Transgender Top Surgery (FTM)

Female to male (FTM) top surgery is one of the most common transgender procedures. It completely transforms a feminine bust into a masculine chest. Since Dr. Alexandre Charão regularly performs, specializes, and studied breast reconstruction surgeries at the Hospital Pérola Byington in São Paulo, receiving this procedure under his care is very safe. He has a proven high success rate among patients and works hard to understand each patient’s individual needs and aesthetic goals.

Contouring Your Chest – Horizontal vs. Periareolar Top Surgery

Dr. Alexandre Charão performs both horizontal incision mastectomy and periareolar (keyhole incision) top surgery for transgender patients.A horizontal mastectomy is the most popular and is ideal for patients with breasts larger than size 44. With this technique, excess skin and tissue (300g-600g) are removed through two horizontal incisions. One is below the breast, and the other is above the nipple. These are closed together to create one line. While there is some noticeable scarring, this option allows for good positioning and reconstruction of the nipple.

If your breasts are small with minimal overhang (up to size 42), a periareolar (keyhole) procedure is recommended. During this surgery, the breast tissue is removed through a small incision at the bottom of the areola. The nipple remains in place, which means it can not be moved. However, it can be reduced in size. Drains are inserted under each arm to allow any excess fluid to leave the chest. This process helps contour the chest and create a natural look.



Other Techniques – Vertical and Fishmouth

If you have sagging breasts ranging from 42-44 in size, a vertical mastectomy might be suitable for you. This procedure allows for more skin removal than the periareolar technique. A large circle is drawn around the areola along with a large “V” which runs down the patient’s abdomen. The mammary gland is removed through these incisions, which means the areola and nipple remain intact. Although there is a visible scar line after the surgery, it can be hidden underneath a patient’s body hair.

Another method is the fishmouth technique. Some advantages for performing a fishmouth incision include a good chance of retaining nipple sensation and it is fairly easy to achieve chest firmness and flatness. A fishmouth incision is not a good choice for patients who prefer to have their scar line located along anatomical lines. The incision lines are much higher than other techniques and radiate out from the nipple.

Below is a chart of all techniques currently offered to FTM patients.

Your Initial Consultation


As you are researching transgender top surgery (FTM) procedures, it is important for you to define your expectations. During your initial consultation, you can discuss various options which will work for your goals and current situation. To help give Dr. Alexandre Charão a clear idea of your desired results, you should send him photos of your chest.

Hospitalization Time and Information

Patients are usually hospitalized for 24 hours. With over 20 years of experience, Dr. Alexandre Charão can safely discharge patients after 1 day following the surgery.

Postoperative Recovery

If you receive a horizontal incision mastectomy, you will need to cover your nipples with surgical sponges for at least 8 days. You should avoid showering during this time, and can wash around the covered grafts.

With the periareolar (keyhole) mastectomy, surgical drains will remain in your body for up to 1 week. You may shower normally, but should be careful of the drains. Since there are no major incision lines, scarring is minimal.

For both procedures, a compression garment is needed for at least 30 days following the procedure. Pain medication is prescribed as needed.

Total Cost and Before & After Photos

Congratulations, if you have read this far, then you are really committed to receiving a top surgery (FTM) procedure. Your next step should be to schedule an initial consultation with Dr. Alexandre Charão. During this 1 hour meeting, he will disclose further details, including total cost. Most international patients can save 50-70% by traveling to Brazil for surgery.

You can contact Dr. Alexandre Charão at Whatsapp, click here.

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