FTM (female-to-male) top surgery often involves the resizing and repositioning of the nipples to achieve a more masculine chest appearance. For many transgender men, this involves a procedure known as nipple grafting. Here’s an overview of the process:

  1. Procedure:
    • During top surgery, after the removal of breast tissue and the reshaping of the chest, the original nipples are often too large and incorrectly positioned to look natural on a male chest.
    • The surgeon will resize the nipple and areola. The excess skin is trimmed away, leaving a smaller, circular piece of tissue.
    • The nipple and areola are then detached entirely from the body. This is why it’s called a “graft” – the tissue is moved from its original location to a new one.
    • The surgeon selects a new, more masculine location for the nipple and areola and attaches the graft using sutures.
    • Dressings are applied to protect the graft and facilitate its integration with the surrounding skin.
  2. Recovery:
    • The healing process for nipple grafts is essential. The grafts rely on the blood supply from the underlying tissue to survive.
    • Special dressings or bolsters might be used to protect the grafts and keep them in place.
    • It’s not uncommon for the grafted nipples to appear very dark or scabbed over during the initial healing stages. This can be alarming for some patients, but it’s typically a normal part of the healing process.
  3. Potential Complications:
    • There’s always a risk that the graft may not “take,” meaning it doesn’t integrate successfully with the surrounding tissue. This can result in partial or total graft loss.
    • Scarring can occur, though techniques have improved over the years to minimize this.
    • Loss of nipple sensation or changes in sensation can occur.
  4. Aesthetic Considerations:
    • Surgeons aim to position the nipples in a natural, masculine position. This often means placing them more to the side and slightly lower than their position on a female chest.
    • The size of the areola is typically reduced to look more masculine.
  5. Alternatives:
    • For those with smaller chests, some surgical techniques, like the peri-areolar or keyhole methods, may allow for nipple resizing and repositioning without detaching the nipple completely.

It’s crucial for anyone considering FTM top surgery to consult with experienced surgeons to discuss their goals, understand the risks and benefits, and set realistic expectations for the procedure and recovery.