What is involved in Male to Female (MTF) Top Surgery?

(Sex Reassignment Surgery (SRS) or Gender Confirmation Surgery (GCS) or Gender Affirmation Surgery (GAS))

Lili Elbe (1882—1931), was among the early recipients of sex reassignment surgery

Male to female (MTF) or male to nonbinary (MTN) top surgery, also known as augmentation mammoplasty, involves placement of implants under the breast tissue or injection of fat into the breast tissue. MTF or MTN top surgery in combination with facial feminization surgery (FFS) may be the only surgical steps in one’s transition.

There are two techniques that are used for placement of implants. One technique involves placing the implant under the muscle (sub-pectoral breast augmentation) and the other involved placement of the implant over the muscle and under the breast tissue (sub-glandular breast augmentation). The decision on where to place the implant depends not only on the breast tissue and chest wall dimensions, but also the patient’s desire. Our preference for cisgender women, is to place the implant under the muscle so long as the patient does not have an extensive muscle mass with strong pectoralis muscles (typically seen in body builders). This provides a more natural upper pole of the chest. Although rarely bothersome, strong pectoralis muscles in muscular individuals could cause what is called “animation deformity”, which happens when the pectoralis muscle is flexed. Placement of implants over the muscle creates a sharper transition from the upper pole of the breast and cleavage to the chest wall, creating a more “done” look, however it avoids the potential animation deformity. In transwomen patients, we pay extra attention to such details and discuss them extensively with patients in advance.

The breast implant options are either saline filled implants or silicone implants. Saline implants are less expensive than silicone implants, but silicone implants feel more natural. When insurance covers the procedure, we prefer to use the newer generation silicone implants which have a cohesive gel and are much more resilient to rupture or long term problems.

Special techniques are used in cases where patients have minimal breast tissue and strong pectoralis muscle to provide the best and most natural outcomes in MTF Top surgery.

We utilize 3 dimensional imaging to assess the chest and various types of breast implant sizes in order to achieve the best results with each individual patient. Our patients can look at these images during their consultation and select the implant size and type that they prefer as long as there is adequate tissue to support the implant. To see an example of a before and after result of a MTF surgery as well as a video of intraoperative details of the surgery, please visit www.amirlakplasticsurgery.com