Gender Affirming Surgeries
Gender-affirming surgery is any cosmetic or reconstructive surgery that helps a person feel more like their inner identity by altering their physical appearance with implants, facial contouring, or other procedures.
Dr. Fichadia provides gender-affirmation procedures in the form of top surgery, a customized procedure for chest contouring that is designed to help with gender dysphoria for transmasculine, transfeminine, and gender non-binary individuals. This procedure is performed for trans men and transmasculine nonbinary patients to alleviate gender dysphoria by shaping the chest to a masculine contour.
For transmen, this is called FTM top surgery or chest masculinization surgery. For transwomen, it’s known as MTF top surgery. FTM involves reducing and contouring the breasts by removing glandular and fat tissue, as well as excess skin, and positioning the nipples and muscle contours in a more masculine orientation. MTF surgery involves breast augmentation with or without fat grafting for a feminine chest contour. For gender non-binary individuals, the surgery depends on the goals of the patient.
Transgender men, women, and some nonbinary individuals are likely candidates for top surgery so long as they are generally healthy overall. Most patients should also have been living in a gender role that is congruent with their gender identity for at least a year.
Top surgery is often covered by health insurance. A letter of support from a mental health professional is recommended to follow the World Professional Association for Transgender Health (WPATH) guidelines. To confirm that you are a candidate, Dr. Fichadia will also review your health history and discuss your goals for the procedure.
There are several techniques that may be used to complete FTM top surgery.
The first option is liposuction. This is a preferred approach for patients who have very little glandular tissue but rather the chest is enlarged due to fat deposits. Liposuction involves making a small incision through which a cannula can be inserted. This cannula is then used to break apart fat and suction it away.
Patients with a moderate amount of tissue with suitable skin elasticity may also be candidates for keyhole, or circumareolar, top surgery. This procedure involves making an incision around the areola, through which excess tissue is removed and the chest is reshaped for a more masculine appearance.
Patients with larger chests are often best suited to double incision, inverted T, or buttonhole techniques. Double incision top surgery requires two U-shaped incisions across either side of the chest to remove excess tissue as well as around the nipple so it can be repositioned with free nipple grafts. Inverted T or buttonhole procedures require either a vertical incision between the nipple or a periareolar incision in addition to horizontal incisions below the breast tissue. These techniques help to preserve more nipple sensation, and inverted T techniques allow for more tissue to be removed as necessary.
Before your procedure, Dr. Fichadia will explain which technique is recommended for you and what you can expect.
The main techniques for chest feminization involve the use of breast implants. While feminizing hormones can stimulate breast growth, many transwomen desire breast implants for fuller, rounder breasts. The breast implants are placed over the muscle and under the breast tissue in most cases. Incisions are designed to be placed in the most inconspicuous locations for the most natural-looking results.
Sometimes, the use of a tissue expander is needed to slowly stretch the skin so it can accommodate a larger implant eventually. In certain cases, additional techniques such as fat grafting and the use of an internal mesh may need to be utilized.
For gender non-binary individuals, Dr. Fichadia will have a detailed discussion on their goals and vision for their post-operative chest shape and size. Various techniques combining breast reduction, breast lift, and mastectomies are utilized to achieve the final outcome.
Immediately after top surgery, you can expect some swelling and soreness. The first 1-2 days are usually the most uncomfortable, but you will be prescribed pain medication to mitigate your discomfort. A compression garment should be worn to reduce swelling and ensure proper healing, and drains will likely be in place, especially for FTM top surgery.
Swelling usually dissipates within about 2-3 weeks after procedures, at which point you will begin to see your results.
Most top surgery patients return to work, school, or other normal routines about a week after the procedure. Dr. Fichadia will monitor your healing and give you specific instructions for your recovery period during follow-up appointments.
Dr. Fichadia understands the mental and emotional toll gender dysphoria can have on people who are transgender in Portland, which is why she offers top surgery to give people the physical appearance they identify with on the inside. To learn more about top surgery and how it can help you achieve a result congruent with your gender identity, schedule an appointment with Dr. Hetal Fichadia. Call our Portland, OR office at (503) 488-2344 or contact us online to start the journey to your truest self.