FTM Chest Masculinization

If you are considering chest masculinization surgery, we invite you to use our discreet online form to contact Dr. Paul Steinwald, board-certified Colorado plastic surgeon.

FTM Top Surgery/Chest Masculinization
 Before & After Photos

Case: 1 of 9
Case: 1 of 9
Before/After (13 months)
Case: 1 of 8

Athletic 36 year-old on T for several months, who wished to have as much muscular definition as possible. I advised an inverted-T approach (as opposed to a "button-hole" (true double-incision) approach, to show his pecs as best possible. The patient had approximately 180 gm of tissue removed on either side, and ultimately did very nicely, sho... Read More
Surgeon: Paul M. Steinwald, M.D.
Before/After (6 months)
Case: 2 of 8

19 year-old athletic trans-man with a smaller chest size, but wished to have more pectoralis definition showing - underwent (drain-free) "inverted-T" Top Surgery, shown here at 6 months post-op. If you have similar issues/desires and live in or near Denver, Top Surgery techniques such as this may give you optimal results as well. Read More
Surgeon: Paul M. Steinwald, M.D.
Case: 3 of 8

This 21 year-old patient was fairly early in the process of gender reassignment, having bound her chest for several months (and still favoring the “she” pronoun), but was committed to the idea of “top surgery” to masculinize her chest, which was otherwise in a moderate B-cup bra size range.  She came to me from Connecticut, having found... Read More
Surgeon: Paul M. Steinwald, M.D.
Before/After (6 weeks)
Case: 4 of 8

Surgeon: Paul M. Steinwald, M.D.
BEFORE / AFTER (1 week)
Case: 5 of 8

24 year-old patient from the Boston area with a very large DD/DDD size chest; "inverted-T"/nipple attached Top Surgery performed (perhaps the largest breast size on which this should be attempted), but the patient did fine overall, with longer-than-average scars, but a very masculinized effect appreciable within a week, especially on side vie... Read More
Surgeon: Paul M. Steinwald, M.D.
BEFORE / AFTER (3 years)
Case: 6 of 8

24 year-old transgender male following a standard one-stage "inverted-T" FTM procedure (starting as a 38D cup, with significant ptosis or drooping). This fair-skinned patient had fairly red scars the first year, but here (by year 3) they have faded appreciably. Read More
Surgeon: Paul M. Steinwald, M.D.
BEFORE / AFTER (1 year)
Case: 7 of 8

This 28 year-old transgender male from Chicago came to us seeking "top surgery"/chest masculinization via the "keyhole technique" to help preserve nipple sensation.  Had been identifying male and binding for several years, on testosterone for one.  5'4", 145' at time of surgery.  Had 460 gm removed from the right side, 640 from... Read More
Surgeon: Paul M. Steinwald, M.D.
Case: 8 of 8

24 year-old trans-man with an excellent pre-operative testosterone effect, maintained and complementing the standard-approach chest masculinization procedure to address asymmetries and leave the nipple attached and sensate.  Photos are from approximately 1 month post-op. If you are in the process of "gender affirmation" an... Read More
Surgeon: Paul M. Steinwald, M.D.

Keep in mind that each patient is unique and your results may vary.

Over the past decade-plus, many transgender males from Colorado Springs, Fort Collins, and beyond who are in the process of undergoing “gender affirmation” have contacted Dr. Paul Steinwald to inquire about chest masculinization (“top surgery”) in Denver, especially in light of the potentially disappointing results associated with nipple excision and grafting (somewhat misnamed the “double incision” technique). Dr. Steinwald is now able to achieve a masculine-appearing chest in most cases in one stage. A pioneer in the field of optimal chest masculinization while maintaining a degree of nipple sensation, Dr. Steinwald has delivered several formal lectures on the topic, and has built an international patient base, having performed hundreds of female-to-male (FTM) breast surgery procedures for patients from near and far.

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I was very happy with Dr. Freeman! Not only was he able to get me in quickly, he made me feel at ease...
Dr. Wolfe and his staff were wonderful! I went to Dr. Wolfe as he was recommended by someone that I...
Dr. Paul Steinwald at The Center for Cosmetic Surgery in Golden is nothing short of exceptional. From...
Absolutely love everyone at this center. Very professional and made me feel really good about my decision....

What are the different types of top surgery?

There are several different techniques that plastic surgeons can use to give the chest a flatter, more masculine appearance, including:

  • Periareolar
  • Buttonhole
  • Keyhole
  • Inverted T
  • Double incision

As a top surgery specialist, Dr. Steinwald typically uses a variation of the inverted T technique (inferior pedicle/Wise pattern) approach to breast reduction. His technique, often performed in a single surgery, is basically an extended or “extreme” version of a standard breast reduction, applying established principles of that procedure. This procedure usually results in an anchor-shaped scar (mostly along the fold beneath the breast) and has a reasonably high probability of retaining at least some nipple sensation.

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Am I a good candidate for top surgery?

There are risks above and beyond a standard breast reduction, especially in patients with D cup breasts or larger, or those who smoke. Patients are carefully screened preoperatively for the above reasons, but mostly because this is a (relatively) irreversible procedure that will have a significant impact not just on their life, but their actual identity. In appropriate candidates with realistic expectations, however, the results can be dramatic (as with all plastic surgery!), and most patients express extreme satisfaction with the results. A consultation with Dr. Steinwald in Denver will determine whether top surgery will work for you.

Will my insurance cover this procedure?

Because this procedure is being performed to dramatically change one’s appearance (and not for chronic symptoms associated with mammary hypertrophy), and because Dr. Steinwald is one of the few surgeons in the country applying specialized techniques and taking on added risks to perform this surgery, we do not accept insurance for this procedure. If you are interested in more detailed information on this innovative and effective procedure that Dr. Steinwald performs for Denver-area FTM patients, we invite you to also visit www.topftmsurgery.com.

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Financing Your Procedure

Where is the surgery performed?

Your surgeon will perform your gender reassignment procedure at our Apex Surgical Facility in Denver on an outpatient basis.

What kind of anesthesia is used?

Most cases require general anesthesia from our board-certified anesthesiologists. Top surgery generally takes 2 to 3 hours depending on the amount of tissue to be removed and other factors.

What is recovery like after top surgery?

Recovery following chest masculinization is similar to standard breast reduction surgery for women. Patients can either have their surgery as an outpatient procedure or they may choose overnight nursing care. Patients usually have small surgical drains after their procedures, which are usually removed within 7 to 10 days at a follow-up appointment. Patients may be asked to wear a special compression garment for several weeks to provide support and help with swelling.

Most patients are pleasantly surprised at how little discomfort they experience (usually a heaviness or general soreness). Most discomfort is in the underarm area, as the central breast skin is relatively numb for several months. Patients are usually sent home on a moderate strength pain medication and 5-day course of oral antibiotics.

Patients are encouraged to rest during the days just after surgery, returning slowly to light activity in the first week. Most return to work and other activities in about 7 to 10 days. After about 2 weeks, light exercise such as walking is encouraged, and patients can return to full exercise levels after about 4 to 6 weeks.

Dr. Steven Vath, Dr. Matthew Freeman, Dr. Teresa Cunningham, Dr. Andrew Wolfe, Dr. Paul Steinwald


Our team of experienced plastic surgeons are respected industry leaders, having investigated breast implants and published, lectured, and taught on the subject of breast augmentation surgery, to both national and international audiences.

The Center for Cosmetic Surgery has 2 offices conveniently located in the Denver metropolitan area. One is just outside Denver in lovely Golden, Colorado, immediately off 6th Avenue West, and the other is downtown in Cherry Creek, Denver. Please schedule a personal consultation to learn what top surgery can do for you. Simply call (303) 278-2600 or request your consultation online.

For information about preparing for your surgery and postoperative guidelines, visit our patient resources page.