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.
Please call our office to setup a phone consultation at (954) 752-7842
Dr. Charles Garramone is the leading pioneer and one of the earliest creators of FTM Top Surgery & FTN Top Surgery
FTM Top Surgery is a procedure developed by Dr. Charles Garramone to create a more masculine looking chest in transgender men and non-binary individuals. This procedure developed by Dr. Garramone involves the removing of excess breast, fat, and skin, and repositioning the nipples through reconstruction to create a natural looking massculine chest. FTM top surgery will help relieve gender dysphoria and help alleviate issues related to chest binding.
For almost 20 years The Garramone Center has been providing the most sought after FTM Top Surgery & FTN Top Surgery results in the world.
Dr. Garramone and his team have paved the way and advanced Transgender health and surgical care for thousands of individuals, and have set the medical standard of care for generations to come.
Our website is full of educational material and we encourage you to explore everything we have presented so that you have a complete understanding of how Dr. Garramone can help you reach your goal of having FTM Top Surgery & FTN Top Surgery.
FTM Top Surgery started here, so please read along and learn about this innovative surgery.
The Most Experienced FTM Top Surgeon in the World
Dr. Garramone has performed more FTM Top Surgery & FTN Top Surgeries than any other Plastic Surgeon in the World
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Professional & Friendly Staff
Our staff works with thousands of FTM Top Surgery patients every year across the globe, helping to deliver a smooth and efficient experience for your upcoming Top Surgery
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Dr. Garramone On Call 24/7
Dr. Garramone is available to his surgical patients at all times for any concerns that may arise after FTM Top Surgery & FTN Top Surgery
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Convenient Appointments
We make your first consultation with Dr. Garramone easy and convenient for you. Your FTM Top Surgery & FTN Top Surgery Journey starts here.
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Clean & Efficient Office
Our office is comfortable and clean. We are located near the Hospital where your FTM Top Surgery & FTN Top Surgery will take place.
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Fees Explained in Detail
We explain all fees in detail before your appointment, with no suprise fees or costs regarding your FTM Top Surgery & FTN Top Surgery
FTM Top Surgery and Gender Related Services
Below we have organized the entire surgical process from start to finish for you. Here you can learn all of the treatment options for FTM Top Surgery & FTN Top Surgery (Transgender Top Surgery) and ManSculpture® Body Masculinization.
Gender Confirmation Surgery Types
Learn about the different FTM Top Surgery & FTN Top Surgery types and body masculinization known as ManSculpture
Before Surgery
Learn about the steps required before planning your FTM Top Surgery & FTN Top Surgery and ManSculpture® surgery. Including requirements, consultations, and before surgery planning.
After Surgery
Learn about FTM Top Surgery & FTN Top Surgery and ManSculpture® aftercare and what to expect when completing your surgery.
Cost of Surgery
Learn about the projected costs of FTM Top Surgery & FTN Top Surgery and ManSculpture® surgery, how to finance the procedure, and insurance steps to help with reimbursement
Non-Binary Top Surgery
Learn about what Non-binary top surgery is and how Dr. Garramone can help
Botched Surgery Revisions
Have you had a poor outcome with your FTM Top Surgery & FTN Top Surgery with another doctor? Learn about what we can do to help correct your results.
“I have been providing Transgender surgical services, specifically FTM Top Surgery & FTN Top Surgery and ManSculpture®, for almost two decades for thousands and thousands of patients. I have dedicated my life to improving the quality of life for so many individuals. I cannot think of a better way to use my surgical skills than by continuing to lead Transgender Healthcare into the future. My staff and I look forward to helping you.”
Dr. Charles Garramone
Board Certified Plastic & Reconstructive Surgeon
Surgery Types
Here you will learn about the many different procedures being performed for Transgender Surgery and Gender Confirmation Surgery for Female to Male and Female to Non-binary individuals. Dr. Charles Garramone is an expert in all of these surgeries, but will only recommend what will work best for your body type.
You will learn about:
- FTM Top Surgery & FTN Top Surgery Chest Surgeries
- ManSculpture® Body Masculinization
- Other Surgeries
and FAQ’s
The Most Experienced Plastic Surgeon in the World
Dr. Charles Garramone has performed more FTM Top Surgery & FTN Top Surgeries than any other physician in the world. He is the inventor of ManSculpture® Body Masculinization and a leader in Transgender Healthcare.
Dr. Charles Garramone’s Services
FTM Top Surgery & FTN Top Surgery and ManSculpture® Body Masculinization are the New standards of care when having FTM Top Surgery, and Dr. Garramone is the creator and the only Plastic Surgeon offering these methods. His methods are based on him performing Thousands of these procedures. Not many surgeons can attest to performing thousands of these techniques during their entire career, but Dr. Garramone has and continues to lead in this field of Plastic Surgery
FTM Top Surgery & FTN Top Surgery
At The Garramone Center, Dr. Garramone performs two types of chest masculinization surgery (FTM Top Surgery & FTN Top Surgery Procedure) for his FTM (female to male) transgender, trans-masculine, trans-male, non-binary, gender neutral, gender variant, lesbian, pan-gender, and female identifying patients:
- FTM Top Surgery & FTN Top Surgery Procedure Double Incision Method
- FTM Top Surgery & FTN Top Surgery Procedure Peri-areolar or Keyhole Method
FTM Top Surgery & FTN Top Surgery Procedure Double Incision Method: Transgender Surgery FTM Top Surgery & FTN 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 & FTN Top Surgery Procedure Peri-areolar or Keyhole Method: Transgender Surgery FTM Top Surgery & FTN 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 & FTN 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.
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- 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 readily 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.
Breast Reduction for Gender Confirming Care (non-masculinization breast reduction)
Many people contact our office regarding Breast Reduction surgery for Gender Confirming Care. Most of these patients do not want the traditional Double Incision Method Chest Surgery, and would prefer a reduction in the size of their breasts to something more congruent with their Gender Identity. There are two main types of Breast Reduction Surgery that can be performed, and this is dependant on the patient’s breast size and requested new breast size:
- Traditional Breast Reduction
- Breast Reduction with Free Nipple Grafts (most commonly performed for Gender Confirmation)
The options for Breast Reduction can be discussed during your phone consultation with Dr. Charles Garramone. He will discuss the expected results and scar placements required. Most of the postoperative care is similar to traditional chest masculinization.
ManSculpture® Body Masculinization (MaleSculpture®):
Transgender Surgery ManSculpture® Body Masculinization is commonly performed at the same time as the FTM & FTN 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 with ManSculpting, Dr. Garramone can give your body a more streamlined and masculine appearance. By performing ManSculpture® at the same time as the FTM & FTN 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.
Who created ManSculpture® or MaleSculpture®?
ManSculpture® or MaleSculpture® are names Dr. Garramone created to refer to use of liposuction to perform Body Masculinization. Dr. Garramone has specific techiniques and protocols to performing ManSculpture®, which no other surgeon can claim to be able to perform ManSculpture® or MaleSculpture® specifically. Dr. Garramone has performed thousands of ManSculpture® procedures, and is the only Plastic Surgeon in the World who can perform the ManSculpture® or MaleSculpture® procedure. If you are seeking Transgender Body Masculinization, then Dr. Garramone’s procedure ManSculpture® is the “gold standard” procedure and most recognized procedure for achieving this goal.
Remember, “No other surgeon in the World can say they will perform ManSculpture® or MaleSculpture® for body masculinization, as Dr. Garramone is the only Plastic Surgeon in the World who can offer this procedure.”
What areas can ManSculpture® Body Masculinization be performed?
Most common areas requested are the Flanks (love-handles), Outside Thighs, Abdomen (stomach), Inside Thighs. Look at the image to the right—–>
Scars and FTM Top Surgery & FTN Top Surgery Procedure
We receive a lot of questions regarding scars with the FTM Top Surgery & FTN 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 & FTN Top Surgery Procedure
Most patients will undergo only one FTM Top 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 charges a nominal fee for revision surgery of his prior patients within the first year after surgery, but keep in mind, this fee may be higher if revisions are required to be performed in a surgical center or hospital. The Operating Room, materials, and Anesthesia Fees cannot be waived and are the responsibility of the patient.
The “NEW” Buttonhole and Inverted-T Technique for FTM Top Surgery
At least once a week we receive an email or phone call requesting this “New” procedure, and whether Dr. Garramone will start offering this as a choice for chest surgery. The simple answer is “No, not unless there is an absolute indication for it, which is true of all chest procedures.”
The Buttonhole technique has lately been touted as a “New” procedure unlike anything else, and superior to many other choices including the Double Incision Method, because it allows preservation of nipple sensation. But, it shares the common technique of making the exact same incisions as the Double Incision Method, but leaving the nipple attached to underlying breast tissue and then creating a new incision or “buttonhole” to bring the nipple out through, thus the “Buttonhole” technique. Very simply, it is the exact same procedure as the “Inverted-T” procedure, but without the small vertical scar. Sadly, both the Inverted-T and Buttonhole techniques promise maintaining nipple sensation, which is rarely true. They also require leaving behind a fair amount of breast tissue to maintain the nipple sensation, thus running into the same problems of giving the appearance of excessive breast tissue. Basically, it looks like the Patient still has breasts and fullness in the lower portion of the chest and therefore prevents them from attaining the “Ideal Aesthetic Male Chest” they are looking for. Photographs or diagrams on a Plastic Surgeon’s website can show you a great result for any procedure ever described. Why? Because they are taken with proper forward lighting and with the Patient in a neutral position, thus hiding any shadows or appearance of chest fullness. Dr. Garramone has performed many consultations for Revisions of the Inverted-T and Buttonhole technique, and it almost always requires converting the procedure to a Traditional Double Incision method just to remove the excessive amount of breast tissue that was voluntarily left behind by the previous surgeon. “Is it indicated for all Patients?” No, it may be indicated for some very rare specific cases, but should never be considered as a first option for the general population seeking chest surgery. The same way the “Keyhole” technique is not indicated for Patients with D-cup breasts.
Finally, the “NEW” Buttonhole Technique for FTM & FTN Top Surgery is not really a “New” procedure by any means, and was first described in 1925 by Dr. R. Passot and has been performed in all types of Breast Reduction and Mastectomy Surgery for over 90 years (if not longer) in the specialty of Plastic Surgery. Labeling something as “New” does not make it revolutionary, nor does it make it “New”.
FTM Top Surgery & FTN 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 & FTN 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.
Can I have the surgery with No Drains?
Yes, but Dr. Garramone does not recommend it. There are risks to not having drains placed after surgery including excessive swelling, increased pain, seroma (fluid pocket) formation, contour irregularities from a seroma, delayed healing from a seroma, etc. If you are willing to accept these risks then you can request not to have any drains placed during your surgery.
Can I have the surgery with No Nipple Grafts?
Yes, many patients are opting to NOT have any Nipple Graft Reconstruction done during their chest surgery. Most of these patients want to have the nipples Tattooed onto their chest at a later date, but some patients just do not want to have Nipples. This is your choice, and if you do not want Nipple Grafts then let us know during your consultation with Dr. Garramone.
Non-Binary Top Surgery? What is it?
We receive many inquiries every day asking “Does Dr. Garramone perform top surgery for Non-Binary (nonbinary) patients?
The answer is “Yes!”
Dr. Charles Garramone has been performing Non-Binary (nonbinary) Top Surgery for many years as far back as 2005, even before Non-Binary (nonbinary) was even a common term used by idividuals who identify as Non-Binary (nonbinary) or Gender Variant or Gender Neutral, etc. He has been performing this surgery before it was even common for any surgeon to do so. Up until about 2012, most of Dr. Garramone’s patients identified as FTM (female to male), while only about 20% identified as Non-Binary (nonbinary). Since 2012 the number of patients identifying as Non-Binary (nonbinary) has steadily increased in Dr. Garramone’s practice and comprises about 40% to 50% of patients seeking Top Surgery.
Why are there so many people identifying as Non-Binary (nonbinary)?
There is no clear answer to this question. From a sociological point of view, there were probably always people who identified as something not male or female. They just didn’t know how to express this, or there were no labels for this classification. Also, society has become more understanding of the differences of gender identities, which allows many people who identify as Non-Binary (nonbinary) to be able to live their lives with this identity. So the answer isn’t so precise, but it is very apparent that we live in a modern era with an understanding of gender being able to exist in various degrees of male, female, or somewhere in between.
What is GenSculpt® FTM Top Surgery?
Dr. Garramone performs several hundred FTM Top Surgeries per year and has had thousands of excellent results. He is considered the World’s Leading Authority on FTM Top Surgery. Dr. Garramone speaks with over 2,000 new patients a year about having chest surgery and body surgery, so as you can imagine, these people represent a very diverse and comprehensive uniqueness of the Gender Spectrum. Chest surgery is sought after by many people with different gender variances, so Dr. Garramone created GenSculpt® . It is a chest surgery method and protocol for people born as biological females or intersex, with varying Gender Identity or Gender Dysphoria.
What Gender do you identify with?
Traditionally, the “FTM Top Surgery” designation originated from “Female to Male” chest surgery. This would classify each person as strictly identifying as a Transgender Person transitioning from Female to Male. While traditional questions to ask a patient are “Do you identify as female or male?”, this does not completely apply to our current practice.
What if you were born as a biological female or intersex, and strictly identified as a male and were seeking FTM Top Surgery to give you a male contoured chest as a part of your Gender Confirmation Surgery? Then GenSculpt® is right for you.
What if you were born as a biological female or intersex, and identified as a Non-Binary (nonbinary), Gender Neutral, Gender Variant, Omnigender, Transmasculine, etc. and were seeking FTM Top Surgery to give you a more masculine contoured chest to help you feel more aligned with your Gender Identity? Then GenSculpt® is right for you.
What if you were born as a biological female or intersex, and identified as a Female and were seeking FTM Top Surgery to give you a more masculine contoured chest just because you preferred the appearance? Then GenSculpt® is right for you.
Chest contour, scar placement, scar shape, scar length, nipple-areolar position, nipple size, and areola size are all discussed with patients seeking GenSculpt®. All of the options are able to be modified to the patient’s personal preferences, and Dr. Garramone will discuss these options with you with great care.
The Garramone Method of GenSculpt® FTM Top Surgery
Dr. Garramone has a specific set protocol for all patient when performing GenSculpt® surgeries. He has specific drawings and marking for each individual chest, and a systematic set of measurements he performs with each and every surgery. From his pre-operative assessment to the post-operative treatement regimen, this method of care is truly The Garramone Method. Having performed thousands of successful FTM Top Surgeries or Non-Binary (nonbinary) Top Surgeries, The Garramone Method is a time tested and reliable set of treatment protocols for FTM Top Surgery.
We now call The Garramone Method of FTM Top Surgery one concise word “GenSculpt® “, which is combined from the words “Gender” and “Sculpting”. This way you know when you or someone you care about is having FTM Top Surgery and they choose GenSculpt® , they are getting The Garramone Method of FTM Top Surgery. They are getting a reliable, safe, effective, time tested, and reproducible result that cannot be matched by any other method.
GenSculpt® is the new standard of care when having FTM Top Surgery and Dr. Garramone is the creator and the only Plastic Surgeon offering this method.
The Garramone Center
Botched FTM Top Surgery and Revisions
Botched FTM Top Surgery
Have you had FTM Top Surgery performed by another Doctor?
Have you had a Botched or Awful Result of FTM Top Surgery performed by another Doctor?
Do you want your FTM Top Surgery performed by another Doctor to look better and have a better result?
Did your other Doctor tell you they couldn’t fix your Botched or Awful Result of FTM Top Surgery performed by them?
Dr. Garramone Can Help
Dr. Charles Garramone can help
Over the past decade, Dr. Garramone has seen many physicians starting to perform FTM Top Surgery. Some of these doctors do a great job and really want to help, but many of these doctors are performing really poor work giving patients Botched results. These new physicians see this surgery as a “trend” and a new money-making revenue stream, and really do not seem to care or be able to help a lot of patients they are performing FTM Top Surgery upon. Dr. Garramone has seen the names of these doctors last for a while, and then slowly disappear and fade away from their initial popularity of being “A New Surgeon”.
“I was once the New Surgeon almost two decades ago, but at that time there were only about three doctors in the United States performing this surgery and one of them has since retired, another has passed away. I found an interest in this surgery and became very good at it, so I’ve dedicated my entire practice to this one specialty of FTM Top Surgery and FTM Body Masculinization. You have to look back 10 years ago and realize there weren’t any Reality TV Shows sensationalizing the Transgender Movement; there weren’t any superstars in the media; there were only people trying to become themselves, and I played a huge part in changing thousands of those lives. What I have been seeing in the last 12 months has been horrifying. Every day we receive inquiries from patients all over the world begging for me to fix their Botched FTM Top Surgeries. I speak with over 2,000 new patients a year, and about 10-20% of those patients have had recent FTM Top Surgery by another doctor or FTM Top Surgery by another doctor many years ago, and they are looking for me to fix their Botched results. I can help almost every one of them, but there are a few patients that have irreversible damage that cannot be fixed or even made to look better. My fear is that this will continue to get worse as I progress through my career, but at least I believe I have the skill to help these people with their Botched FTM Top Surgeries performed by other surgeons. The key to being a great surgeon is to know your limitations, and many of these New Surgeons have egos that blind them of these limitations, and that’s when people get hurt. It is very sad and I’m standing here cleaning up the mess made by these other doctors. Botched FTM Top Surgery is not a joke, for me it is a new career path I’ve been forced to take along side of my current practice. Now, I’m not just the Top Surgeon for FTM Top Surgery in the World, I am now the “Go To Guy” for Fixing Botched FTM Top Surgeries performed by other doctors. So I guess I have a new title, and I’ll keep helping people for the right reasons as I’ve always done.”