Our chest masculinization Top Surgery surgeons in NYC and Los Angeles (LA) perform a unique FTM top surgery procedure “Genderplasty™”. Our practice has refined a special technique for top surgery which we refer to as a Genderplasty™ surgical procedure. A Genderplasty™, available only through our practice, involves three main components: (1) a bilateral chest masculinizing breast reduction which will leave a flat but not “scooped out” chest and does not require drains, (2) an intraoperative nerve block that eliminates the need for postoperative prescription pain medicine, and (3) cosmetic liposculpting for superior aesthetic results. 

Please note: To provide a more streamlined and convenient process, ALL consultations are scheduled virtually.

The main surgical component of Genderplasty is a bilateral chest masculinizing breast reduction. “Bilateral” means both breasts. “Chest masculinizing” means recontouring the chest to achieve a more masculine phenotype, but this terminology is unrelated to the patient’s gender identity (whether a patient identifies as masculine or non-binary). The term “breast reduction” is used instead of the term “mastectomy” to describe this aspect of the procedure. This is because a mastectomy is an operation in which the goal is to remove all breast tissue and is a term best suited for treating or preventing breast cancer. Top surgery is a different type of operation. It is a plastic surgery procedure for recontouring the chest, not a cancer operation. In our approach, leaving behind a small percentage of breast tissue can keep the subcutaneous tissue a bit thicker. This prevents a “scooped out” appearance to the chest, and can be useful for smoothing out contouring irregularities, and aids in mimicking the pectoral bulk associated with the male phenotype. This is what makes our Genderplasty™ technique different from how many other plastic surgeons approach top surgery. It should be noted that although the patient’s risk of breast cancer is dramatically reduced after top surgery, it does not become zero, and breast cancer screening may be necessary postoperatively. 

A variety of specific technical approaches are available, which leave different scar patterns. Your surgeon will explain which approach is best suited for you based on your individual anatomy. A majority of patients are candidates for the “double incision” technique. This approach is best suited for patients with larger breasts because of the extra skin that must be removed. The extra skin is cut out as an ellipse, the edges of which are then sewn together leaving a transverse scar along the lower border of the pectoralis muscle. The double incision technique generally involves using a free nipple-areola graft. However, some patients elect not to have grafting performed. A smaller number of patients are eligible for the “periareolar” technique. This approach is better suited for patients with smaller breasts where no extra skin needs to be removed. An incision is placed along the lower border of the areola (which makes this procedure virtually “scarless”).

Regardless of the technical approach used, there are no drains and all of the stitches are beneath the skin and do not need to be removed.

The second component of Genderplasty™ is a special technique performed during surgery called an intercostal nerve block, which places long-acting anesthetic medicine along the rib cage. This eliminates the need for postoperative prescription-strength medication. All that is needed will be Tylenol and ibuprofen (Advil or Alleve) allowing patients a quicker return to work and school.

The third component of the Genderplasty™ surgical procedure is cosmetic liposculpting. This involves using liposuction at the end of the procedure to enhance the aesthetics of the chest by smoothening contour irregularities, adding more definition, accentuating the “V” shape of the lateral male chest, and allowing better symmetry. Adding liposuction should be thought of like a sculptor using a fine chisel to finish the work. Although top surgery can be done without it, it is an extra tool to help enhance the result.

Regardless of the specific techniques used, the procedure is performed under general anesthesia and takes approximately three hours. Patients return home that same day. An elastic garment will be placed over the chest to provide snug compression, and it may need to be worn continuously for up to one month.

Bruising and swelling are normal, no matter which specific techniques are used, and may take a few weeks to resolve. The dressings and compression vest must stay on and remain dry for one week. Patients are permitted to walk and return to their activities of daily living immediately following surgery, however, strenuous exercise and heavy lifting and pulling should be avoided for two weeks. Patients typically return to work that doesn’t require manual labor in about a week. It takes about one to two months for patients to feel like they’re able to get back to their preoperative activity level.

Major complications and postoperative emergencies are uncommon. Our surgeons take a conservative and educated approach to top surgery and will discuss in detail all the risks, alternatives, and benefits prior to performing surgery.

Some health insurance plans will cover top surgery, however, cosmetic liposuction is never covered by health insurance plans.

All consultations and procedures are performed by plastic and reconstructive surgeons, Board Certified/Eligible by the American Board of Plastic Surgery. Our surgeons are graduates of renowned plastic surgery training programs including New York University, Brown University, Cleveland Clinic, Memorial Sloan Kettering Cancer Center, and MD Anderson Cancer Center. They specialize in breast reduction and breast lift surgery for cosmetic or medical reasons, as well as transgender and non-binary top surgery (chest masculinization and breast augmentation). Our surgeons are recognized for their expertise in the field and are honored to be included on the Super Doctors and Castle Connolly Top Doctors lists for the past nine years in a row.

Upper East Side Plastic Surgery Practice
800A 5th Ave
Suite 300A
New York, NY 10065
(212) 427-3982

Los Angeles Plastic Surgery Practice
435 N. Roxbury Dr.
Beverly Hills, CA 90210
(213) 319-2741