FTM Double Incision Top Surgery

Mr Vahidi is a specialist plastic surgeon with a passion for gender affirmation surgeries. With over 30 years of experience, Mr Vahidi has mainly worked for the NHS and has also worked Pro Bono within Europe, recently he has decided to bring his much-needed skills to the private sector. 

Top surgery is aimed to improve symptoms of gender dysphoria and self-confidence. Some people decide that top surgery is needed as a part of their transition, this is done by surgically altering the chest permanently and can help transgender men and non-binary individuals feel physically self-affirmed. 

To find out a little more about what top surgery means to somebody who is transgender go to: https://www.webmd.com/a-to-z-guides/what-is-top-surgery-transgender-people

Currently, wait times for top surgery in the NHS are very long, with many waiting 4-5 years to even have a consultation. This is then followed by yet another lengthy wait to be provided with a date for the procedure. This has caused a detrimental effect on the transgender and non-binary community that are far more likely to experience homelessness, unemployment, violence and discrimination than cis-gendered individuals. 

With private healthcare being harder to gain access to, Mr Vahidi is very aware of the financial constraints put on the community. Whilst the costs to deliver these services remain quite high,he is constantly looking for ways of making top surgery and other gender-affirming surgeries more accessible to those that need it.  

You can see GIC referral wait times on their website: https://gic.nhs.uk/appointments/waiting-times/

Mr Vahidi performs at Fitzrovia Hospital and The London Welbeck Hospital  which is a short journey from Euston and King Cross. 

Who is suitable for Female to male or non-binary top surgery?

Those who feel gender dysphoria from their chest. Individuals must have been socially living in their preferred gender for at least 1 year.  Psychological referral for top surgery is also needed, this will have to be completed by a GMC or HCPC registered psychologist or psychiatrist. If you are not sure if your psychologist is registered, then you can check on the GMC website…

https://www.gmc-uk.org/registration-and-licensing/the-medical-register

Top Surgery referrals are guided by the WPATH standards which you can find a lot more about at their website: https://www.wpath.org/

For private top surgery referral options

https://www.harleystgenderclinic.com/

https://laurascarrone.com/what-to-expect/

https://helijoubert.co.uk/#top

Can I get top surgery without taking testosterone?

Yes, you can get top surgery without being on testosterone, many professionals advise you to start hormone therapy before getting top surgery, simply there is no one way to do it. Some patients never start taking testosterone, these individuals can still have top surgery. Non-Binary Top surgery is common, these individuals quite often are not taking hormones, these patients don't come off worse than patients taking hormones.
Occasionally there might be the need to change testosterone via injecting to Testogel for a short period of time, this is because there is a clotting risk. Please let Mr Vahidi know if you take testosterone via injection.

Is Top Surgery reversible?

Top surgery is a procedure that permanently alters the chest. Top surgery is not reversible. It is important that you see a psychiatrist for a top surgery referral, the referral must be within 12 months of the surgery taking place. About 1% of transgender and/ or non-binary individuals regret having top surgery, this is far less than many other procedures. 

Double incision mastectomy 

Double Incision Mastectomy (Top Surgery) procedure is the technique most suitable for medium to large chest sizes. The skin on the chest is opened with two incisions, at the top and bottom of the pectoral muscle. The muscle itself is not touched. The skin is pulled back and the breast tissue is then removed. 

Liposuction may be used to make a more masculine contour and to help prevent Dog Ears.  If you have a smaller sized chest then please visit: 

Peri-Areola Top Surgery

How long does double incision top surgery take?

Double incision Top-surgery takes an average of 3 hours to complete. 

What are dog ears?

Dog ears after top surgery is excess skin and fat that puckers out at the sides, by the armpit area. Small dog ears are expected on a lot of top surgery patients however usually go away on its own, along with the swelling. Dog ears tend to be more common in individuals with higher BMI’s are it is advisable to do the best you can to get in good shape before your surgery.

Mr Vahid understands that this may be difficult for some, please ask if you are struggling with wait loss there are specialist fitness trainers that help coach you towards your weightloss goals. If dog ears persist after some time, then revision can be performed in the form of liposuction. 

Top Surgery Post-Operative Care 

Typically, after the surgery, patients are left with two drains. These are small gauge tubes that go along the incisions, under the skin, and come out with a small incision under the arm. 

Patients will need to wear a compression garment after surgery, for around 6 weeks. The garment helps prevent fluid build-up, aids the skin in adhering back to the chest wall, and helps with minimizing scars. Try and keep your garment on as much as you can during the first 6 weeks recovering from top surgery. 

MLD (Manuel lymphatic drainage) Services are also provided as a part of your recovery. MLD works by moving the fluid around the body, allowing the body to get rid of this fluid and decreases swelling after top-surgery. You will receive your first MLD appointment the day after your surgery. This is the best time for you to receive such treatments. Following this you will have another MLD session 5-days after surgery, this will take place after your drains are removed

If you want to know more about MLD or the people providing this service, then please visit:

https://essentialfeeling.co.uk

Double incision top surgery recovery timeline- 

Days 1 - 4 of recovery are often the most uncomfortable. This discomfort can be the result of the anaesthesia wearing off as well as the compression binder, which is holding the dressings over the incisions and/or grafts tightly in place. Your surgeon will come to see you before discharge the morning after surgery.

Day 5 you will likely have your first in clinic post-op appointment. This will be the day your drains are removed.

Week 2 At your appointment you will have your dressings changed. This is going to be the first time you are going to see your chest. The swelling generally decreases within two-three weeks, but for some, this can take up to four-six months.

Week 6 At this point, you can usually remove your compression garment.

Weeks 6-8 You can typically resume physical exercise such as sports, lifting swimming and running.

Things to discuss at your consultation:

Be prepared with a list of questions for the consultation. You need to make an informed decision for your surgery, Mr Vahid will help you to feel relaxed, comfortable, and confident. 

This is your body; your life and you are in control of it. Any question on your mind is important and nothing is silly or insignificant. 

If you are overwhelmed or stressed, we can go over it again until you fully understand and are clear about every detail. 

• Incision lines and the placement typically follow the natural line of the pectoral muscle, straight incisions are possible, please tell Mr Vahidi if this is what you wish.
• Will they be straight or curved? Please ask Mr Vahidi if you have specific requests in how the incisions are placed. 
• Size and placement of the nipple-areola?
• What will the recovery be like?
• What can I do to prepare prior to having top surgery?
• Is there anything individual to me that I should be aware of?

Commonly asked questions? (Top Surgery)