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Female to male, or FTM chest reconstruction, is a gender affirming surgery often performed as part of a transgender transition from female to male. Dr. Javad Sajan is a uniquely qualified plastic surgeon in the Seattle area that performs many methods of chest reconstruction. He does not use drains for his chest reconstruction surgeries because of his advanced techniques. One of the most sought after types of chest reconstruction is the keyhole method which can result in less scarring. World renowned transgender plastic surgeon, Dr. Sajan at Allure Esthetic offers keyhole chest reconstruction to patients from all around the United States and world.

Understanding FTM Surgery

What Is FTM Chest Reconstruction?

FTM chest reconstruction is a surgical procedure that removes the breast tissue and creates a masculine chest. In the case of top surgery, a plastic surgeon creates a masculine chest in addition to removing the breast tissue. Along with removing breast tissue, Dr. Sajan performs ultrasound assisted liposuction to remove genetic feminine fat pads. The ultrasound helps with skin tightening and the liposuction helps produce a more defined masculine chest.

Dr. Javad Sajan at Allure Esthetic performs many types of chest reconstruction surgeries, including the keyhole technique. Every chest reconstruction patient will require an individual care and surgical plan catered to their specific needs. When you come in for your chest reconstruction consultation, Dr. Sajan will evaluate your anatomy, goals, and health. Helping him determine the surgical method that will best suit your needs. Dr. Sajan believes the goal of surgery is to create a custom chest for you. He does not believe in a cookie cutter approach to top surgery.

There are a variety of surgical methods possible for performing a chest reconstruction. Dr. Sajan uses many techniques for chest reconstruction depending on the candidate. The three most popular techniques include: double incision, periareolar, and keyhole methods.

Types of Chest Reconstruction Surgery:

Double Incision:

One of the most popular types of chest reconstruction, the double incision, includes two incisions on either side of the chest. A double incision chest reconstruction often results in a more masculine chest than less invasive methods. It permanently creates a male chest because it removes skin, breast tissue and feminine fat pads through liposuction. The double incision surgery does result in larger scars than the other operations. To combat scarring, we use a proprietary 5 step scar cream protocol that lessens the appearance of scars over the first year of recovery. Dr. Sajan works to create the least visible scars possible.

The double incision method is best for those who require a large removal of tissue and want a very masculine or flat chest. Less invasive methods exist for patients who need minimal skin correction or tissue removal.


This technique involves an incision around the areola. Suited for those with smaller breast tissue with large areolas, this chest reconstruction method removes tissue and skin like the double incision technique. Additionally, it usually reduces the size of the areolas and makes them proportionate to your new chest.


A keyhole chest reconstruction combines liposuction and sometimes a small incision to remove breast tissue. The keyhole technique is only possible when a patient has a small B-cup or less and no excess skin. This type of reconstruction does not significantly scar, but does depend on the skin settling well over your new chest.

When possible, the keyhole chest reconstruction provides a masculine or flat chest with nearly no incisions or scarring. While it may not result in the same masculine look as the double incision method, the less invasive nature makes it a popular procedure.

Chest Reconstruction: Before And After

The decision to undergo chest reconstruction surgery can take months or even years of deliberating and research. All before you finally book a consultation. At Allure Esthetic, we take all of your questions and concerns seriously because we understand the difficult chest reconstruction journey.

Consultation With Dr. Sajan

When you come in for a consultation with Dr. Sajan, he will fully explain the procedure, recovery, benefits, and risks. He will ask about your medical history and goals. After he understands your goals, he will examine your current chest and determine if you are a good candidate. Once he decides you are a candidate, Dr. Sajan will discuss the various chest reconstruction techniques. Furthermore, providing you recommendations on which technique will best serve you.

Dr. Sajan will customize your keyhole chest reconstruction to fit your unique medical history, anatomy, and desired chest. Three weeks before surgery you will meet with Dr. Sajan’s nurse where you will receive individualized instructions. These will include health clearances, beginning or halting certain medications, and other preparations.

The Three Steps of Keyhole Chest Reconstruction Surgery

FTM Surgery Seattle

Revisional FTM Top Patient

The day of your keyhole chest reconstruction you will come to our state-licensed and nationally accredited surgery center. Chest reconstruction procedures of any type are usually performed under general anesthesia and administered by a board-certified anesthesiologist. Most patients do not require an overnight stay.

Dr. Sajan will review your surgical plan with you and make marks to guide him during surgery. You will then be placed under general anesthesia and the entire operation should take around two hours.

Ultrasound Therapy:

First, Dr. Sajan will use an ultrasound to break up the breast tissue, fat, and glandular tissue. This will make the liposuction smoother and more effective. This also promotes the tightening of the skin for improved results and easier recovery. Patients will often see a 20-30% improvement in the tightness of their skin after a liposuction procedure that utilizes an ultrasound.

Suction Assisted Glandular Removal:

Once the tissue is broken up, Dr. Sajan will liposuction it out using a special liposculpting technique. This liposculpting technique makes your new chest look masculine (or flat) and match your contours. This technique will remove breast tissue and fatty tissue to sculpt your chest to your goals.

Small Periareolar Incisions:

Not every keyhole chest reconstruction patient will require incisions around the areola. It will depend on how much Dr. Sajan can remove with liposuction and how your skin responds during surgery. If you require any incisions, Dr. Sajan will hide them in the areola. Unlike with the other techniques, patients typically do not require nipple removal because the incisions are smaller or non-existent. This results in most keyhole patients not losing any nipple sensation.

Keyhole VS. Double IncisionChest Reconstruction

The double incision technique is one of the most popular chest reconstruction methods that Dr. Sajan performs. For many patients, a double incision chest reconstruction will provide the best results. For those who are candidates for a keyhole procedure, this technique can offer results without large incisions or scarring.

Beyond the basic surgical differences between the two procedures, each method offers unique benefits and risks. Dr. Sajan will decide if you are a candidate for a double incision or keyhole chest reconstruction. Every chest reconstruction patient varies in their anatomy, goals, and needs. He will ensure that you understand all of your chest reconstruction options and which one will benefit you most.

Double Incision

  • No risk of loose skin
  • More masculine looking chest
  • Increased risk of scarring
  • Two incisions
  • Larger risk of sensation loss in the nipples


  • No major scars (in most cases, no
  • scarring)
  • Less invasive technique
  • Small or no incisions
  • Nipples not removed or repositioned surgically

Keyhole Chest Reconstruction Gallery >>

Keyhole Recovery

Following your keyhole chest reconstruction, your caretaker will take you home and care for you. You will immediately see the difference in your chest. There will be swelling with your surgery and it will take time for your skin to fall into place. In the coming weeks, you should continue to see the look of your chest improve.

Chest reconstruction patients often return to work and daily activities within a week of surgery. Dr. Sajan places no drains during surgery, which aids in recovery and helps you return to work and exercising quicker. Based on your medical history and needs, Dr. Sajan can provide an accurate recovery timeline.

Risks Of The Procedure:

Every surgical procedure comes with some risk and a keyhole chest reconstruction is no exception. Because it is less invasive than other FTM chest reconstructions, the keyhole technique carries less overall risk. In an ideal candidate, there is little risk during a keyhole chest reconstruction performed by Dr. Sajan.

The risks of a keyhole chest reconstruction can include:

  • Appearance of lumps and bumps
  • Loose skin
  • Reliance on skin contraction
  • Risk of chest settling unevenly
  • Fluid collection
  • Necrosis (skin or nipple death)

Globally Recognized Top Surgery Plastic Surgeon: Dr. Javad Sajan, MD

Dr. Javad Sajan is one of the leading chest reconstruction surgeons. He has performed hundreds of gender affirming surgeries with varying techniques. One of the best surgeons for FTM top surgery in the world, Dr. Sajan provides the gold standard of keyhole chest reconstruction.

Allure Esthetic makes the experience of seeking top surgery comfortable and seamless. In our waiting room you can find freshly baked cookies, refreshments, and our welcoming staff. We always strive to ask your pronouns and use your preferred name. Chest reconstruction surgery can improve your health, self esteem, and lessen gender dysphoria.

A FTM top surgery is not a cosmetic surgery to Dr. Sajan and Allure Esthetic. Chest reconstruction is medically necessary to those individuals experiencing gender dysphoria and a decline in health due to their breasts. We work with most insurance companies to help fund your chest reconstruction.

To schedule a consultation with Dr. Sajan at Allure Esthetic, call us at 206-209-0988 or fill out the form below.

Allure Esthetic Plastic Surgery

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