What Is Double Incision Top Surgery?

If you’re looking for chest masculinization surgery, double incision top surgery is one of the most popular options. It is a reconstructive surgery for those who wish to remove breast tissue and contour the chest to be more masculine in appearance.

It is a gender-affirming surgery that can bring enormous confidence to certain individuals, most commonly those within the transgender and nonbinary communities.

If you or someone you know is considering double incision top surgery, you’re going to want to do your research. It’s a decision that can move you toward your body goals, but there’s a lot to know before committing to the procedure.

Keep reading to know more about it and what to expect.

What is Top Surgery?

Top surgery is a group of surgeries that can reshape the chest to look more masculine in appearance.

It’s important to note that not every transgender or nonbinary person pursues gender affirming surgery. From time to time, people outside these communities also undergo the procedure. An individual’s relationship to their body varies and what might be a necessity for one person may not apply to someone else.

With that in mind, gender-affirming surgery is growing and it is a life-altering option.

The most common top surgeries are:

• Female to male (FTM), which involves removing breast tissue and shaping the chest to look more masculine.
• Female to nonbinary (FTN), which involves removing breast tissue and shaping the chest to look more androgynous.
• Male to female (MTF), which involves using saline or silicone implants to create a more feminine chest.
• Male to nonbinary (MTN), which involves contouring or augmenting the chest to appear more androgynous.

For people labelled “female” at birth, the most commonly pursued top surgeries are:

• Double Incision Surgery – This is usually performed on people with a moderate to large chest. It can also be used with people who want to achieve precision placement of their nipples and/or pectoral contour lines.
• Peri-areolar Surgery – This is usually performed for people with a small to moderate chest.
• Keyhole Surgery – This is usually performed on people who have little breast tissue to remove. The key benefit of this limited incision procedure is that there is almost no scarring.
• Inverted T Surgery – This is an uncommon type of top surgery that can be used to help patients with a moderate to larger chest retain sensation in their nipples and areola.

This article will focus specifically on double incision top surgery.

What Is The Double Incision Procedure?

There are different types of female-to-male (FTM) surgeries, ranging from top and bottom surgery to  hysterectomy. All of them achieve different results that can provide more confidence, but like anything else, you want to be aware of any risks.

While the most popular top surgery procedure is double incision, there are other variations that could also align well with your needs.

Candidates and Cost

For double incision top surgery, you’ll want to know if you’re a suitable candidate. This surgery should be for you, not for anyone else or to fit into an ideal image. If you’re unsure, talk to a surgeon or a supportive medical professional. They’ll be able to answer the personal questions you may have.

Next, you must determine the cost for top surgery. The price will vary depending on how experienced the surgeon is and where they’re located. The good news is that there’s usually financing for top surgery and your insurance might cover it.

One of the leading surgeon’s who performs the double incision procedure is Dr. Garramone in Florida. The reason he is leader in this surgical procedure is that it’s the only one he performs. He won’t do any other type of top surgery and he doesn’t perform any other plastic surgery procedures. The out-of-pocket costs of doing surgery with him total to approximately $10,000. This includes his surgeon fee, as well other associated fees.

Dr. Medalie is a highly skilled surgeon who performs multiple types of top surgery procedures. His fees for double incision top surgery total to approximately $8,000. He is based in Cleveland, OH. Other talented double incision surgeons include Dr. Scott Mossner in San Francisco, CA, Dr. Kathy Rumer in Philadelphia, PA, and Dr. Dustin Reid in Austin, TX, as well as many others.

On average, the total cost for double incision top surgery ranges from $7,500 on the low end to $10,000 on the high end. The three biggest costs included in that total are the surgeon’s fee, the anesthesiologist’s fee, and the hospital fee.

The full list of costs included in top surgery are the:

• Surgeon’s fee
• Anesthesia costs
• Hospital fees
• Medical tests and X-Rays
• Prescriptions
• Post-surgery garments (a compression binder)
• Travel fees (optional)

As you talk to different surgeons, make sure you feel comfortable with them. Remember that this is a highly personal procedure and you don’t want to be out of your comfort zone, a good surgeon will make you feel secure.

Now that you know that you’re a good fit and how much it’ll cost you, it’s time for the consultation.

Consultation

The consultation will be when you and a surgeon will discuss things like your transition process, your surgical goals, previous medical conditions and previous surgeries. There’ll also be discussions about any current medication you’re using.

Then the surgeon will evaluate your health, making sure there are no risk factors. Your chest will be examined, either virtually via photos you send in or in person. The surgeon may also take measurements.

You and your surgeon will then discuss all the different options and they’ll give you information about the expected outcomes and potential complications. Finally, you’ll discuss scheduling and payment terms, after which you’ll get booked on their calendar.

Surgerical Procedure

On the day of your surgery, you’ll be asked to fast and avoid water from 12am onward. You’ll usually get a call from the surgical center the day before telling you when to report for surgery. This could be anytime after 8am.

Once you report to the hospital and get prepped for surgery, the first step of the surgical process is to receive anesthesia. The anesthesiologist overseeing your surgery will administer it to you.

Then, the skin on the chest will be opened along two horizontal incisions. There’ll be an incision at the top and bottom of the pectoral muscle. Afterward, the skin is pulled back and the breast tissue is then removed.

The nipples are removed, re-sized and grafted on the chest. You might have reduced sensitivity in that area.  One of the benefits of double incision top surgery is that it allows the surgeon to place your nipples in the anatomically correct position.

Usually, all of this is done as an outpatient surgery that takes approximately 1-2 hours to complete. By evening, you will typically be recovering at home or in a hotel.

Post-Op Care

Once the surgery is over, most patients will be left with two medical drains. These are small tubes that exit through a small incision and attach to a reservoir bulb. The purpose is to collect excess blood and lymphatic fluid.

The drains are left for several days to a week and need to be emptied a few times a day. There’ll also likely be a compression binder placed on you after the double incision surgery, anywhere from 1 to 6 weeks.

This is to prevent fluid buildup and helps minimize scars.

The most common timeline for drain removal is to remove it at your one-week post-op appointment.

Recovery Time

Once the surgery finishes, you might be wondering what the recovery time is. This varies by patient, but generally you’ll likely be able to return to your desk job and light work after two weeks.

However, there should be no lifting or weight training for 8-12 weeks (two to three months).

If you decide to weight train before your scars have fully healed, you’ll be at risk of stretching them. This can cause them to appear larger and thicker than necessary. Meaning, it’s best to be patient.

Double Incision Top Surgery

If there’s one thing that everyone deserves, it’s the ability to feel like themselves. Medical advancements are now allow folks to create a physical version of themselves that aligns with their self identity.

For transgender and nonbinary individuals, this can be a life-changing option. Double incision top surgery is one of these essential procedures that can create a sense of congruency, confidence, and freedom.

What questions do you have about top surgery? Ask them in the comments below.

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