FTM “Top” Edition
Updated: Oct 29, 2020
Your Daily Google Search and Self-Education
By Bren Bartol
Image via John Hopkins Medicine.
FTM: Female to Male
Being trans is not an easy experience, and when other people don’t know much about the trans experience, it makes it even harder. What can others do to help make this easier? Learn.
“Passing” is a concern of many trans people, and there are several different ways to do it.
For FTM people, or trans-masculine individuals, they have several options to remove breast tissue, or create the illusion of a flat chest.
I talked to Sam (he/him), a trans man who shared his experience with me.
Non-surgically, there are many options. Unfortunately, binders (typically a tank top or bra-like piece of clothing that is tight, and flattens the breasts as much as possible) are more expensive than tape, but more effective. Binders are an investment that will last you a long time, but they will eventually need to be replaced. Two certified brands of binders are gc2B, which serves the international trans community, and Underworks, whose products can be found in stores like Walmart.
There are less expensive ways to bind, but ultimately they are more risky and require you to listen to your body much more closely. A method many people who bind use is to wear multiple sports bras. However, this is incredibly risky, and could be very detrimental to you if you are not careful.
A more safe way to bind without multiple sports bras is lots of layers and baggy sweatshirts.
“I use sports compressors... which worked better. And other than that, big sweaters. I am looking at my closet right now. I'd say comparatively, we've got like probably 1/10th shirts and 9/10th sweaters because I'm transgender and that's how we do it,” Sam said. Sam didn’t use binders or tape, as they just weren’t right for him.
The least well known method is tape. A great place to find tape for a more masculine look is TransTape. Their products are about 15 dollars, as opposed to gc2B’s 40, and they take you through the steps on how to apply it, use it, remove it, and after/pre-care.
There are several medical options, one of which being hormone therapy (testosterone, also known as T). This often results in a deeper voice, among other things, but unlike estrogen, does not affect someone’s breast tissue. It is not required to be on hormones before the operation.
Surgically, it’s a little more complicated than just breast augmentation, and unlike breast augmentation, surgery offers a broad range of options.
Pre-operation, most surgeons require the patients to be 18 years old (all World Professional Association for Transgender Health standards must be met prior to surgery), and require no nicotine/drugs for 3 weeks prior to and after the surgery, as well as no alcohol for 7 days prior to and after the operation. Keep in mind, mastectomies are expensive, and depending on where you are in the world, it won’t be covered by insurance. In the US, where my research is centered, we do not have universal healthcare. Lots of insurances in the US will cover the surgery, but they require a letter from a trans competent mental health professional.
Sam got top surgery in June 2020, but started inquiring about it in August of 2019.
“The biggest hoop was insurance. I was lucky enough that my insurance paid for my surgery. Um, but about a week before they rejected our claim and we had to fight the legal battle. And we got the news about two days before my surgery that they would actually pay for it. And we were worried that we were going to have to cancel it if they didn't,” Sam explained as he took me through his journey. “You kind of have to lie to your insurance. History of depression or anger issues and you're like, no, not at all. What are you talking about? And then you have to do a 180 when insurance says, cool, and we're denying your surgery because it's not life saving, so we won't pay for it. And then you have to say, but I am so sad.”
Known as ‘top surgery’, the surgery is a subcutaneous mastectomy. Within this label, there are many techniques and methods to actually completing surgery.
An important aspect to note is what is called “nipple-sparing subcutaneous mastectomy.” This is more often used for people with smaller breasts, and can spare the areolar, nipples, and surrounding skin from loss of feeling. People with larger breasts often have to have their nipples and areola removed, then they are grafted back on once the breast tissue has been removed.
If nipple feeling, tightness of skin, or chest flatness is most important to the patient, it is advised to get Double Incision, which leaves the patient with the ‘typical’ scars -- two U shaped scars under the pectoral muscle. With Double Incision, sometimes the patient's nipples will be removed and reattached.
Other options include: Liposuction (best for small chests or in combination with other techniques, there is a small incision near the armpit), Keyhole/Periareolar (best for small to moderate chests, and the incision is on the edge of the areola or the circumference of it), Fish Mouth (produces incision contours that are higher on the chest, as it’s trying to mimic the shadow of the chest muscle, but it may not always have a natural proportion), and Buttonhole/Inverted T (which are best for those wanting to retain nerve feeling). There are other, lesser known options, but these are the most common. Whether you fit the guidelines for these or not, always consult your surgeon on what is best for you.
After surgery, you need to be driven home (depending on your surgeon's facility or offsite facility), and with someone for 24 hours after. Alcohol is a no go for seven days, and drugs and nicotine are a no go for three weeks.
You will have to have drains and a chest compressor - which can help reduce swelling - that you must wear for a few weeks after. One of the most common side effects is nausea.
“I’m grateful I don't remember ever being in pain. But the nausea was insane. Be ready for
that,” Sam cautioned.
You cannot lift anything above 15-20 pounds for a few weeks. After 7-9 days you should be able to go back to light to moderate work. It is advised to try and start walking immediately to avoid blood clots.
“I recovered super fast. Two days or three days after surgery, I walked all the way downtown with my friend on a hot day. So I was very much up and around and moving,” Sam explained. “...Also like, you have to sleep on your back obviously for forever, which is really hard. Um, but like make sure you're comfortable and ready for that. I actually still am not technically allowed to raise my arms above my shoulders, uh, because it'll stretch them [the scars] out.”
Because it is a major surgery, there are risks. The most prevalent risks are asymmetry, seroma (fluid buildup, small ones go away on their own, larger need medical intervention), hematomas (small pool of blood under skin, 2% chance of being any danger), or tissue necrosis (losing feeling in the nipple or tissue around due to damaged or dead tissue). Infection is very rare - only about a 1% chance.
Sam’s advice was simple and straightforward: Allow yourself to rest longer than you think you’ll need too, and don’t do too much at the beginning. It’s okay to take it slow.
In the end, it’s your body. Do what feels right (and is safe) for you.
Written by writer Bren Bartol