Gender Affirming Procedure
Conveniently located to serve Brookline and Boston, MA
Gender affirming top surgery is a highly individualized procedure designed to align your chest with your gender identity and how you experience your body. Dr. Richard Bartlett offers thoughtful, patient-centered gender-affirming procedures for individuals seeking chest masculinization in Brookline and Boston, MA, as well as across the United States and overseas. Learn more about the surgery here.
What Is A Gender Affirming Chest Surgery?
Gender affirming top surgery is intended to align the patient’s body with their gender identity. It is also referred to as chest masculinization surgery or FTM top surgery, which removes breast tissue and reshapes the chest to create a flatter, more masculine contour. The procedure may also include repositioning or resizing the nipples to achieve balanced, natural-looking results that align with your anatomy.
Types of gender affirming top surgery techniques
The surgical approach is selected based on chest size, skin elasticity, and your desired outcome.
Keyhole top surgery
This option is appropriate for patients with smaller chests and good skin elasticity. Breast tissue is removed through a small incision along the areola, minimizing scarring and ensuring a more discreet appearance.
Double incision top surgery
This surgery is recommended for larger chests or reduced skin elasticity. It enables the complete removal of tissue and the precise reshaping of the chest wall.
Periareolar top surgery
This procedure involves an incision around the areola to remove excess tissue and tighten the skin. This technique enables contouring while keeping scars confined to the areolar border.
Free nipple graft top surgery
This top surgery option involves resizing and repositioning the nipples after tissue removal. This technique is often paired with double incision surgery to achieve optimal masculine contouring.
For individuals unsure which technique is best, a consultation at Richard A. Bartlett, MD, PC Cosmetic & Reconstructive Plastic Surgery will include counseling to determine the most appropriate procedure. Gender affirming top surgery is part of the breast procedures offered by Dr. Bartlett. For some patients, techniques used in breast reduction may inform surgical planning, particularly when addressing excess tissue, skin laxity, or contour balance.
Am I an Ideal Candidate for Top Surgery?
You may be an ideal candidate for gender affirming top surgery if you are in generally good health, have reached a stable weight, and have realistic expectations for your surgical outcome.
Qualifying for surgery typically requires meeting established readiness guidelines, often supported by letters from a qualified therapist and your primary care provider. Additionally, candidates should be committed to following pre- and postoperative instructions, including, where applicable, stopping tobacco use, to support optimal healing and minimize complications.
What to Expect Before and During the Procedure
Gender affirming surgery consultation
If you are considering gender affirming surgery, the first step is a confidential consultation with Dr. Bartlett. At this time, he will perform a medical evaluation and listen carefully to understand your goals. He will answer questions about the benefits and risks of top surgery, describe the treatment process, and may discuss alternative treatment options.
Dr. Bartlett will create a personalized surgical plan tailored to your specific needs. He will provide pre- and post-op instructions based on your medical evaluation. You will be asked to arrange for a friend or family member to drive you home after surgery and assist with your initial recovery. You may also be asked to stop or change your current medications as part of the preparation. This is because certain medications may result in increased bleeding and must be avoided.
Patients must have realistic expectations and should be in good health, at a stable weight, and non-smokers. Smokers can have a higher incidence of unfavorable scarring. Patients who are still healing from recent surgeries or injuries will need to wait until they have fully recovered.
To better understand the procedure before your visit, many patients find it helpful to review Dr. Bartlett’s FTM top surgery overview. Additional educational resources, such as information on gynecomastia treatment and breast reduction surgery, can also provide helpful context about chest surgery options and recovery.
What happens during the gender affirming surgery
During your consultation, Dr. Bartlett will recommend either keyhole or double incision top surgery. Dr. Bartlett uses the World Professional Association for Transgender Health (WPATH) guidelines to screen patients regarding their suitability for surgery. All patients must have a therapist’s letter and a letter from their primary care physician.
For keyhole incision top surgery, an incision will be made 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 around the areola) to decrease the size of the areola. Drains are placed on both sides of the chest and are usually removed within 1-2 weeks after surgery.
If undergoing the double incision top surgery, both breasts are removed with formal mastectomies, leaving scars along the border of the pectoralis (chest) and muscle. The nipples are removed and resized to a male dimension. The nipples are reapplied as “free nipple grafts” with bolster dressings, which are removed at one week postoperatively.
Although scars from the double incision are more visible, the technique is highly effective at producing a male contour, and drains are not typically placed.
In both types of top surgery, a compression vest and band are applied and will remain in place day and night until your first follow-up appointment with Dr. Bartlett.
General anesthesia is recommended for top surgery.
3 to 4 hours. The exact duration of surgery will depend on the treatment plan, techniques used, and if there are other procedures performed during your procedure.
Top surgeries are performed in our AAAASF Certified office operating room and in hospital settings in the Boston, Massachusetts, area.
Gender Affirming Top Surgery And Recovery
Dr. Bartlett and his staff will review the recovery process details and provide instructions and prescription medications prior to surgery.
A compression vest (similar to spandex) must be worn at all times, day and night, for one week until your first follow-up appointment. The vest is removed at the first follow-up appointment to evaluate incisions and healing. Drains and/or nipple bolster dressings are typically removed at the first postoperative visit. If free nipple grafting is performed, you will be instructed to apply daily dressings to the nipple grafts.
The vest is worn for an additional 2-6 weeks, depending on your healing progress. During this time (after one week), patients are allowed to remove the vest briefly each day to shower. No sports or vigorous activity is allowed for six weeks following surgery. Discomfort is mild, and recovery is rapid. All patients are advised that the final result is judged one year after surgery.
When will I see results from top surgery?
Early improvements are visible once swelling decreases, typically within the first few weeks. Although your chest contour continues refining over several months, most patients see the final results around one year post-surgery.
See for yourself
Before-and-after photos offer real patient transformations and demonstrate the effectiveness of individualized surgical planning. These visuals help set expectations and highlight the range of possible outcomes with expert gender-affirming care.
What our patients are saying
Hearing directly from others who have undergone surgery through patient testimonials for gender affirming surgery can also offer insight into the patient experience and long-term satisfaction.
“Thank you so much for everything you have done for me. Not only am I very very happy with my post-op results, but I am also very happy with how helpful and understanding everyone in the office has been. I have referred a lot of my friends to Dr. Bartlett. Thank you Joan, Christine and Sarah for making everything easy and being very helpful!”
Benefits of Gender Affirming Top Surgery
Patients who undergo gender affirming top surgery often experience a range of meaningful benefits, including:
- Reduced chest dysphoria, allowing greater comfort and alignment with gender identity
- Improved confidence and self-image in clothing and daily interactions
- More comfort during exercise and physical activity, with less binding or compression needed
- Greater ease in social and intimate situations can enhance the overall quality of life
For some patients, chest dysphoria overlaps with conditions such as enlarged breast tissue. In those cases, procedures like gynecomastia or other related male procedures may also be discussed during your consultation to ensure the most appropriate surgical plan.
How Much Does a Gender Affirming Procedure Cost?
Cost depends on factors such as the time required for surgery, the type of anesthesia, and the techniques used.
An estimate of the cost can be provided over the phone by the front desk administrator. After your consultation with Dr. Bartlett, a specific, detailed quote will be provided.
Why Choose Dr. Bartlett for Gender Affirming Surgery?
Richard Bartlett, MD, PC, is a board-certified plastic surgeon with more than 30 years of experience and a reputation for integrity, artistry, and compassionate care. Recognized as one of “Boston’s Most Trusted Doctors,” he is known for spending the time needed to educate patients, explain options thoroughly, and personalize treatment plans to individual goals.
Dr. Bartlett’s expertise is supported by professional memberships, faculty roles in surgical education, and long-standing hospital affiliations, ensuring you receive skilled, safe, and thoughtful care throughout your gender affirming top surgery journey.
Frequently Asked Questions
Is top surgery the same as a mastectomy for transgender patients?
Top surgery does involve the removal of breast tissue, similar to a mastectomy. However, it is specifically customized to create a masculine chest contour with attention to aesthetics and proportion.
How long does gender affirming top surgery take?
The procedure typically takes several hours, depending on which surgical technique is selected. Anesthesia, operative planning, and individual anatomy all contribute to the operating room time.
Will I need drains after surgery?
Drain use depends on the surgical method selected for your case. Dr. Bartlett will explain whether drains are necessary during your consultation and how they are managed.
Are the results of top surgery permanent?
Yes, the removal of breast tissue is permanent and typically does not grow back. Maintaining a stable weight and following postoperative care instructions helps preserve your long-term results.
How visible will scars be after surgery?
All surgical approaches involve some degree of scarring. Scars typically improve over time, fading within months, and are positioned to minimize visibility.
Schedule A Consultation
Our staff takes pride in their knowledge and sensitivity towards patients seeking gender-affirming procedures, making every effort to make the process as straightforward as possible. Consult Dr. Bartlett regarding gender-affirming top surgery. He can advise you on whether surgery is the best option and can help you achieve outstanding results from your procedure.
If you’re in Brookline or Boston, MA, contact us today to book an appointment.
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