Top surgery is a broad term used to describe different types of procedures for patients who experience gender dysphoria or gender incongruence and wish to either feminize their chest (e.g., breast augmentation or fat transfer) or masculinize their chest (e.g., mastectomy). Whether the transition is from male to female (MTF), female to male (FTM), or non-binary (N), the surgical technique is always individualized to meet your personal aesthetic goals. At the time of your consultation, Dr. Li will analyze your chest in detail and discuss the techniques which are best suited for you.
SURGERY UNDER GENERAL ANESTHETIC
GO HOME THE SAME DAY (DAY SURGERY)
RETURN TO NORMAL ACTIVITIES WITHIN 4 WEEKS
HIDE SCARS IN CAMOUFLAGED AREAS
ADD SIZE, SHAPE, AND FORM TO THE BREASTS
CREATE MORE FEMININE CURVES
BOOST YOUR SELF-ESTEEM
ACHIEVE GENDER CONGRUENCE
CHEST FEMINIZATION SURGERY (MTF):
Various techniques can be used to feminize the chest. Ultimately, the goal is to add tissue, projection, and shape to the chest. The technique that is best suited for you depends on your goals.
Often, patients who are already taking hormone therapy develop softening of their skin and some breast growth. This may lead to development of enough breast shape such that fat transfer or grafting is all that is desired. In this technique, fat is liposuctioned from different areas of your body, processed, and then injected into your chest. Dr. Li prefers to process his fat using the PureGraft® system to have the highest quality fat for injection. The higher the quality of the fat, the greater the likelihood of its survival. The technique of injecting the fat also influences the fat survival and Dr. Li has significant experience with fat transfer to the face, breasts, and buttocks. After the fat is injected, it eventually becomes a part of your chest, such that if you lose weight, the fat will get smaller, but on the other hand, if you gain weight, the fat will get larger. The liposuction performed to retrieve the fat can also help feminize the torso. Lastly, fat transfer or grafting can be combined with breast augmentation with saline or silicone implants to further improve results, e.g., it can be used to target certain areas like the upper half and medial half of the breasts to make it fuller. This is especially helpful in patients who are thinner as fat transfer can make results appear more natural and minimize visibility or palpability of implants.
The limitations of fat transfer or grafting are that you may not always have enough fat to liposuction, and there is a limit to which fat can increase the size and projection of your breasts. This limit is determined by the current volume of your tissues and the tightness of your skin, and generally you can expect the breasts to increase 1 cup size with each surgery. Notably, the skin can sometimes be tighter and stiffer in patients hoping to have MTF top surgery. If larger increases in volume and projection are desired, breast augmentation with saline or silicone implants may be a better option.
The techniques used to place breast implants for transgender patients are the same as those used for cisgender patients, with several nuances to consider. Different incisions can be used to access the chest tissues, including transaxillary, peri-areolar, or inframammary incisions, through which either subglandular/prepectoral or submuscular/subpectoral pockets are created for the implants. Both saline and silicone implants can be placed, although Dr. Li prefers the latter because they are lighter for the same volume and have a more natural feel. To read more about breast augmentation, click this link (https://www.caaesthetics.com/contents/for-her/breast-surgery/breast-augmentation1).
As aforementioned, patients hoping to have MTF top surgery can sometimes have stiffer and tighter skin, and so there may be greater benefit in placing implants in a subglandular/prepectoral pocket to allow maximum stretch and shaping of the skin by the implants. It may also be helpful to use higher profile implant styles as well as more filled implants such as the newer Mentor Xtra or Boost implants to help shape the breasts. If the skin is very tight, it may be necessary to progressively create larger breasts through multiple or staged procedures with gradually larger implants or use special implants called tissue expanders to stretch the skin in a controlled fashion over time.
WHAT TO EXPECT BEFORE SURGERY
You will be evaluated by Dr. Li at the time of your initial consultation to determine if Breast Augmentation Surgery is the best option for you
You will be required to quit smoking and oral contraceptives 4 weeks before surgery
You will need to complete testing before surgery, which may include a physical with your PCP/primary physician, blood work, and an ECG
Prescriptions for your surgery will be sent to your local pharmacy, please obtain these medications ahead of time and bring them to your surgery
A deposit is required to secure your surgery date
Full payment is required 2 weeks before surgery; payment options include cash, cashier's check, or credit through Alphaeon or CareCredit
WHAT TO EXPECT AFTER SURGERY
General anesthesia can sometimes cause generalized body soreness and fatigue for a couple of days
Maximum discomfort will occur in the first few days after surgery and gradually improve
You will not allowed to lift more than 10lbs for 4 weeks as a safety precaution
You will be provided a bra and compression garment to wear; it is recommended that you wear this for 6 weeks to help shape your breasts and minimize swelling
You may experience temporary bruising, swelling, numbness, or a burning sensation involving your breasts and over areas you had liposuction; bruising and swelling takes several weeks to improve; numbness takes a couple months to normalize
Scars may be red and firm for approximately 6 months before they soften and fade