Cincinnati Cosmetic Surgeon Explains Gender Affirming “Top Surgery” Options
Gender-affirming “top surgery” has become one of the most sought-after procedures in cosmetic surgery, with demand actually tripling between 2016 and 2019. In fact, top surgery now accounts for more than 55% of all gender-affirming surgeries.
For many, achieving physical alignment with their gender identity represents a deeply personal and transformative journey. Gender-affirming “top surgery” procedures, including male-to-female breast augmentation and female-to-male chest masculinization, have become a cornerstone of this process, offering patients the opportunity to feel more comfortable and confident in their own bodies.
At the Mandell-Brown Plastic Surgery Center, we respect each individual’s personal health journey. Cincinnati cosmetic surgeon Dr. Mark Mandell-Brown has lectured nationally on top surgery techniques and emphasizes that achieving your intended goals may require multiple procedures to ensure the most natural-looking results.
Gender-Affirming Top Surgery With Dr. Mandell-Brown
“Top surgery” refers to chest procedures designed to align your physical appearance with your gender identity. For patients transitioning from female to male, this involves creating a more masculine chest contour. For those transitioning from male to female, the goal is to develop feminine breast curves that complement your frame.
Dr. Mandell-Brown requires confirmation from a treating gender-affirming physician or psychological clearance before proceeding with these important, life-changing procedures. This collaborative approach ensures you’re fully prepared for your surgical journey.
Dr. Mandell-Brown holds triple board certification in Facial Plastic Surgery, Body Cosmetic Surgery, and Head & Neck Surgery, with over 30 years of experience.
Female-to-Male Top Surgery Options
Creating a masculine chest requires careful consideration of your anatomy, skin elasticity, and aesthetic goals. Dr. Mandell-Brown offers several approaches, always aiming for the least invasive option that achieves your desired result.
1. Liposuction with Renuvion Skin Tightening
Since breast tissue is approximately 80% adipose (fatty) tissue, liposuction through small 2mm incisions can significantly reduce breast size. Dr. Mandell-Brown often combines this with Renuvion, a helium plasma-based energy device that tightens skin through the same access points used for liposuction. This approach works best for patients with good skin elasticity and moderate breast size.
2. Circumareolar Excision (“B” Lift)
This technique involves removing skin around the areola while performing breast liposuction and gland excision. The resulting scar is hidden within the areola’s natural border, making it virtually undetectable.
For some patients, Dr. Mandell-Brown recommends a staged approach, performing a second “B” lift 6 to 12 months later to further flatten the chest. This two-stage method often eliminates the need for more chest incisions and potential scarring.
3. Vertical Mastopexy with Anchor Incision
For patients with larger, more pendulous (drooping) breasts, a “keyhole” or “C” lift incision extending into the mid-breast area may be necessary. While more skin and breast tissue can be removed with this approach, the trade-off is a potentially visible scar.
4. Double Incision Mastectomy with Free Nipple Graft
This procedure is reserved for patients with large, pendulous breasts who desire the flattest possible chest contour. While more tissue can be removed, patients should understand that the nipple will have no sensation after this procedure. Additionally, the nipple skin graft doesn’t always survive completely, though it will heal if properly cared for. In some cases, permanent micropigmentation (medical tattooing) can help create a natural-looking areola if needed.
Several procedures may be required to obtain your intended goal; Dr. Mandell-Brown will discuss all benefits, risks, and alternatives during consultation.
Male-to-Female Top Surgery Options
Creating feminine breast contours requires careful attention to proportion, implant selection, and surgical approach to achieve results that complement your body frame.
1. Breast Augmentation with Implants
Both saline and silicone implants can create feminine curves. During your consultation, Dr. Mandell-Brown will discuss the pros and cons of each option based on your anatomy and preferences.
Implant placement, either over or under the muscle, is also carefully considered. Dr. Mandell-Brown typically uses the inframammary approach (under the breast), transaxillary approach (through the armpit), or transareolar approach (through the areola) based on your specific anatomy and goals.
2. Fat Grafting Considerations
While fat transfer to the breasts is possible, the significant amount of fat required and the unpredictable absorption rates generally make this approach less beneficial for achieving the dramatic changes most patients desire.
What Sets Dr. Mandell-Brown Apart
Dr. Mandell-Brown has lectured nationally on top surgery techniques and brings over three decades of experience to every procedure. He’s known for his Natural Look™ results and takes a conservative, staged approach when possible to minimize scarring and optimize outcomes.
“I highly recommend Mandell-Brown Plastic Surgery Center. Dr. Mandell-Brown and his staff do a wonderful job making patients and their family members feel comfortable, understood and important. He took time to understand exactly what outcomes I wanted to achieve, and the results are perfect. The experience feels very personalized, and Dr. Mandell-Brown even made an appointment for me on a Sunday morning!”
All procedures can be performed at our state-licensed, accredited surgery center, which provides hospital-quality care with the added privacy and comfort of a dedicated cosmetic surgery facility.
If you’re considering gender-affirming top surgery, we invite you to schedule a personal consultation where Dr. Mandell-Brown can evaluate your anatomy and discuss realistic outcomes tailored to your goals.
As one of the most experienced gender affirmation surgeons in the Cincinnati, Springboro, and Dayton areas, Dr. Mandell-Brown combines technical expertise with an understanding of the deeply personal nature of these procedures.
Call 513-984-4700 or contact us online to schedule your consultation and learn more about your top surgery options.
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