Gender Confirming Surgery Performed by
Boston Plastic Surgeon Dr. Richard Bartlett

Gender Confirming Surgery

Dr. Bartlett performs gender confirming top surgery for both female to male and male to female transgender patients. Our patients come from the greater Boston area as well as other parts of the United States and overseas. In general Dr. Bartlett uses the WPATH guidelines to screen patients regarding their suitability for surgery. Dr. Bartlett’s staff takes pride in their knowledge and sensitivity to transgender individuals and makes every effort to make the process as straightforward as possible.

FTM Top Surgery

There are two basic operations in FTM top surgery. For individuals with smaller breasts and good skin elasticity a “keyhole” approach can be used. This involves making an incision at the junction of the areola and the lighter surrounding skin. Through this small incision the underlying breast tissue is removed. Some patients also require a periareolar mastopexy, (incision all the way around the areola), in order to decrease the size of the areola. The advantage of the keyhole technique is the inconspicuous scar.

For patients with larger breasts, or loose or lax skin a “double incision” technique is used. Both breast are removed with formal mastectomies, leaving scars along the border of the pectoralis, (chest), and muscle. The nipples are removed, resized to a male dimension and reapplied as “free nipple grafts”. Although scars from double incision are more visible the technique is highly effective at producing a male contour with minimal chance of needing any significant secondary operations.

For individuals who are unsure of which technique would be best for them, a consultation with Dr. Bartlett will include counseling to determine the best procedure for you.

MTF Top Surgery

Most MTF patients are candidates for breast enhancement surgery with breast implants. Hormone therapy can result in considerable breast development but often an implant is needed to achieve a more feminine figure. Many patients can have a breast augmentation with no significant preparation but individuals with tighter skin who desire larger implants may need tissue expansion. This technique expands the chest skin by placing expandable temporary implants under the skin and muscle on the chest. The expanders are gradually inflated over a period of months by weekly injections. After adequate expansion of the skin, the expanders are removed and permanent implants are placed.

Top Surgery: What to expect

  • Surgical Setting –top surgery is performed on an outpatient basis. You go home the day of surgery and do not stay overnight. Regional out of state patients have to stay locally for 24-48 hours and be seen prior to returning home. More distant patients should expect to stay in Boston for 7-10 days
  • Anesthesia – general anesthesia is used
  • Post Surgery – a compression vest (similar to spandex) must be worn for 1 week at all times, 24/7. The vest is removed after 1 week to check the incisions. Many patients have drains which are usually removed at one week. If healing is progressing normally the vest is worn for 2-6 more weeks. During this time, (after one week), patients are allowed to remove the vest briefly each day to shower. Absolutely no sports or vigorous activity are allowed for 6 weeks following surgery.
  • Discomfort is mild and recovery is rapid
  • All patients are counseled that the final result is judged one year after surgery