Kryger Institute of Plastic Surgery in Thousand Oaks, Ca Kryger Institute on Facebook Kryger Institute on Twitter Kryger Institute on YouTube

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Female to Male "Top" Surgery

At the Kryger Institute of Plastic Surgery, we specialize in treatment of the FTM breast. We have a large amount of experience in treating various breast shapes and sizes. We focus on procedures that minimize scarring and preserve sensitivity of the nipple.



FTM before and after

before & after photos

Female to Male Transitions

At the Kryger Institute of Plastic Surgery, we have experience in a vast array of surgical and non-surgical procedures. Click below to see some before and after photos of female to male "top" surgeries.

more top surgery photos

Who is a good candidate for female to male transition?

Any man who is otherwise in good health may be a candidate for surgery. We have treated FTMs as young as 13 and as old as 60. Smokers are at higher risk for complications, and every effort should be made to quit smoking prior to surgery. Diabetics are also at an increased risk for postoperative infections, and perfect blood sugar control before and after surgery is essential. Patients need not stop taking testosterone prior to surgery.

Planning your FTM surgery

In your initial consultation, your surgeon will begin by evaluating your health. Be sure to tell your surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs. Be sure to tell your surgeon how your chest has changed over time-both in terms of size and shape. Discuss any family history of breast cancer. The surgeon will then explain which surgical technique is most appropriate for you, based on the size and shape of your breasts. The surgeons at the Kryger Institute offer all types of male breast reduction, including minimal incision techniques.

Does insurance cover FTM top surgery?

In rare instances, insurance companies will cover transgender related surgery, however this is done on a case by case basis. The Kryger Institute will do everything possible to work with your insurance carrier to obtain approval for your procedure. If the insurance company denies coverage for your surgery, the cost of surgery will be your responsibility. Make sure to speak to our patient care coordinator about these issues ahead of time.

Preparing for surgery

You will be told which medications to stop and which to take before surgery. Aspirin must be stopped for 7 days before surgery but motrin and ibuprofen can be taken up to the day of surgery. Testosterone need not be stopped before surgery. If you smoke, you must quit smoking entirely for 6 weeks before and 6 weeks after surgery. You must strictly follow the instructions about when to start fasting before surgery (usually at midnight). If you get sick or have any health issues in the days before surgery, please notify the office at once in case we have to postpone your operation.

The surgery and the incisions

The surgery usually takes 2-3 hours to complete. The type of incision you end up with is determined by how large and droopy (ptotic) your breasts are. Your surgeon will mark your chest before surgery and go over the incisions with you one final time. Men with no excess skin and only enlarged nipple-areola regions may be candidates for removal of breast tissue alone through a small hidden incision along the border of the areola. Medium sized breasts may require a two stage approach in order to minimize scarring and preserve the nipple. Very large  breasts will require an incision around the entire circumference of the areola and a second horizontal incision below the breast. This procedure also involves grafting the nipples back onto the chest.

The anesthesia

FTM top surgery is often performed under general anesthesia. it can also be performed under "twilight" anesthesia for very small reductions. Twilight anesthesia consists of intravenous sedation and pain medication that keeps you relaxed and sleepy during the surgery. In addition, the surgeon uses local anesthesia to numb the abdomen. General anesthesia involves going completely to sleep with a breathing tube in your throat. There is a slightly higher risk of nausea and vomiting after general anesthesia, however both techniques are extremely safe. Your surgeon will discuss the anesthetic options with you before surgery.

What kind of dressings and drains are there?

Your chest will be wrapped with an ACE wrap over gauze. You can remove the gauze dressings the day after surgery. If there is tape or adhesive strips directly on your incision, do not remove these. If they fall off in the shower there is no need for concern.

Top  surgery usually involves the use of drains. This will be determined by your surgeon at the time of surgery. These drains help drain the fluid that is produced under your skin as part of the healing process. Without drains, this fluid can accumulate, termed a seroma. Drains stay in until the drainage is less than 25 ml per drain in a twenty four hour period. This usually takes 7-10 days, but can be shorter or longer in some cases. The drains are easy to take care of, and do not hurt to take out.

Can you go home the day of surgery?

FTM top surgery is routinely performed as an outpatient, and all patients will be able to go home the same day. Some patients may prefer to spend a night in an aftercare facility if they have young children at home or live alone and do not have any help at home.

How much pain is there after surgery?

Pain from this type of surgery is highly variable, and ranges from minimal to moderate. It is worst in the first few days after surgery, but then it rapidly improves. It is impossible to predict a person's expected pain. If you have done well with surgery in the past, you will likely be fine after this surgery. Our surgeons have a lot of experience treating pain, and have published scientific articles and written book chapters about anesthetics and pain control. They will do everything possible to minimize your pain, including using pain pumps after surgery and utilizing all the newest pain medication. By the end of the first week, most people's pain is controlled with plain Tylenol or Motrin.

What about swelling and bruising?

Swelling and bruising are normal signs of the healing process. They occur after any surgery to varying degrees. Swelling peaks at about 48 hours, and then rapidly decreases. By the end of the first few weeks, 50 percent of the swelling is gone. During this early period, your breasts will appear larger than their final size due to the swelling. By 6-8 weeks, a majority of the swelling has diminished. By six months, all the swelling is gone. Bruising is worst the day after surgery and then rapidly gets better. It is usually gone by two weeks. You may also experience a burning sensation in your nipples for up to two weeks, but this will subside as bruising fades.

What restrictions are there?

You can usually shower the day after surgery, but you should not bathe, use a hot-tub, or go swimming for at least two weeks. The first two days after surgery are usually spent doing minimal activity. Most patients then begin to get back to their regular routine. Within 3-5 days, you will probably be ready to leave the house for short trips and light walks. More vigorous walking and mild stretching exercises can be resumed about a week after surgery. Strenuous activities such jogging, aerobics, weight-training should not be done until 3-4 weeks after surgery. Also, you shouldn't do any heavy lifting (over 10 pounds) during this period. A good guide before beginning activities that involve direct contact to the breasts is to wait until pain and sensitivity in the breasts has resolved.

When can I go back to work?

This, of course, depends on the kind of work you do. Most people go back to work after one week. Sedentary jobs, such as computer work or talking on the phone can begin even sooner. If you have a strenuous job that involves a lot of lifting or physical activity, you may have to wait 2 weeks until you are ready for work. Please review the restrictions for further guidelines about getting back to work.

What kind of scars can I expect?

Scarring is an unpredictable part of any surgery. It is impossible to cut through the full thickness of the skin and not have a scar. For most patients, the incisions from FTM top surgery heal well and do not become bothersome scars. Our surgeons have published numerous scientific papers about the scarring process and wound healing, and will do everything possible to minimize scarring. To a large extent, however, scarring is determined by your genetics. If you are prone to hypertrophic (wide, raised) scars or keloids, make sure to inform your surgeon ahead of time. Our surgeons will use all the available techniques to minimize your scars based on their extensive research experience on hypertrophic scarring.

Your scars will be firm and pink for at least six weeks. After six weeks, scars are very strong and can withstand any activity. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely. It takes 1-2 years for a scar to completely heal. Make sure to apply sunscreen containing zinc-oxide to your scars for six months so that they do not darken due to increased pigmentation.

What if I have a problem? When should I call the office?

The Kryger Institute welcomes calls from patients. If you have any concerns at any time, please feel free to call our office. If it is an emergency, the doctors are available 24 hours a day, including weekends and holidays. There is always a plastic surgeon on call. Your surgeon will discuss all the risks and potential complications with you before surgery. You will receive detailed instructions about situations that warrant a call to the office.

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Kryger Institute of Plastic Surgery
Cosmetic and Reconstructive Plastic Surgery of the Face, Breast, Body and Hand.
947 E. Thousand Oaks Blvd.
Thousand Oaks, CA 91360
805-777-3877

Board-certified plastic surgeons, Dr. Gil Kryger and Dr. Zol Kryger provide concierge-level plastic and cosmetic surgery of the face, breast, and body at their Thousand Oaks Institute. They also perform numerous non-surgical procedures such as fillers and Botox®. The Institute serves residents of Westlake Village, Agoura Hills, Newbury Park, Simi Valley, Calabasas, Moorpark, Camarillo, Oxnard, Ventura, Malibu, West Hills, Woodland Hills, and surrounding Southern California communities.

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