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Transgender Surgery
FTM & MTF Chest Reconstruction

FTM Top Surgery in Seattle

Dr. Tony’s FTM Top Surgery Patients Posts & Videos:

Finding Kim Trailer

Reddit FTM patient post

LiveJournal FTM patient post

Youtube video – FTM patient Evan

Youtube video – FTM patient Jayce

“Top surgery” is typically one of the first procedures that FTM patients undergo. This involves the removal of breast tissue to create a male chest reconstruction. There are two main surgical techniques that can be used to reconstruct the chest. Which technique is used depends on the amount of skin and breast tissue present.

For those with a lot of excess skin and breast tissue, the most common procedure is the bilateral simple mastectomy with nipple grafts, commonly known as the double incision (DI) surgery. This procedure does leave a scar on each side of the chest, but the scars are generally placed along the lower border of the pectoral muscle fold to help hide the scaring. While the scars are permanent, they should fade significantly with time. The area around the nipple (the areola) is reduced to an appropriate male size and is repositioned to an appropriate male location.

For those with minimal excess skin and breast tissue, another technique called a Subcutaneous Mastectomy is preferred as it removes breast tissue leaving only a small “key hole” incision. The clear advantage is that there is much less scarring.

Come visit us today! We will provide you with a customized treatment plan that makes it as safe and easy as possible for you to have the look and results you desire.

FTM Top Surgery Recovery

FTM top surgery recovery can be a challenging process. It’s important to take steps to ensure that your body is able to heal properly and that you are able to manage any pain effectively. By taking these steps, you can make sure that you are able to recover at a reasonable pace and avoid any complications.
One of the most important things to do when recovering from top surgery is to make sure that your body has the nutrients it needs. Eating a healthy diet full of fruits and vegetables can help ensure that your body is able to get the nutrients it needs. When eating healthy, make sure you are also eating plenty of protein. This will help keep your metabolism working properly and ensure that you don’t put on too much weight.
Another thing you should do when recovering from top surgery is to make sure that you are getting enough rest. When you aren’t getting enough rest, your body isn’t able to heal properly and can end up causing more issues than it would have otherwise. Make sure you are getting enough sleep each night and try not to stay up too late.
Finally, it is important to keep an eye on your incisions to make sure they are not getting infected. If they begin to look red, swollen and painful, there may be an infection brewing below the surface. It’s important to be examined as soon as possible.

FAQ for Top Surgery

  • We do not have a set age limit for top surgery.  Dr. Mangubat will evaluate adolescent patients seeking top surgery on a case-by-case basis to make sure surgery is an appropriate treatment.

    If you are younger than 18, we will require at least one parent or legal guardian to be present at your consultation.  We also require all legal parents and/or guardians to sign your surgery consent forms.

    If you are looking to have insurance cover your surgery fees, please be aware that your insurance provider may have an age limit for gender affirming surgery.  We have come across age requirements of 16yo and 18yo with different insurance providers.  You are welcome to email us a picture of the front and back of your insurance card, and our insurance coordinator would be happy to check coverage for you.

  • We follow WPATH standards and will require supporting letters for top surgery. If you are 18yo or older, “One referral from a qualified mental health professional is needed for breast/chest surgery (e.g., mastectomy, chest reconstruction, or augmentation mammoplasty)”. If you are younger than 18, we require the letter from the mental health provider and an additional supporting letter from your PCP.
    WPATH recommends the following content for the mental health referral letter for surgery:

    1. The client’s general identifying characteristics (legal first and last name, preferred name, DOB)
    2. Results of the client’s psychosocial assessment, including any diagnoses
    3. The duration of the mental health professional’s relationship with the client, including the type of evaluation and therapy or counseling to date
    4. An explanation that the criteria for surgery have been met, and a brief description of the clinical rationale for supporting the patient’s request for surgery
    5. A statement about the fact that informed consent has been obtained from the patient
    6. A statement that the mental health professional is available for coordination of care and welcomes a phone call to establish this.

    The letter can be emailed to our office or faxed to 206-575-1881 any time before your pre—operative appointment. We do not require a letter to have a consultation.

    Patients with a significant medical history may require additional letters for medical clearance. Dr. Mangubat will review your medical history at your consultation appointment and let you know if any further clearances will be needed.

  • Dr. Mangubat treats patients across the entire gender spectrum and hormone therapy may not be the right treatment for everyone. We do NOT require you to be on hormone therapy to have gender affirming chest reconstruction or breast augmentation surgery.
    Some insurance providers may require you to be on hormone therapy to cover gender affirming top surgery. You can call your insurance to find out their requirements or our insurance coordinator would be happy to check for you.
    Testosterone does not need to be stopped before surgery. Estrogen and Progesterone need to be stopped one full month prior to surgery.

  • Patient safety is the top priority for our anesthesia team. All patients with a BMI of 36 or over will meet with one of our anesthesia providers at the pre-operative appointment about 2 weeks prior to surgery to get cleared for anesthesia. For patients with a BMI of 45 or above anesthesia and surgery eligibility will be determined on a case-by-case basis.

    • You are not allowed to lift anything over 10 lbs. over your shoulders for 1-month post-surgery. Also please refrain from reaching, stretching, pushing, pulling, stooping, running or any other strenuous activities for 2-3 weeks after surgery to prevent any damage to the incision.
    • Please make sure to wash your hands before and after touching your incisions and after using the bathroom.
    • Do not lie or sleep on your stomach or side for 1-month post-surgery.
    • Do not use a hot tub, hot bath, or submerge your incisions under water for at least 1 month or until all scabbing is resolved.
  • We require a trusted adult to pick you up from surgery and stay with you for the first 24 to 48 hours after surgery. Your caregiver will receive detailed post-operative care instructions and must be able to understand English sufficiently. Please also make sure your caregiver is capable of providing physical assistance if needed.

  • Patients may heal at different rates and have different tolerances for pain, which can make it harder to determine how much time you will need to take off work for recovery. Generally, we recommend taking 1 to 2 weeks off if your job is sedentary and 3 to 4 weeks if your job is more active or requires you to lift more than 10 lbs. regularly and/or over your shoulders.

  • Patients may heal at different rates. In general, we recommend refraining from the following common activities for the listed amount of time.

    • Sleeping on stomach and side – 1 month
    • Exercise/lifting weights – 1 month, during weeks 5 and 6 gradually increase lifted weight.
    • Gardening – 1 month
    • Dancing – 2-6 weeks depending on the strenuousness of the dance.
    • Horseback Riding – 8 weeks
    • Hot tubing/ using bathtub – at least 1 month or until all scabbing is resolved.
    • Swimming – 1 month
    • Scuba Diving – 6 weeks
    • Hiking – 1 month
    • Backpacking – 4-6 weeks
    • Rock Climbing – 8 weeks
    • Sex – 2-4 weeks
  • Cleanliness during recovery is extremely important to prevent infections. Please ensure your bed sheets are clean and refrain from having any pets sleep with you for 2-3 weeks after surgery.

  • You can start using Silicone sheets or tape as soon as your bandages are removed. To prevent weakening of your scars before they are healed, please refrain from using any steroid scar treatments for the first 3 weeks post-surgery. Dr. Mangubat will evaluate your incisions at your 3 week and 3 months post-operative appointment and will prescribe a compounded prescription scar gel if needed. This scar gel is available at our office and will be dispensed at your appointment if prescribed.

  • Generally, once you have recovered from the aftereffects of anesthesia (about 24-48 hours post-surgery), there are no restrictions on air travel for most of the procedures we provide.

    • If you are travelling shortly after surgery, you may require somebody to accompany you to help with your luggage.
    • If you are traveling from out of state, we will require you to stay in town for post-operative care until all dressings have been removed. Commonly, for Chest Reconstruction with free nipple grafting the dressing will be removed 6-7 days post-surgery.
    • If the surgical approach does not include nipple grafting, all dressings will be removed at the 3–4-day post-operative visit.
    • If there are any complications during recovery, you may be required to remain in our area until the complications have resolved.
  • If your or your care givers’ work requires FMLA forms, we would be happy to fill them out for you. You can email the forms to, fax them to 206-575-1881, or bring them with you for any appointment.
    Based on job description and the surgery performed, Dr. Mangubat will allow 2-4 weeks off for patients. We require you to have a caregiver for the first 24-48 hours, but Dr. Mangubat will allow as much as 1 week on their FMLA form if traveling from out of town.

  • Absolutely. Dr. Mangubat will be able to do a virtual consultation if you are out of state.
    When booking your surgery, we will book you for a pre-operative phone call with our medical team about 2 weeks before surgery. We will need to see you in person at our office a couple of days before your surgery appointment to meet with Dr. Mangubat to confirm the scheduled procedure and finalize your surgery preparations with our medical staff.
    You will be able to travel back home once all your dressings have been removed, about 1-week post-surgery.
    We require a caregiver for 24-48 hours. You may have to bring a family member or friend with you, or we can provide information for a nursing service you can hire for the first few days after surgery.
    If you are looking to have insurance cover the surgery, please email us a copy of your insurance card (front and back), and our insurance coordinator would be happy to check if you have out of state coverage.

FTM Top Surgery in Seattle Testimonials

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