FTM Top Surgery by Melissa Johnson MD, FACS
FTM Top Surgery
Chest Wall Reconstruction (F to M)
Chest wall reconstruction surgery, also referred to as bilateral mastectomies for gender reassignment or FTM top surgery, is a procedure to remove excess fat, glandular tissue and/or skin from the patient's breasts. In severe cases of enlarged breasts, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple.) In these cases, the position and size of the areola can be surgically improved and excess skin may need to be removed. There are a variety of surgical techniques for FTM chest wall reconstruction. The technique, along with the surgical approach, will depend on your preferences, your anatomy, and your surgeon´s recommendation. The two main procedures that Dr. Johnson performs are Double Incision and Keyhole. The goal is to shape the female breast to male. Prior to scheduling your surgery, we require a letter from your therapist documenting how long you have been in therapy. A minimum of 3 months of therapy is required. See our female to male (FTM) top surgery photos & FAQs.
Double incision procedure
Patients who have large breasts or who have an excess amount of loose breast skin will be recommended to have this technique. The breast is removed with an incision along the breast fold and the nipple/areolar complex is replaced as a graft. This technique does leave a scar across the chest wall. A drain is placed on each side and removed about a week later.
Good candidates for this procedure must have small breasts without a significant amount of loose breast skin. The breast is removed with an incision around the nipple/areolar complex. A drain is placed on each side and removed about a week later.
New Consultation Checklist
In order to schedule a consultation, you will need the following:
- If you plan to pay for the surgery, you can call us at (413) 731-7877 and schedule the consultation. You are required to pay the $100 consultation fee over the phone when you schedule the appointment. The fee will be applied to the overall surgery cost.
- If you want to use your insurance for coverage you will need to do the following:
- Provide us with a letter of support from your mental health provider. The letter must state how long you have been in therapy, the diagnosis of gender dysphoria, the duration of time you have been living full-time as the desired gender and the therapist's opinion regarding your readiness for surgery. The letter must be signed by the care provider.
- Fax or email the letter(s) to our office (fax # 413-731-7870) or email to firstname.lastname@example.org. Include your phone number so we can contact you with your appointment.
- This is NOT a requirement to schedule a consultation, but it is helpful if you contact your insurance company to ensure that Dr. Melissa Johnson is contracted with your insurance. It is also helpful to verify that your policy covers Gender Reassignment Surgery.
- Once we have received the documentation, we will call you to schedule your consultation. If you have not received a phone call from us after 3 days, please check in with us to make sure we have received everything.
*Note: In addition, some insurance companies require referrals. If your insurance does, please contact your primary care doctor for the referral and ask them to fax it to us. The appointment cannot be scheduled without the referral.
We Love Questions!
FTM Top Surgery FAQs
How should I prepare for my FTM top surgery consultation?
If you have friends or family who have had breast reconstruction, ask them about their experience. Researching Transmasculine Top Surgery surgery on reputable internet sites such as the American Society of Plastic Surgeons can provide an informative overview. The best information for your personal case, however, will be obtained by making an appointment and speaking with your surgeon. It may also be helpful to view before and after photos of patients that have had the procedure. It's best to view photos of patients with a similar body type as yours. Remember to write down any questions or concerns you have so they can be addressed at your consultation. Know what your surgical expectations are so your surgeon can discuss them with you. If you are a smoker we recommend you quit to help reduce the risk of wound healing. We also recommend a healthy lifestyle to help your recovery process.
Will I be seen by the surgeon?
Yes. Dr. Johnson will meet with you and she will discuss all your surgical options. You may also see a Physician Assistant first. Together they will provide you with the necessary information so that you feel confident and comfortable with your surgical decision.
Will I be charged for an initial consultation?
Yes. There is a $100 cosmetic consultation fee for your initial visit. If you choose to have surgery with Dr. Johnson the $100 consultation fee will go towards your surgery cost.
Is the plastic surgeon board certified?
Yes. Dr. Johnson is board certified by the American Board of Plastic Surgery, is a fellow of the American College of Surgeons, and is a proud member of the American Society of Plastic Surgeons. Additionally, she is a member of the American Society for Aesthetic Plastic Surgery, which recognizes surgeons who specialize in cosmetic plastic surgery.
Are there different types of FTM chest wall surgery procedures?
Yes. The two techniques used for F to M chest wall reconstruction are the double incision and keyhole, or periareolar, techniques. The type or procedure performed is chosen on a patient-by-patient basis. Your breast size and amount of loose skin determine which procedure is recommended.
Where will my FTM top surgery incision be?
The incision for the double incision approach is at the breast fold along the length of the breast. The nipple/areolar complex is grafted back on. The incision for the keyhole approach is periareolar which means around the nipple/areolar complex. We place a drain on each side and place you in a binder for compression.
What is the FTM top surgery surgical process?
The surgery is performed at a hospital. During surgery you will receive general anesthesia. The surgery will take between 1-2 hours. Once you are awake you are taken to the recovery room for another 1-2 hours. Our recommendation is that you spend one night in the hospital.
Where will my FTM surgery be performed?
Dr. Johnson has privileges at Baystate Medical Center and Mercy Medical Center. Both are accredited by the Joint Commission and have been awarded the Gold Seal of Approval, and both are conveniently located in Springfield, MA.
What is the FTM top surgery recovery process?
The first few days you may feel soreness or pain. You will notice that the pain decreases with each passing day. You are sent home on pain medications which will decrease your discomfort. We will recommend that you wear the binder to provide compression and help minimize swelling. We will see you one week after surgery to evaluate your healing process and remove the drains. We request that you do no heavy lifting for at least one month following surgery.
How much does FTM surgery cost?
The cost is approximately $8300, which includes the surgeon's fee, hospital fee, anesthesia, and the overnight stay. The pathology fee, approximately $150-200, is not included and you will be billed by the hospital after surgery.
Can I finance my FTM top surgery?
What forms of payment are accepted?
We accept all major credit cards, debit cards, cash, money orders, and certified bank checks, or you can finance through CareCredit.
Can I make payments online?
Yes. You can make credit card payments securely online.
Do you accept insurance for FTM surgery?
Yes, we accept many different insurances. You can contact your insurance and ask if Melissa Johnson, MD is listed as a contracted provider.
Which codes can I provide to my insurance carrier for FTM top surgery?
To find out if your insurance covers the surgery, provide them with the following codes: CPT Code (procedure code): 19318-50 (reduction mammoplasty) and diagnosis code: F64.1 (gender dysphoria).
Can I have FTM top surgery without ever seeing a therapist?
No. Dr. Johnson requires a letter prior to performing your surgery. For self-paying patients the requirement is at least 3 months of therapy. For insurance patients, the therapy requirements vary. Please check the medical policy for your insurance.
What does the therapist letter need to state for FTM top surgery?
The letter must be from a licensed social worker, psychiatrist, or psychologist. It must state how long you have been in therapy, the diagnosis of gender dysphoria, the duration of time you have been living full-time as the desired gender, and the therapist's opinion regarding your readiness for this next important step in this process. The letter must be signed by the therapist.
Is hormone therapy a requirement for FTM top surgery?
Dr. Johnson does not require you to have hormone therapy. However, some insurances do require a minimum of 12 months. You will need to review the medical criteria for your insurance policy.
What are the age requirements for FTM top surgery?
For insurance patients, most insurance companies require that you be at least 18 years of age. For self-paying patients, Dr. Johnson will determine if you are a good candidate, regardless of age, at the time of your consultation.
Can I get a letter from Dr. Johnson after my FTM top surgery to change my birth certificate?
Yes, we will be happy to provide a notarized letter upon request after your surgery. Please contact our office.