Female-to-Male Chest Masculinization Procedures at UPMC in Central Pa

Female-to-Male Chest Masculinization, otherwise known as Transmasculine Top Surgery or “Top Surgery,” is a common surgical procedure for a female transitioning to a male.

High Quality, Multidisciplinary Care

The breast tissue and excess skin are removed from a female-to-male patient, and the chest and nipple areolar complex are reconstructed to appear masculinized. Depending on the size of the patient’s chest, either the keyhole (subcutaneous mastectomy) or double incision (simple mastectomy) techniques are utilized. In most cases, the nipple areolar complex is also resized, reshaped, and placed in a more masculine position, which is typically away from the central aspect of the breast mound.

The procedure is performed as an outpatient, and most patients return to work within two weeks. The surgery is well-tolerated by most and, in experienced hands, complications such as infection, hematoma, wound healing difficulties, and nipple areolar loss are rare. Healing will continue for several weeks as swelling decreases and the chest shape improves.

Care of individuals with gender dysphoria requires a multidisciplinary team approach that includes mental health professionals, primary care physicians, endocrinologists, and plastic surgeons. There are many questions that you may want to answer before you decide if this is the right surgery for you.

Is Top Surgery Right for You?

The goal of top surgery is to remove the breast tissue (mastectomy) from both breasts and create a masculine appearance to your chest. It is performed as a single stage procedure. There are many techniques used to perform top surgery, and many factors should be taken into consideration when choosing which technique is best, such as:

• Amount of breast tissue
• Amount of excess skin
• Desire for nipple sensation

Top surgery is a highly individualized procedure. You should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Top Surgery is a good option if:

• You have been diagnosed with persistent gender dysphoria
• You have been under the care of a mental health professional who can provide a letter of recommendation supporting their decision to undergo surgery
• You have been living as a member of their desired sex
• You are of the age to make consent
• You have a positive outlook and realistic expectations

If significant medical or mental health concerns exist, they must be reasonably well-controlled.

Will Insurance Cover Top Surgery?

Top surgery is considered a reconstructive procedure and can be covered by health insurance. However, coverage may only provide a small part of the total fee. It is important for the patient to verify with the carrier that “trans benefits” are a part of their plan. We cannot provide cost estimates for surgical procedures prior to the initial consultation appointment.

What Kind of Results Can I Expect?

The final results of top surgery can help alleviate the feelings of gender dysphoria that some individuals may experience. The removal of the female breast tissue typically also removes some sensation in the chest. Over time, some sensation to the chest skin and nipples may return, and scar lines will improve, although they’ll never disappear completely. There are trade-offs, but most transmen feel these are small compared to the large improvement in their quality of life and the ability to look and feel like a man. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Will I Still Need to Be Concerned About Breast Health?

Although the breast tissue is removed during the procedure, and growth of breast tissue is suppressed by testosterone therapy, the risk of developing breast cancer is not zero. Careful monitoring of breast health through self-exam is essential to long-term health. The practice of medicine and surgery is not an exact science.

What are The Risks?

Dr. Cicuto and his staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications. The decision to have top surgery is extremely personal. you will have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Many individuals view this procedure as a necessary step toward alleviating their gender dysphoria.

Ready to Take the Next Step?

There is some important preliminary information we will need you to fax to us at 717-625-4258 before we can schedule you for a consultation with Dr. Cicuto for top surgery:

1. A copy of your insurance card, front and back. It is your responsibility to verify with your insurance carrier that we are participating with your plan. You will be responsible for all charges billed for your consultation if we do not accept your insurance.
2. Name, date of birth (must be 18 years of age or older), address, social security number, and best daytime phone number. We need this information to verify your insurance coverage. (We also get the pre-certification requirements at this time.) Please note that anyone under the age of 18, smokers, and patients whose body mass index is higher than 35 cannot be considered for surgery.
3. Two letters:
   1. A letter from a mental health professional (licensed therapist, psychologist, or psychiatrist)
   2. A letter from a physician, such as your family physician, Ob-Gyn, or other transgender physician (must be an MD or a DO) Both letters must verify the following:
      1. That you are mentally stable and capable of making an informed decision for surgery
      2. That you have been living with gender dysphoria for more than a year as the gender with which you are currently associating
      3. That it is their recommendation that top surgery be performed

Note: Some insurance companies may be more specific in their requirements for these letters. You are advised to confer with your insurance as to their exact requirements.

Dr. Cicuto will review your information. Once approved, we will contact you to schedule an initial consultation appointment. At your consultation, photos will be taken. These photos, the letters provided by you, and the documentation from your visit will be submitted to your insurance company for review. A decision is typically returned in two to six weeks.

This process does take time. We appreciate your patience as we work together towards your goal.

Our Providers

• Bryan Jonathan Cicuto, DO
• Jessica Marie Brubaker, CRNP

Locations

Plastic & Aesthetic Surgical Associates
Part of Plastic & Aesthetic Surgical Associates
1535 Highlands Drive
Suite 300
Lititz, PA 17543-7681

Phone: 717-625-3509
Fax: 717-625-4258