Male to Female Surgery / MTF Surgery in Dallas TX

male to female surgery dallas tx

MTF Top Surgery & Facial Feminization Surgery

What is involved in Male to Female (MTF) Top Surgery?

Male to female (MTF) or male to nonbinary (MTN) top surgery, also known as augmentation mammoplasty, involves placement of implants under the breast tissue or injection of fat into the breast tissue. MTF or MTN top surgery in combination with facial feminization surgery (FFS) may be the only surgical steps in one’s transition.

There are two techniques that are used for placement of implants during male to female surgery. One technique involves placing the implant under the muscle (sub-pectoral breast augmentation) and the other involved placement of the implant over the muscle and under the breast tissue (sub-glandular breast augmentation). The decision on where to place the implant depends on not only on the breast tissue and chest wall dimensions, but also the patient’s desire. Our preference in non-transgender women is to place the implant under the muscle so long as the patient does not have an extensive muscle mass with strong pectoralis muscles (typically seen in body builders). This provides a more natural upper pole of the chest.

Although rarely bothersome, strong pectoralis muscles in muscular individuals could cause what is called “animation deformity,” which happens when the pectoralis muscle is flexed. Placement of implants over the muscle creates a sharper transition from the upper pole of the breast and cleavage to the chest wall, creating a more “done” look, however it avoids the potential animation deformity. In transwomen patients, we pay extra attention to such details and discuss them extensively with patients in advance.

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The breast implant options are either saline filled implants or silicone implants. Saline implants are less expensive than silicone implants, but silicone implants feel more natural. When insurance covers the procedure, we prefer to use the newer generation silicone implants, which have a cohesive gel and are much more resilient to rupture or long term problems.

Special techniques are used in male to female surgery cases where patients have minimal breast tissue and strong pectoralis muscle to provide the best and most natural outcomes in MTF top surgery.

We utilize 3 dimensional imaging to assess the chest and various types of breast implant sizes in order to achieve the best result with each individual patient. Our patients can look at these images during their consultation and select the implant size and type that they prefer, as long as there is adequate tissue to support the implant.

To see an example of a before and after result of a male to female surgery, as well as a video of intraoperative details of the surgery, please visit www.amirlakplasticsurgery.com or our before and after gallery.

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What are the Risks of MTF Top Surgery?

Breast asymmetry is always a risk of any breast augmentation. Although we utilize the most advance technique in order to overcome breast asymmetry, there are often times when the pre-existing breast anatomy dictates the position of the augmented breast. Use of fat grafting has dramatically improved some of these issues, however this technique rarely necessary.

Nipple sensation change or loss is rare, but is a potential risk in MTF top surgery.

Hematoma or bleeding under the breast tissue is also a risk of male to female surgery. This can be prevented by avoiding heavy lifting and increased physical activity after surgery, as well as avoiding all daily activities that increase blood pressure.  Avoiding medications such as aspirin, ibuprofen (Motrin), fish oil, glucosamine, chondroitin, vitamin E, and Omega 3 for two weeks before surgery can decrease the incidence of unwanted bleeding during or after surgery. Please see the complete list of medications that are to be avoided at least two weeks before surgery.

Breast pain following surgery could be a rare but potential risk.

Capsular contraction is also a potential risk following male to female surgery. If severe, this issue would need to be addressed with an additional surgery.


Do I Have to Stop Hormonal Treatment before Male to Female Surgery?

Typically, it is not necessary to stop hormone treatments prior to male to female surgery. However, female hormones can increase the risk of certain cancers as well as venous thrombosis, which should be assessed on individual basis.


Facial Feminization Surgery (FFS)

Facial feminization surgery (FFS) includes multiple maneuvers which may include forehead reduction, rhinoplasty, upper lip lift, reduction or shaving of the chin, and electrolysis. Often the result of a well done natural facelift will increase the aesthetic goals.

Insurance does cover certain operations, though it can be more difficult to obtain approvals for FFS in comparison to MTF top surgery. We have a dedicated team of insurance coordinators who will work on the patient’s behalf to obtain appropriate approvals from their insurance company.

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Forehead Reduction

Forehead reduction includes reducing the frontal bossing in order to create a more feminine look to the upper brow forehead area. This can be done through traditional approach with a coronal or hairline incision and shaving the bone or doing a bone setback operation. Dr. Amirlak has been involved in research and publication of the first ever operation for reduction of frontal bossing using a minimally invasive endoscopic approach. This is called endoscopic reduction of frontal bossing and is a great option in patients that do not want a coronal incision or hairline incision. The disadvantage of this procedure is that it can only be done in certain patients with specific thickness of the frontal bone. In order for us to assess the potential for this option, we obtain a CT scan with specific measurements.

To see an example of the before and after following FFS forehead reduction, as well as an intraoperative video using minimally invasive endoscopic shaving of the frontal bossing, please visit www.amirlakplasticsurgery.com or our before and after gallery.


Dr. Amirlak proudly provides transgender patients from Dallas, TX and surrounding areas with Male to Female Top Surgery and Facial Feminization Surgery. Contact Amirlak Plastic Surgery at (214) 974-4948 or fill out a Contact Form here.

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