Gender-Affirming Top Surgery

Gender-Affirming Top Surgery in Austin

Achieving an aesthetic look that fits your true self is an important part of improving your physical, emotional and psychological wellbeing. Dr. Danielle Dumestre, MD, FRCSC understands that choosing to pursue a gender-affirming top surgery is a personal decision that comes naturally from the experience of gender dysphoria, defined by the American Psychiatric Association as a conflict between your physical or assigned gender and the gender with which you identify. Dr. Dumestre offers gender-affirming top surgery options to transgender, gender-diverse, nonbinary and gender-nonconforming people who want their physical appearance to align with their internal identity.

This is a quality-of-life issue that Dr. Dumestre and the Austin Plastic & Reconstructive Surgery team are passionate about. We are committed to providing a welcoming, body-positive environment where you feel safe discussing your goals.

What is Gender-Affirming Top Surgery?

Gender-affirming top surgery can create a more masculine-looking chest or a more feminine-looking chest; Dr. Dumestre is able to offer patients both kinds of surgery. Top surgery creates a more masculine-looking chest through the removal of breast tissue and repositioning of the areolas (also called female-to-male top surgery), or a more feminine-looking chest through breast augmentation with placement of implants (also called male-to-female top surgery or transgender breast augmentation). In either case, improved self-image, relief from gender dysphoria, reduced depression and an overall improved quality of life are often reported by patients who have undergone gender-affirming top surgery.

If you feel this speaks to you, then gender-affirming top surgery may be right for you. Every patient interested in male-to-female or female-to-male top surgery can call our office at (512) 815-0123 to schedule their consultation with Dr. Dumestre.

Your Top Surgery Consultation

Every patient interested in gender-affirming top surgery sees Dr. Dumestre for a thorough consultation. Dr. Dumestre is warm, reassuring and thrives on human connection. She uses this time to get to know you and your body, and to discuss if this surgery will help you achieve your goals. This appointment is the ideal time to ask any questions you may have about gender-affirming top surgery. Together, you will develop a safe plan to deliver your desired results. The consultation also involves a thorough review of your personal and family medical history, current medications, general health status and lifestyle habits such as smoking. A physical examination will also be conducted, at which time we will take breast and chest measurements and assess your current breast tissue, if relevant.

The Austin Plastic & Reconstructive Surgery team is run entirely by women, ensuring all our patients feel comfortable discussing their breast or chest concerns. At the conclusion of your in-depth consultation with Dr. Dumestre, our cosmetic patient care coordinator will meet with you to go over your complimentary surgical quote.

Chest-Feminization Top Surgery Procedure

The chest-feminization top surgery procedure is also known as male-to-female top surgery or transgender breast augmentation. This is an outpatient surgery performed under general anesthesia in which breast implants are placed to reshape your chest to create a more feminine appearance. This gender-affirmation surgery helps the physical appearance of your chest better match your internal sense of identity.

Our patients often desire not just to add volume to the chest area, but to enhance the body’s proportions with a natural look. Dr. Dumestre prefers to use silicone implants because they provide a more natural appearance and feel than saline implants. Silicone implants contain a cohesive gel as opposed to saline (a saltwater solution), which better simulates the feel of natural breast tissue. Silicone gel implants are also less likely to show visible “wrinkles” or “rippling” than saline implants.

Incision options for chest feminization top surgery include:

  • Inframammary fold incision — along the fold under the breast
  • Periareolar incision —around the areola

For most patients, an incision in the fold of the breast is the best option, as this results in no scars on the front of the breast. However, this does vary based on patient anatomy. Once the incisions have been made, the implants will be placed either behind the breast tissue (prepectoral placement) or under the chest muscle (subpectoral placement). Fat grafting can sometimes be performed during your surgery for additional volume and optimal breast contour. This involves performing liposuction on one part of the body (often the flanks, abdomen, or inner thighs) and grafting that fat to the breasts.

Chest Feminization: Your Options


Chest-Masculinization Top Surgery Procedure

The chest-masculinization top surgery procedure is also known as female-to-male top surgery or transgender mastectomy. It is an outpatient surgery performed under general anesthesia in which Dr. Dumestre removes your breast tissue to masculinize your chest. This gender-affirmation surgery helps the physical appearance of your chest better match your internal sense of identity.

Incision options for chest masculinization top surgery include:

  • Keyhole incision — made across the lower part of the areola. Breast tissue is removed through direct excision, excess skin cannot be removed, and the areola is usually not resized.
  • Periareolar incision — made around the border of the areola. Breast tissue is removed through this opening, and the areola can commonly be resized with this technique.
  • Double incision — two incisions are made, one along the fold of the breast and the other higher up on the breast. Breast tissue and excess skin are removed, and the upper chest skin is pulled down like a window shade. After the incision is closed the nipples and areolas are reattached.

Liposuction can also be performed alongside the above procedures to remove excess fatty tissue and enhance your chest contour.

Dr. Dumestre will use the natural contours of your breasts to minimize scarring as much as possible. In some cases, depending on your breast size and anatomy, a small bunching of tissue may result in scars colloquially known as “dog ears” following mastectomy. These can be smoothed out in a simple revision surgery to optimize the aesthetic result. Ultimately, your plan will depend on your anatomy and the size of your breasts.

Chest Masculinization: Your Options


Recovery from Gender-Affirming Top Surgery

We ask patients to take one week off work following gender-affirming top surgery, and to refrain from vigorous exercise and heavy lifting for a minimum of four weeks. If you underwent the chest-feminization procedure, you will wake up in a supportive surgical bra. If you underwent the chest-masculinization procedure, you will wake up in a compression chest vest to prevent fluid from pooling; you will also have post-surgical drains in place for about a week after surgery that are generally removed at your first follow-up appointment.

While initial recovery takes about one week, it does take three to six months for post-surgical swelling to subside and for scars to fade. It is important to wear sunscreen on your scars — even under your bathing suit — for a year after surgery to minimize hyperpigmentation of the scars.


Gender Affirming Top Surgery Recovery: How Long Should I Take Off Work?


Schedule Your Gender-Affirming Top Surgery Consultation with Dr. Danielle Dumestre in Austin, TX

Dr. Dumestre is a plastic and reconstructive surgeon who is fellowship trained in breast reconstruction and a fellow of the Royal College of Surgeons of Canada. She performs hundreds of reconstructive and gender-affirming breast and chest procedures every year. Her technical skill, artistic eye and passion for helping people combine to provide an affirming experience at Austin Plastic & Reconstructive Surgery. Call (512) 815-0123 to schedule your consultation to discuss gender-affirming top surgery with Dr. Dumestre.

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