What Does Transgender Top Surgery Involve?

When an individual identifies with a different gender, to the gender they have been born with, this is referred to as gender dysmorphia.  The majority of transgender individuals will begin their journey to change to the gender they identify with by having counselling and hormone therapy. The hormone therapy will help to either feminise or masculinise the anatomy and facial features of the transgender individual. Male to female transgender individuals (MTF) identify as female and female to male transgender individuals (FTM) identify as male. When hormone therapy has not resulted in the change desired transgender individuals may choose to have surgical procedures to change their anatomy. 

MTF and FTM Top Surgery

Top surgery is sought after by MTF and FTM individuals who want to physically look more like the gender they identify with. MTF top surgery is a breast augmentation procedure. This is normally performed with breast implants, although fat transfer, also called autologous fat grafting, is opted for by individuals who do not want to have breast implants. 

FTM top surgery is also referred to as transgender mastectomy or just double mastectomy and involves the removal of breast tissue and excess skin to create a flat, masculine looking, chest. Top surgery should always be performed by a plastic surgeon or a surgeon that has a history of special training and experience performing top surgery for transgender individuals. 

Scars From Transgender Top Surgery

As with all surgery, scars are inevitable.  Taking care of yourself and your incision scars by wearing compression garments has been shown to help reduce swelling and reduce the appearance of scars. Scar treatments can also help to significantly improve the appearance of scars by supporting the healing process. There are various scar treatments on the market including topical silicone gels and silicone gel sheets. 

Following scientific research into the best ways to support the healing process, CicaLux Energized Scar-Care is different as it uses a combination scar therapy device. The device consists of the CicaLux silicone sheet over which a disposable CicaLux tape is applied, the combination ensures the scar stays moist and also helps to limit tension as the scar heals. Additionally, the tape adds helpful pressure on the scar tissue.  The CicaLux Energized Scar-Care combination scar therapy device also comes with a unique CicaLux stone that can be placed into the silicone sheet and increases the blood flow by providing infrared heat. Massaging the scar with the CicaLux stone has also been shown to improve the final appearance of the scar. This combination therapy when used as instructed should help to make the scar tissue softer resulting in  a flatter, thinner, paler, less noticeable scar, once healed.

FTM Transgender Mastectomy

Double incision top surgery – This method is often recommended to individuals with larger breasts, typically cup size C and above. When the breasts are a certain size this will mean more limited choices and the surgery recommended is likely to be a bilateral mastectomy, with nipple grafts. This involves 2 incisions that can be either curved or straight and are positioned above and below the pectoral muscle.  Nipples are removed and repositioned once adequate breast tissue has been excised. This procedure often causes a reduced nipple sensation and has a higher risk factor as nipples may not survive the graft and the risk of infection is also greater. This procedure can also be performed without repositioning the nipples if desired.

Inverted-T top surgery – This is another option recommended to individuals with a significant amount of breast tissue and excess skin, who are concerned about losing nipple sensation. As with double incision top surgery 2 incisions are positioned above and below the pectoral muscle. Another incision is made around the edge of the areola and a fourth incision is made vertically between the bottom of the areola and the lower scar below the pectoral muscle.  The areola can be reduced if desired and due to the nipples not being removed, sensation is normally maintained.

Periareolar top surgery – This incision option is normally offered to individuals that are smaller busted, typically cup size A and B with high skin elasticity. The first incision is positioned around the outer edge of the areola, the second incision is positioned in a bigger circle a little further out.  Breast tissue is then removed and the skin between the areola and the second circle is excised. The skin is restitched to the edge of the areola which can also be reduced if desired. Once healed the scar should be difficult to detect and nipple sensation should not be affected.

Keyhole top surgery – This method is only suitable for individuals with very little breast tissue and high skin elasticity. Only one incision is made in a semi-circle around the bottom of the areola. Liposuction is used to remove excess breast tissue and a semi-circle of skin might be excised before the edge of the areola is restitched to the skin. This method is also referred to as scarless top surgery as the scar once healed will be difficult to detect and nipple sensation should remain the same. The optimum result of all FTM top surgery should be a nicely contoured masculine chest with nipples that sit in a pleasing position.

MTF Transgender Breast Augmentation with Breast Implants

Transgender women more than often desire breasts, hormone therapy can help small breasts to grow, however most transgender women are not happy with their overall size and shape. To achieve a fuller bust and more cleavage, breast implants can be used to augment the breasts that have developed. Breast implants can also be placed in transgender women who have decided against having hormone therapy, although the results may look less natural. Another option is to have tissue expanders which can be gradually filled with saline to increase their size and either sealed once the size desired is achieved and left in place or replaced with a second procedure with silicone breast implants. When breast implants are not wanted it may be possible to enhance breast size and improve shape with fat transfer also known as autologous fat grafting or autologous fat breast augmentation.

Breast Implant Placement Options

Submuscular placement – Many surgeons prefer to use this placement option due to the extra layer of cover the pectoral muscle provides over the breast implant. This placement option is also associated with lower rates of capsular contracture (excessive thickening and tightening of the scar tissue capsule that forms around the breast implant).

Dual Plane placement – This option is also used when there is sufficient breast tissue to cover the lower pole (portion) of the implant. As only the top section of breast implant is covered by the pectoral muscle the breast shape will appear more natural and the breast implants will have more movement and the breasts may also feel softer.

Sub glandular placement – This method of placement is only possible when there is sufficient breast tissue to cover all of the implant. When this is the case this placement is less painful and often considered to provide the most natural breast shape, unless this is not desired. The breasts may also feel softer, than with the submuscular and dual placement options.

Breast Incision Options

Inframammary (natural crease) incision – A curved incision is made in the inframammary crease. This option makes all placement options easier as it provides greatest access and is often preferred by surgeons due to lower rates of infection and capsular contraction.

Periareolar (nipple) incision – This option may be offered if the breast shape that has developed following hormone therapy is generally acceptable. An incision is made in the lower outer edge of the peri-areolar  and the implant is put through the gap.

Transauxillary (underarm) incision – This is the least preferred option due to higher infection rates and limited access. Breasts that have developed following hormone therapy need to be a reasonable size and shape to enable a pleasing result.

Breast Implant Options

Breast implants come in a puzzling choices of different shapes, volumes and profiles, as well as different filling options. Your surgeon should be able to recommend the shape, cc volume and profile of breast implants that will give you the result you desire. 

Both silicone filled and saline filled breast implants have an outer silicone shell and come in both anatomical and non-anatomical shapes, with profiles from low to extra high (extra, extra high may also be available depending on the manufacturer). As a general rule low and medium profile, non-anatomical implants will provide a more natural breast shape as they will produce less volume in the upper pole (upper part) of the breast and tend to look less round in shape. High profile non-anatomical breast implants tend to provide a fuller, rounder breast shape. Extra high profile implants will almost certainly provide a full, round breast shape. Anatomical implants are shaped to create a more natural breast shape and the profile is normally chosen based on individual anatomy and the cc volume desired. 

Scar Treatments

Regardless of the procedure, scars may be a concern. Ensuring you follow all post-operative instructions and use scar treatments (as soon as your surgeon advises it is safe to do so) is important to help support healing and prevent the formation of a Keloid (darker, thicker and wider scars) or Hypertrophic (raised) scar.  Per numerous scientific studies to better understand how to support the healing process,  the medical community agrees  that there is not one single therapy approach but rather a combination  scar therapies is best to improve the final appearance of a scar. CicaLux Energized Scar-Care is a combination scar therapy device inspired by this research and unmet need. 

Risks and Complications

Take your time to find your surgeon and remember there are serious risks and complications associated with all surgery. Prior to having top surgery, you should seek specialist counselling and support. The benefits of top surgery have been well researched and the majority of transgender individuals do not regret having gender confirmation procedures. 

Check your plastic surgeon is qualified and registered with one of the worldwide professional bodies.

About the author:
Annabelle has had 3 breast augmentation procedures to achieve the size and shape she wanted and went from a 32A cup to a 32F cup. She has also had 3 rhinoplasty procedures and abdominal liposculpture and writes regular blog posts about advancements in plastic surgery. Her mission is to make it safer to find a qualified plastic surgeon online. Her cosmetic surgery website features a consultant register and the qualifications of every consultant listed are checked on a rolling 3 month basis. 
This sponsored article provides general information and discussions about health and related subjects. The information and other content provided in this article, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical.


For before and after Top Surgery scar results – click here!

Scar treatments and the process of wound healing following plastic surgery

Plastic surgery, otherwise referred to as cosmetic surgery, is growing in popularity. Numerous plastic surgery procedures are now safer, with more reliable results and higher patient satisfaction rates. The media have highlighted the role social media has played in the rise of plastic surgery and research has also shown that the popularity of selfies, has made many individuals more self-conscious of how they look in photos. In addition, since the start of the coronavirus pandemic there has been a significant increase in the need for video calls and online webinars, which has been suggested as one of the reasons the demand for plastic surgery continues to increase, despite the ongoing pandemic. 

Worldwide, including the UK, USA and Australia, any registered surgeon can perform plastic surgery. Normally referred to as cosmetic surgeons, with the exception of surgeons that focus solely on ear, nose and throat (ENT) surgery and oncoplastic breast surgeons, the skill of surgeons that have not completed specialist plastic surgery qualifications is questionable. With regards to any type of plastic surgery procedure I would always recommend checking that your surgeon is registered with a recognised medical body as a plastic surgeon, proving they have completed specialist plastic surgery training and assessment. 

Check worldwide professional bodies for plastic surgeons.

One of the main considerations for plastic surgeons is where the incisions are placed. All surgical incisions will leave a scar and ensuring they are located where they will be naturally hidden and are as fine, flat and close to the nearby skin colour, as possible, is the goal of all surgeons. There are various treatments and products that claim to help support the healing process and improve the final appearance of the scar when used after the stitches have been removed. The processes that occur during wound healing are commonly separated into three stages, known as, inflammation, proliferation, and remodelling. 

Supporting wound healing for a better scar

The most important factor that can negatively impact wound healing is prevention of an infection. Keeping the wound clean, and changing the dressings when they become saturated, is essential to keep out bacteria which could lead to an infection. Scar treatments should not be used until the stitches have dissolved or been removed, as advised by your surgeon. The application of scar treatments during the remodelling phase combined with the correct massaging techniques has been shown to decrease scar formation and improve the final scar.

Numerous external factors can affect the healing process and the resulting scar. These include, but are not limited to, health conditions such as diabetes, medications, alcohol dependence and smoking prior to the procedure. In addition, good nutrition and taking supplements have been linked to faster healing and less noticeable scars. For the purpose of investigating scar treatments, I will only be referring to healthy, non-smoking patients, without alcohol dependency.

Precise techniques during the creation of and the sealing of the incision, are essential to reduce skin tension which can cause raised, wide, uneven scar formation or even contribute to the development of keloid scars. Regardless of how skilled your surgeon is, the way you care for the skin as it heals is important. 

‘Studies have shown that maintaining hydration and allowing healing to occur in a moist environment can be beneficial for healing and reducing scar formation.’ 1

Among the various choices of scar treatments, many plastic surgeons now consider silicone gel sheets the ‘gold standard’. This article investigates if a combination approach could be equal or superior to the benefits provided by silicone gel sheets alone; when applied to a post-operative scar following the removal or re-absorption of dissolvable stitches. 

Scar treatments for a better scar

One combination that has been shown to help reduce the formation of wide, irregular, raised and discoloured scars is the use of micropore tape and silicone gel scar treatments. The micropore tape helps to reduce tension on the scar for the first three to six weeks and is followed by the use of silicone gel sheets for twelve hours a day, for up to six months. This combination is the standard scar treatment regime recommended by numerous surgeons. Gentle scar massage with petroleum jelly is also advised to aid the formation of a supple, softer, flatter and finer less noticeable scar. This is often recommended in between application of silicone gel sheets for twelve hours a day. 

Research into the effect of onion extract contained in a product called Contractubex® has demonstrated improvements with the final healing and look of the scar. Another new topical silicone based gel called PracSil, which contains pracaxi oil, has also been shown to aid healing and the final appearance of the scar. However, evidence is still not clear into whether this added ingredient has an active effect on scar formation or if the improvements are due to the moisture provided by the application of the silicone gel.

Another relatively new product is CicaLux Energized Scar-Care – a combination therapy device that provides moisture, pressure and heat to the scar tissue.  This scar treatment comprises a CicaLux silicone sheet, CicaLux Tapes and a CicaLux stone. The silicone sheet works in the same way as other medical grade silicone gel sheet scar treatments, by reducing transdermal loss of water, decreasing itching and scar discolouration. 

When the disposable CicaLux tape is applied over the CicaLux silicone sheet, the combination helps to reduce tension on the scar while also applying pressure to the scar tissue. In addition, the breathable cotton tape prevents the build-up of excess moisture, which can negatively impede scar healing. The CicaLux stone pops into the silicone sheet and is used to deliver infrared heat that increases blood flow, key to the healing process. The CicaLux stone can also be used separately to massage the scar, helping to further flatten and soften the scar tissue, leading to a finer scar that is more difficult to detect. 

In conclusion,  the use of combination therapy is highly recommended for improved scar outcomes, and the benefits provided by the CicaLux combination therapy device certainly show promising results. In addition to scar therapy product use, avoiding sun exposure on the scar for the first eighteen months is vital to reduce the chance of the scar becoming thicker and discoloured.


1. Traci A. Wilgus, Inflammation as an orchestrator of cutaneous scar formation: a review of the literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592345/
About the author:
Annabelle Bough has had numerous plastic surgery procedures including breast augmentation, rhinoplasty and liposculpture and writes regular blog posts about advancements in plastic surgery. She wants to make it safer to find a qualified plastic surgeon online. Her website features a consultant register and she checks the qualifications of every consultant on a rolling 3 month basis. 
Resources: Update on Postsurgical Scar Management
Sarah Jane Commander, Edward Chamata, Joshua Cox, Ryan M. Dickey, Edward I. Lee
Semin Plast Surg. 2016 Aug; 30(3): 122–128. doi: 10.1055/s-0036-1584824
Plast Aesthet Res. 2020; 7: 54.
Published online 2020 Oct 16. doi: 10.20517/2347-9264.2020.150
A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring
G. P. Sidgwick, D. McGeorge, A. Bayat
Arch Dermatol Res. 2015; 307(6): 461–477. Published online 2015 Jun 5. doi: 10.1007/s00403-015-1572-0
Disclaimer: This sponsored article provides general information and discussions about health and related subjects. The information and other content provided in this article, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment.