For many transmasculine individuals, chest dysphoria is among the most persistent barriers to feeling at home in their body. FTM top surgery removes breast tissue and reshapes the chest to create a flat, masculine contour — eliminating the need for binding and allowing you to move through the world with the chest you have always envisioned.
What Is FTM Top Surgery?
FTM top surgery, or subcutaneous mastectomy with chest contouring, is a gender-affirming procedure that removes breast tissue and excess skin to create a flat, masculine chest profile. The surgeon also repositions and resizes the nipple-areolar complex to match typical male chest anatomy. Technique selection depends on the amount of breast tissue, skin elasticity, and the patient's desired aesthetic outcome.
This is one of the most commonly requested gender-affirming surgeries worldwide and has been shown to significantly reduce chest dysphoria and improve quality of life. Most international guidelines recommend a referral letter from a mental health professional, and many patients undergo top surgery either before or independently of hormone therapy. An in-depth consultation covers your chest anatomy, goals, and which technique best suits your body.
Common Concerns FTM Top Surgery Can Address
- Persistent chest dysphoria affecting daily life
- Discomfort or health effects from chest binding
- Inability to exercise or swim freely without binding
- Desire for a chest that aligns with masculine identity
Are You a Good Candidate?
- You experience persistent, well-documented gender dysphoria related to your chest
- You are in good overall health and at a stable weight
- You have a referral letter from a qualified mental health professional
Techniques & Options
The right surgical technique depends on your chest size, skin quality, and aesthetic priorities. These factors are assessed during consultation to identify the approach that gives you the flattest, most natural-looking result with the least visible scarring for your anatomy. The two principal techniques for moderate to large chests are outlined below, each with distinct advantages.
Double Incision with Free Nipple Grafts
The most commonly performed top surgery technique for patients with moderate to large chests (typically C cup and above). Two horizontal incisions are made across the lower border of the pectoral muscles, allowing complete removal of breast tissue and excess skin. The nipples are removed, resized, and grafted into an anatomically masculine position on the chest wall. This approach provides the greatest control over final chest contour.
- Most effective for larger chest sizes with significant tissue and skin
- Allows precise nipple repositioning and resizing
- Produces a reliably flat, well-contoured masculine chest
Buttonhole Technique
A nipple-sparing variation of the double incision method. Instead of fully detaching the nipple as a free graft, the surgeon leaves it connected to a pedicle of tissue that maintains its blood supply and nerve connections. The nipple is then repositioned through a small opening in the skin flap. This technique preserves more sensation than free nipple grafts, though it is best suited to patients whose anatomy allows adequate nipple repositioning without full detachment.
- Preserves nipple blood supply and sensation in most cases
- Avoids the free graft healing process
- Suitable for patients whose nipple position requires moderate adjustment
Recovery Timeline
Days 1–3
A compression vest and surgical drains help manage fluid accumulation. Moderate soreness, tightness, and chest swelling are typical at this stage and kept in check with prescribed pain medication. Rest at your recovery accommodation with daily care coordinator check-ins. Light walking is encouraged.
Week 1–2
Drains are typically removed within the first week. Swelling and bruising begin to subside. You will attend a follow-up to check incision healing and, if applicable, nipple graft viability. Continue wearing the compression vest as directed. Light daily activities are manageable.
Weeks 3–4
Significant improvement in comfort and mobility. Most patients can resume desk work and gentle lower-body exercise. The compression vest is worn for four to six weeks total. Avoid lifting anything heavier than a few kilograms and all upper-body exercise during this period.
Months 2–6
Chest contour continues to refine as swelling fully resolves and scars mature. Upper-body exercise and full physical activity can restart after surgical clearance. Scars will fade from red to pink and eventually pale over 12–18 months with proper scar care.
What to Expect
Safety & Risks
FTM top surgery is a well-established procedure performed thousands of times each year by gender-affirming surgeons worldwide. Understanding the potential risks allows you to make a fully informed decision about your care.
- Haematoma or seroma (fluid collection requiring drainage)
- Partial or complete nipple graft loss (with free nipple graft technique)
- Changes in or loss of nipple sensation
- Hypertrophic or widened scarring
- Residual breast tissue or contour irregularities requiring revision
- Infection or delayed wound healing (uncommon)
Your individual risk profile is reviewed during consultation, taking into account your anatomy, chosen technique, and health history. Careful surgical planning, compression garment use, and post-operative follow-up significantly reduce the likelihood of complications.
How Much Does FTM Top Surgery Cost in Thailand?
Our pricing is transparent and all-inclusive — your quote covers everything from surgeon fees to hospital stay.
FTM Top Surgery
All-inclusive surgical package- Board-certified surgeon fee
- Anaesthesia & operating theatre
- Hospital stay & nursing care
- Post-operative medications
- Follow-up appointments
- Dedicated care coordinator
Common Questions About FTM Top Surgery
Everything you need to know before your procedure
Dr. Kanokwan Pattanaporn
MEDICALLY REVIEWEDDr. Kanokwan Pattanaporn
MEDICALLY REVIEWEDGender Affirmation Surgeon · Bangkok
Last reviewed: February 25, 2026
Medical References
- WPATH Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (2022)
- Bustos VP et al. Complications and Patient-Reported Outcomes in Transfemale Vaginoplasty and Transmasculine Top Surgery — Annals of Plastic Surgery (2021)
- McEvenue G et al. A Systematic Review of Surgical Outcomes in Transmasculine Top Surgery — Annals of Plastic Surgery (2017)
- van de Grift TC et al. Body Satisfaction and Physical Appearance in Gender Dysphoria — PLOS ONE (2016)
- Endocrine Society — Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons (2017)
Medical disclaimer: Content on this site is provided for informational purposes and should not be treated as medical advice. Outcomes, timelines, and eligibility differ from person to person. Speak with an experienced gender-affirming surgeon before proceeding with any procedure.
What's Included
- Board-certified surgeon fee
- Anaesthesia & operating theatre
- Hospital stay & nursing care
- Post-operative medications
- Follow-up appointments
- Dedicated care coordinator
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