(413) 731-7877
100 Wason Avenue
Springfield, MA 01107
Pioneer Valley Plastic Surgery
Pioneer Valley
Plastic Surgery
Reconstructive & aesthetic plastic surgery

FTM Top Surgery

Chest wall reconstruction surgery, also referred to as bilateral mastectomies for gender reassignment or FTM top surgery, is a procedure to remove excess fat, glandular tissue and/or skin from the patient's breasts. In severe cases of enlarged breasts, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple.) In these cases, the position and size of the areola can be surgically improved and excess skin may need to be removed. There are a variety of surgical techniques for FTM chest wall reconstruction. The technique, along with the surgical approach, will depend on your preferences, your anatomy, and your surgeon´s recommendation. The two main procedures that Dr. Johnson performs are Double Incision and Keyhole. The goal is to shape the female breast to male. Prior to scheduling your surgery, we require a letter from your therapist documenting how long you have been in therapy. A minimum of 3 months of therapy is required. See FTM top surgery photos & FAQs.


Double incision procedure

Patients who have large breasts or who have an excess amount of loose breast skin will be recommended to have this technique. The breast is removed with an incision along the breast fold and the nipple/areolar complex is replaced as a graft. This technique does leave a scar across the chest wall. A drain is placed on each side and removed about a week later.

Keyhole procedure

Good candidates for this procedure must have small breasts without a significant amount of loose breast skin. The breast is removed with an incision around the nipple/areolar complex. A drain is placed on each side and removed about a week later.
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Female to Male (FTM) chest wall reconstruction before & after photos

All photos are of actual procedures performed by Dr. Melissa Johnson
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #1
Chest Wall Reconstruction (Female to Male) Case #1
Age: 40. Height: 5' 4"
Weight: 132 pounds
After photos were taken 2 months post surgery
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BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #2
Chest Wall Reconstruction (Female to Male) Case #2
Age: 22. Height: 5' 2"
Weight: 123 pounds
After photos were taken 3 1/2 weeks post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #3
Chest Wall Reconstruction (Female to Male) Case #3
Age: 21. Height: 5' 3"
Weight: 125 pounds
After photos taken 3 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #4
Chest Wall Reconstruction (Female to Male) Case #4
Age: 21. Height: 5' 4"
Weight: 100 pounds
After photos were taken 7 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #5
Chest Wall Reconstruction (Female to Male) Case #5
Age: 32
After photos were taken 4 months post surgery.


BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #6
Chest Wall Reconstruction (Female to Male) Case #6
Age: 23
After photos taken 6 1/2 weeks post surgery.


BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #7
Chest Wall Reconstruction (Female to Male) Case #7
Age: 53 Height: 5' 6"
Weight: 178 pounds
After photos were taken 9 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #8
Chest Wall Reconstruction (Female to Male) Case #8
Age: 16 Height: 5' 1"
Weight: 144 pounds
After photos were taken 10 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #9
Chest Wall Reconstruction (Female to Male) Case #9
Age: 18 Height: 5' 4"
Weight: 128 pounds
After photos were taken 2 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #10
Chest Wall Reconstruction (Female to Male) Case #10
Age: 26 Height: 5' 5"
Weight: 144 pounds
After photos were taken 2 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #11
Chest Wall Reconstruction (Female to Male) Case #11
Age: 50 Height: 5' 6"
Weight: 170 pounds
After photos were taken 12 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #12
Chest Wall Reconstruction (Female to Male) Case #12
Age: 27 Height: 5' 8"
Weight: 217 pounds
After photos were taken 2 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #13
Chest Wall Reconstruction (Female to Male) Case #13
Age: 23 Height: 5' 6"
Weight: 148 pounds
After photos were taken 2 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #14
Chest Wall Reconstruction (Female to Male) Case #14
Age: 16 Height: 5' 6"
Weight: 125 pounds
After photos were taken 2 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #15
Chest Wall Reconstruction (Female to Male) Case #15
Age: 23 Height: 5' 3"
Weight: 116 pounds
After photos were taken 2 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #16
Chest Wall Reconstruction (Female to Male) Case #16
Age: 45 Height: 5' 7"
Weight: 179 pounds
After photos were taken 2 months post surgery.
BEFORE & AFTER: Chest Wall Reconstruction (Female to Male) #17
Chest Wall Reconstruction (Female to Male) Case #17
Age: 18 Height: 5' 7"
Weight: 133 pounds
After photos were taken 8 months post surgery.
You can see other plastic surgery procedures in our

What do I need to schedule a FTM top surgery consultation?

If you will not be using insurance coverage
Call us at (413) 731-7877 and schedule the consultation. You are required to pay the $100 consultation fee over the phone when you schedule the appointment. The fee will be applied to the overall surgery cost.
If you want to use your insurance for coverage, complete all of these steps:
1) Contact your insurance company and find out if Gender Reassignment Surgery is a covered benefit in your policy as well as verifying that Melissa Johnson MD is contracted with your insurance.
2) If it is a covered benefit, you will need to obtain a copy of the medical policy listing the criteria that is required and document the person you spoke with.
3) Fax or email the medical policy AND proof of covered benefit to our office (fax # 413-731-7870) or email to info@pvps.net along with the required documentation (i.e. therapist letter). Include your phone number so we can contact you with your appointment.
4) Once we have received all of the documentation, we will call you to schedule your consultation. If you have not received a phone call from us after 7 days, please check in with us to make sure we have received everything.
5) Get insurance referral if required. If your insurance plan requires a referral, please contact your primary care doctor for the referral and ask them to fax it to us. Your appointment cannot be scheduled without the referral.

How should I prepare for my FTM top surgery consultation?

Research on reputable internet sites can be very informative to help provide an overview. However, the best information will be obtained by making an appointment and speaking with Dr. Johnson. At the time of your consultation we will provide you with all the needed information for you to be able to make a comfortable, confident decision about having surgery. It's a good idea to write down any questions or concerns you have so they can be fully addressed at your consultation. Know what your surgical expectations are so Dr. Johnson can discuss them with you. If you are a smoker we recommend you quit to help reduce the risk of wound healing. We also recommend a healthy lifestyle to help your recovery process.

Will I be seen by the surgeon?

Yes. Dr. Johnson will meet with you and she will discuss all your surgical options. Dr. Johnson will provide you with the necessary information so that you feel confident and comfortable with your surgical decision.

Will I be charged for an initial consultation?

Yes. There is a $100 cosmetic consultation fee for your initial visit. If you choose to have surgery with Dr. Johnson the $100 consultation fee will go towards your surgery cost.

Are there different types of FTM chest wall surgery procedures?

Yes. The two techniques used for F to M chest wall reconstruction are the double incision and keyhole, or periareolar, techniques. The type or procedure performed is chosen on a patient-by-patient basis. Your breast size and amount of loose skin determine which procedure is recommended.

Where will my FTM top surgery incision be?

The incision for the double incision approach is at the breast fold along the length of the breast. The nipple/areolar complex is grafted back on. The incision for the keyhole approach is periareolar which means around the nipple/areolar complex. We place a drain on each side and place you in a binder for compression.

What is the FTM top surgery surgical process?

The surgery is performed at a hospital. During surgery you will receive general anesthesia. The surgery will take between 1-2 hours. Once you are awake you are taken to the recovery room for another 1-2 hours. Our recommendation is that you spend one night in the hospital.

What is the FTM top surgery recovery process?

The first few days you may feel soreness or pain. You will notice that the pain decreases with each passing day. You are sent home on pain medications which will decrease your discomfort. We will recommend that you wear the binder to provide compression and help minimize swelling. We will see you one week after surgery to evaluate your healing process and remove the drains. We request that you do no heavy lifting for at least one month following surgery.

Are there risks involved with FTM top surgery?

Yes, there are risks with any surgical procedure. Some of the possible risks with chest wall reconstruction surgery are infection, wound healing complications, nipple changes, hematoma/seroma, pain or unsatisfactory results resulting in a revision surgery.

Where will my chest wall reconstruction procedure be performed?

Dr. Johnson has privileges at Baystate Medical Center in Springfield, MA.

Are PVPS facilities accredited?

Yes. Dr. Johnson performs breast surgery at Baystate Medical Center in Springfield MA. It is accredited by the Joint Commission and has been awarded the Gold Seal of Approval.

How much does FTM surgery cost?

The cost is approximately $8300, which includes the surgeon's fee, hospital fee, anesthesia, and the overnight stay. The pathology fee, approximately $150-200, is not included and you will be billed by the hospital after surgery.

Can I finance my FTM top surgery?

financingYes. We offer patient financing through CareCredit, which is a part of GE Capital, one of the nation's most credible and trusted financial partners. You can apply securely online by filling out a CareCredit Online Credit Application, or by calling (800) 365-8295. A decision is usually made within minutes of receiving your application.

If you choose not to finance, you can make payments to our office; however, the entire amount must be paid in full no later than 3 weeks prior to your surgery.

What forms of payment are accepted

Our office accepts all major credit cards, debit cards, cash, money orders, and certified bank checks, or you can finance through CareCredit.

Do you accept insurance for FTM surgery?

Yes, we accept many different insurances. You can contact your insurance and ask if Melissa Johnson, MD is listed as a contracted provider.

Which codes can I provide to my insurance carrier for FTM top surgery?

To find out if your insurance covers the surgery, provide them with the following codes: CPT Code (procedure code): 19303-50 (simple mastectomy) and diagnosis code: F64.1 (gender dysphoria).

Can I have FTM top surgery without ever seeing a therapist?

No. Dr. Johnson requires a letter prior to performing your surgery. For self-paying patients the requirement is at least 3 months of therapy. For insurance patients, the therapy requirements vary. Please check the medical policy for your insurance.

What does the therapist letter need to state for FTM top surgery?

The letter must be from a licensed social worker, psychiatrist, or psychologist. It must state how long you have been in therapy, the diagnosis of gender dysphoria, the duration of time you have been living full-time as the desired gender, and the therapist's opinion regarding your readiness for this next important step in this process.

Is hormone therapy a requirement for FTM top surgery?

Dr. Johnson does not require you to have hormone therapy. However, some insurances do require a minimum of 12 months. You will need to review the medical criteria for your insurance policy.

What are the age requirements for FTM top surgery?

For insurance patients, most insurance companies require that you be at least 18 years of age. For self-paying patients, Dr. Johnson will determine if you are a good candidate, regardless of age, at the time of your consultation.

Can I get a letter from Dr. Johnson after my FTM top surgery to change my birth certificate?

Yes, we will be happy to provide a notarized letter upon request after your surgery. Please contact our office.