruction with pectoral or straight incisions often looks masculine and angular on most body types. The U-shaped incisions and keyhole top surgery may result in a more gender neutral or non-binary look.

Finally, Dr. Sajan has performed hundreds of FTM top surgeries and specializes in creating masculine and flat chests. He has worked with a diverse group of patients of all shapes, sizes, ethnic backgrounds, and identities. Dr. Sajan understands how every patient has a unique idea of what they want their chest to look like following FTM top surgery in Seattle.

At a consultation, Dr. Sajan will discuss your goals for the procedure, evaluate your medical history, and physically examine your chest. After this consult and exam, Dr. Sajan will make his recommendations for what the best FTM top surgery technique for you is.

The Best FTM Top Surgery in Seattle

Dr. Javad Sajan of Allure Esthetic Plastic Surgery is one of the best plastic surgeons in the United States who performs gender affirming surgeries. He has years of experience working with and advocating for the transgender and gender non-conforming community, aiming to provide top medical care to all of his patients.

Allure Esthetic features a state-of-the-art, full scale clinical facility and ambulatory surgery center. We accommodate local and out-of-town patients alike and create a safe environment for all of our transgender patients.

To schedule a consultation, call us at 206-209-0988. You can also reach us online via our Price Simulator™, chat, or contact form.

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