Surgery Types | FTM Top Surgery ® | Dr. Charles Garramone The Best Surgeon

Surgery Types

Transgender Surgery Types for FTM Top Surgery® and ManSculpture®:

At The Garramone Center, Dr. Garramone performs two types of chest masculinization surgery (FTM Top Surgery® Procedure) for his FTM (female to male) transgender, trans-masculine, trans-male, gender neutral, gender variant, lesbian, pan-gender, and female identifying patients:

    • FTM Top Surgery® Procedure Double Incision Method
    • FTM Top Surgery® Procedure Peri-areolar or Keyhole Method

Dr. Garramone also performs the ManSculpture® Procedure (Body Masculinization) for his FTM (female to male) transgender patients.

FTM Top Surgery® Procedure Double Incision Method: Transgender Surgery FTM Top Surgery® Procedure Double incision Method can be performed on FTM patients presenting with pendulous sagging breasts. This usually requires a scar extending from underneath the existing breast fold to the lateral outside of the chest. The nipple and areola are removed, resized, and replaced as a “free nipple grafts” in a new position to give a “male” appearance to the chest. The scars are permanent, but most scars will fade and many patients are very happy with their new chest appearance.

FTM Top Surgery® Procedure Peri-areolar or Keyhole Method: Transgender Surgery FTM Top Surgery® Procedure Peri-areolar or Keyhole Method is usually reserved for FTM patients with very small breasts who have little breast tissue, breast skin that does not sag, or breast skin that is too tight to perform a double incision method. Dr. Garramone may recommend liposuction of the chest first to remove as much breast tissue as possible and then perform an incision along the lower border of the nipple-areolor complex. Through this incision the remaining breast tissue can be removed.

FTM Top Surgery® REVISIONS OF OTHER DOCTORS WORK: Roughly 20% of the consultations performed by Dr. Garramone each year, involve discussions with many patients who have already had FTM Top Surgery performed by a different doctor. Some patients have minor concerns they would like fixed, but many have major deformities from their prior surgery performed by other doctors. Dr. Garramone has become a specialist in fixing these deformities caused by other doctors, and can discuss these options with you if you have had a less than ideal result from another surgeon.

Areas for the Mansculpture procedure

Areas for the ManSculpture® Body Masculinization


ManSculpture® Body Masculinization: Transgender Surgery ManSculpture® Body Masculinization is commonly performed at the same time as the FTM Top Surgery® Procedure. This consists of shaping the body to a more “masculine” form with the use of Power Assisted Liposuction techniques. By lipocontouring the abdomen (stomach), love handles (flanks), and the “saddle bag” area of the outside hips or thighs, Dr. Garramone can give your body a more streamlined and masculine appearance. By performing ManSculpture® at the same time as the FTM Top Surgery® Procedure, you can save money on the overall operating costs, as performing both procedures separately at different times will be considerably more costly. This is why Dr. Garramone recommends this procedure to be performed safely and concurrently with your chest surgery.


FTM Top Surgery® Procedure Double Incision Vs “Keyhole” Surgery: Most patients usually know if they are a candidate for the Double Incision Method. This would include breasts larger than an “A-cup”, sagging breast skin, or personal preference. We receive a lot of inquiries from patients about the “Keyhole” or “Purse String” procedure, and whether this is the right surgery for them. There are a few things that these smaller scar procedures cannot accomplish.

    • First, nipple position cannot be controlled with the “Keyhole procedure. It is not uncommon for the nipple areolar complex to actually become lower on the chest once the breast tissue is removed. The nipple should be placed in the lower outer portion of the pectoralis major muscle to give the most convincing “Male” aesthetic chest, and this is unpredictable with the “Keyhole” procedure.
    • Second, the size of the nipple areolar complex cannot be safely resized without potentially causing the blood supply to the nipple to become compromised leading to “death” of the nipple. Most female areolas are much larger than a biological males, and resizing the areola is a major consideration to be made for proper surgical results to occur.
    • Third, even the slightest bit of excess breast skin below the nipple position can cause contour irregularities of the lower chest. Your skin contracts after surgery only to a certain extent, and the contraction is unpredictable. This leaves little control on how your final chest contour will appear. Also, the final chest contour may not be noticeable until several months after the initial “Keyhole” surgery, where as the chest contour for the “Double Incision Method” is more readibly noticeable immediately after surgery.All of these issues occur with the “Keyhole” or the “Purse String” surgery, and not with the “Double Incision Method”. While some patients are good candidates for the “Keyhole” surgery, they may want to consider these few uncontrollable resulting outcomes and decide whether this is something they can find acceptable. Otherwise, the “Double Incision Method” may be the best option for them, as this is the only surgery that accurately addresses the nipple position, areolar size, lower chest contour, most immediate appreciation of the final chest contour, and most aesthetically pleasing “Biological Male” outcome.

Scars and FTM Top Surgery® Procedure: We receive a lot of questions regarding scars with the FTM Top Surgery® Procedure.Many questions ask about the length of the scar, the shape of the scar (straight or curved), widening of the scar, and color of the scar. You must remember, every patient is different and every patient requires a different scar and scar placement. How your scar heals depends a lot on your genetic makeup and inherent ability to heal. Dr. Garramone will discuss the potential appearance your scar and scar placement during your visit with him.We also recommend the use of silicone based scar products for after surgery and have them available for purchase in our office.

Revisions of FTM Top Surgery® Procedure: Most patients will undergo only one Transgender Surgery procedure to obtain their desired chest or breast shape. Some patients may still require additional procedures to correct excess skin issues, an asymmetry or a complication from the surgery. If a patient is over their ideal body weight, then there is an icreased chance a future revision surgery will be required. Patients who are overweight or have a lot of excess skin, may require additional surgery for contouring which is not part of their initial chest surgery. Dr. Garramone always explains this in great detail when consulting and seeing his patients preoperatively. Transgender Surgery has no guarantees and can be very challenging. The Transgender Patient must be well informed and willing to accept the possibility of future Transgender Surgery to achieve their desired goal. Dr. Garramone does not usually charge for revision surgery of his prior patients within the first year after surgery, but keep in mind, all revisions are required to be performed in a surgical center or hospital. The Operating Room and Anesthesia Fees cannot be waived and are the responsibility of the patient.

With this in mind, the Transgender Patient has many options for their surgical care and after surgery can begin their life with a new sense of well being.