Female Breast Excision (Top Surgery)

Transmen predominantly consider breast removal as a paramount body reconstruction and regard it as the leading surgery for genital reconstruction. This surgery is generally similar to breast reduction in patients with macromastia, but it should decrease the size of the breasts to the nearly flat appearance of male chests and sculpt the pectoral muscular shape or other customized results in light of the patient’s desire. It commonly adopts the method of breast lift via an areolar/inframammary incision (non-vertical scar breast reduction). Dr. Chuang first creates a circular incision at the periphery of the areola and another transverse incision along the inframamary fold to completely dissect the inferior half of the breast skin and mammary tissues, but this needs to preserve the blood circulation at the pedicle of the nipple and areola. Next, the nipple–areola complex is elevated upward to an appropriate horizontal level and fixated to the chest wall. Meanwhile, chest tissues are reconstructed and transferred to sculpt the bulky prominence similar to the pectoral muscle. Finally, the confirmation of the symmetry of both breasts is determined before suturing the wound. The advantages of this surgery are the effective removal of a majority of mammary tissues (at most, 90% of all breast tissues), no vertical scar like that from a traditional inverted T-shaped reduction, and concurrent elevation and reduction of the areola, thus rendering the results almost similar to those of a male chest appearance. The disadvantages are the relatively slow wound healing and atrophy or necrosis of the nipples due to poor blood circulation.


Illustration of breast reduction

Surgical conditions


  • Type of anesthesia: General anesthesia
  • Type of incision: A peripheral incision around the areola and a long linear incision at the breast inferior margin
  • Recovery: 5–7 days
  • Removal of stitches: 10–14 days

General instructions

No food and water on the day of surgery



  • Do not smoke for at least 1 week preoperatively.


  • Do not consume alcohol or smoke for 3 months postoperatively.
  • Avoid carrying heavy objects with the hands or upper body and strenuous activities for 1 month postoperatively.
  • Do not heavily press the chest for 3 months postoperatively.
  • Take care of the scar for 6 months postoperatively to prevent scarring.

Ideal candidates

  • Female patients who want their physical characteristics to be altered to those of males
  • Females who wear neutral clothes and have an aversion to their original breasts
  • Patients who simply want to reduce the weight load of their breasts

Possible complications

  • Scar proliferation
  • Poor wound healing
  • Compromised nipple sensitivity
  • Nipple/areola necrosis
  • Breast lumps (temporary)

Surgical advantages

  1. It is able to effectively resect a majority of the female breast tissues to fulfill the expectation of female-to-male patients.

  2. It is able to concurrently lift and reduce the areola to resemble that of males.

  3. It is able to sculpt the shape of the pectoral muscle in line with the patients’ requirements.

  4. It is able to avoid the inverted T-shaped scar of traditional breast reduction.

Surgical drawbacks

  1. A scar may be left around the areola and at the inferior breast margin.

  2. Wound healing and surgical recovery are relatively long.

  3. Postoperative pain and swelling may be obvious.

  4. Nipple sensitivity may be undermined or absent.

  5. Once dissected, the breast tissues cannot be restored, thus depriving the patient of future breastfeeding.

Probable procedures in conjunction

Before & After

These photographs represent typical results, but not everyone who undergoes plastic surgery will achieve the same.

Female Breast Reduction