Gender Affirmation

The decision to undergo transfeminine top surgery is a very personal one. It requires courage and determination, and it requires a caring surgeon who places the patient’s priorities above all else. Dr. Richard Tepper, Board-Certified Plastic Surgeon for nearly twenty years, is available to assist you during this process of upper body feminization, with the goal of imparting a natural, feminine shape and appearance to the breasts.

There are many things to consider prior to this procedure. Some of the more obvious ones are the desired size change, the type of implant to use, and the location of the incisions to be used. But it is important that the patient have a stable and balanced outlook on this. Patients have typically been under the care of a mental health professional for quite some time, and a supporting letter from that professional is an essential step. Living as a member of the desired sex is another important factor to consider.

As with any surgery that can impact one’s appearance, it is important to have a realistic expectation of what surgery can and cannot deliver.

Despite the importance of such a procedure, not all insurance companies cover the complete cost of treatment. Dr. Richard Tepper will gladly review options for you and help provide a breakdown of fees, depending on the length and extent of your procedure.

Similar in concept to Transfeminine, Transmasculine Top Surgery is designed for individuals seeking a masculine (i.e. male) appearance to the chest for a female to male transition. Transmasculine Top Surgery is surgery to remove the existing breast tissue in order to contour a flatter, male-appearing chest.

There are several surgical options described for this surgery, but many people become too caught up in the name or the incision location and fail to understand why one procedure is chosen over another. In other words, it is usually the patient’s own individual desires, combined with that person’s own anatomy, that leads to the proper choice.

Stated another way, if a patient has a large breast, then more skin needs to be removed. This in turn will result in longer scars. If the starting nipple location is close to a typical “male” nipple location, which tends to be lower and more to the side than in a female breast, then not as much work is required to reposition the nipple. If someone wants a very flat area underneath the nipple, then that patient may ultimately lose nipple sensation because of the need to remove tissue right beneath the nipple.

There are then implications as to whether or not to remove and reapply the nipple as a graft. These specific talking points are essential and Dr. Tepper will review these with you. There may be more than one surgical option, based on size and location of scars, but it is essential that you understand the limitations and benefits of each.