Q: Dr. Eppley, I see that you perform gynecomastia surgeries and wonder whether you also perform mastectomies for FtM transsexual patients. I am investigating surgeons for the procedure who are closer to my home than the big-name options often reccomended to trans men. Thanks for your time.
A: Maximal breast reduction, often called Top Surgery in transgender patients, is merely an extension of a typical female breast reduction procedure with the more extreme goal of a completely flat chest. There are three basic techniques to do it, two of which are based on a free nipple graft method. For breast of some size, the classic inverted-T pattern is done with the removal of all breast tissue leaving only the skin flaps to heal back down to the chest. The nipple is then put back as a free graft at the apex of the vertical incision. This will result in the anchor-style breast reduction scars. In smaller to moderate-sized breasts, the lower pole of the breast may be removed by a horizontal ellipse, the upper skin flap defatted and closed and the nipple graft placed where desired. This results in only a horizontal scar along the inframammary crease/fold. In very small breast mounds, liposuction may only be needed to create a nearly flat mound. This is the ideal way to do FTM breast reshaping because of the lack of scars but can only be used in a minority of patients.
I would need to see some photos of your chest to determine which method may be most applicable to you.
Dr. Barry Eppley Indianapolis, Indiana