overview

Mastectomy (FtM) “Top surgery Trans Men

Mastectomy (FtM) “Top surgery” is a surgical to create “a male looking chest” for gender affirming surgery Female to Male. 

Top surgery (FtM), the goal is to removal female breasts by reposition shaping to a male contoured chest (masculine). This procedure is to create a masculine or nonbinary appearance male looking chest. As objective for Top surgery “Mastectomy” to be preserve as much sensation and trying to minimize scaring by Keyhole or Double incision technique.

Top surgery is performed in a single stage under General Anesthesia. There are two to three mainly techniques used to perform for Top surgery by keyhole technique, double incision and double incision with nipple grafts.

Each technique for Top surgery by Preecha Aesthetic Institute (PAI) Thailand.

Trans men with smaller breasts, the technique may be done by a peri-areolar or “keyhole” procedure an incision made around the areola).

Trans men with moderate to large breast tissues, the technique is usually required by a formal bilateral (Double incision) mastectomy with nipple grafting. There are two horizontal scars under chest and allows easier resizing of the nipple and placement in a typically male position.

Therefore, many techniques with Top Surgery are best at an individual as well as many factors should be taking into consideration when choosing method. Direct consultation is highly recommend to finalize everything.

Mastectomy (Top surgery) is performed by Assoc.Prof.Dr.Preecha Tiewtranon MD, Dr.Burin Wangjiraniran MD FRCST and Dr.Sutin Khobunsongserm MD (Board of Plastic & Reconstructive Surgery, specialized in transgender procedures). It is important that the person should be in a realistic about what cosmetic and reconstructive surgery can and cannot do. Your doctor is in the best position to address these issues and open dialogue is recommended to avoid any misunderstanding.

Notes: To reduce number of times for Trans Men surgery (FtM surgery), addition procedure may be combine at the same trip such as hysterectomy + oophorectomy or Metoidioplasty.

More information, please read other topic procedures. Sex Reassignment Surgery (Female to Male)

Candidate for Mastectomy (Top surgery)

  • Real-Life experience
  • Physically healthy and emotionally stable with realistic expectations
  • At least 18 years old (need a parent’s show up sign permission to pursue top surgery) ; if fully 20 years old able to come by yourselves
  • Harmful experience chest binding
  • Mastectomy / Top surgery help reduce or alleviate negative feelings 
  • Good health conditions
keyhole technique mastectomy

Keyhole's technique after 6 years

mastectomy by double incision technique female to male surgery

Double incision + Nipple graft after 6 years

Package is included for Mastectomy (Top surgery)

Package is included for Top surgery (Mastectomy)

  • Accommodation for 1 night at an international standard hospital private room after surgery ( JCI accredited )
  • Operating room charges: OR room use, recovery room, scrub & circulate nurse
  • Regular menu food charges
  • Laboratory testing: necessary for the procedure as CBC, EKG, UA, Anti HIV, Chest X-Ray (If age over 45 need to check cardiology.  An extra charge is 100 US Dollars + -)
  • Medical equipment and medical supplies
  • General anesthesia - Pre anesthetic drugs, anesthesia and medical gas (oxygen, nitrous oxide)
  • Medical treatments
  • Doctor fees
  • Anesthesia fees
  • Nursing services
  • Take home medication and supplies
  • Post op cares
  • Transportation pick up (optional)

PREECHA AESTHETIC INSTITUTE AND AFFILIATED HOSPITALS - JCI-ACCREDITED INTERNATIONAL HOSPITALS

Preecha Aesthetic Institute (PAI) is the first multidisciplinary Aesthetic and Reconstructive center also best well known the pioneer in Sex Reassignment Surgery (Male to Female and Female to Male) Thailand since 1980. The center has the most advanced 10 consultation rooms, 6 operation rooms (local anesthesia), equipment to any leading Aesthetic Plastic Surgery completed with recovery rooms and the internationally accepted standard of hygienic system.

  • Mastectomy (Top Surgery) is performed under General Anesthesia. This is required one night in hospital.

All cases under general anesthesia, PAI's using two major private International Standard Hospitals affiliated - JCI accredited, for healthcare promoting center located in Bangkok under the philosophy of "World class quality with Thai hospitality", private patient rooms, 230 - 500 beds, modern medical technology, equipment and hospital receiving accreditation for high-quality.

  • Consultation, Medical health checks and Follow ups will be appoints at Preecha Aesthetic Institute.
  • Two international standard hospitals - JCI accredited International Hospitals. 
  • Surgical will perform at affiliated hospitals ⇒ General Anesthesia ⇒ International Standard Hospital. 
International Standard Hospital (JCI accredited)

Affiliated Hospital

Affiliated Hospital

preecha aesthetic institute (PAI)

Preecha Aesthetic Institute (PAI)

SERVICE ACCOMMODATION

  • Transportation pick up from airport –hotel-clinic-hospital-airport as well as follow up period (optional)
  • Hotel reservation 2 km from Preecha Aesthetic Institute
  • Interpreter services with any language

RISK OF Mastectomy SURGERY

Risk of Mastectomy Surgery ¦ All surgery carries risks but can minimize by closely following your surgeon’s advice follow cares during the healing process. Sometimes bruises occur in the area of the operation, but they heal again after a few days. Mild pain can be managed very easily with a simple pain medication.

HEALTH CONCERN

An extra charge is 50% from surgery fee, if HIV +

  • CD4 must be 500 +
  • Viral load must undetectable

QUESTION, APPOINTMENT AND SCHEDULE

Dr.Sutin Khobunsongserm MD, Dr.Burin Wangjiraniran MD FRCST  and Dr.Preecha Tiewtranon MD (Board of Plastic & Reconstructive Surgery, Thailand).

Dr.Preecha Tiewtranon MD, Dr.Burin Wangjiraniran MD and Dr.Sutin Khounsongserm MD (Board of Cosmetic & Reconstructive surgeon Thailand)

All your questions will be direct answers from PAI's doctor.

  1. Write your question, interest
  2. List your expectations or procedure that you are interest and give us your detail as possible
  3. Email to us at consult@pai.co.th
  4. We will get back to you shortly after receive your question

Once all are confirmed. To set up direct consultation and schedule surgery date.

  • Plan your available date to be surgery and departure from Bangkok
  • We will confirm you for surgery date
  • You may start to book your airline ticket
  • We will confirm you all detail and hotel booking, if require
  • For transportation to be pick up from the airport, we need you to confirm your airline flight itinerary

Top surgery / Mastectomy

 

mastectomy top surgery breast removal before and after female to male breasts surgery

Before and After 7 days surgery, After 2 years and After 6 years. (Double incision + nipple graft)

Top surgery / Mastectomy

 

top surgery, breast removal, mastectomy, female to male surgery before and after surgery

Before and After 7 days surgery, After 2 years and After 6 years. (Double incision + nipple graft)

 

Top surgery / Mastectomy

top surgery female to male FtM before and after 7 days and 8 weeks surgery l Preecha aesthetic institute

Before and After 7 days surgery, After 2 months. (Double incision + nipple graft)

TOP SURGERY / MASTECTOMY

 

top surgery keyhole incision before and after remove incision five days surgery l preecha aesthetic institute

Before and After 5 days stitches removal. (Keyhole's Technique)

 

TOP SURGERY / MASTECTOMY

before and after two weeks keyhole incision top surgery side view

Before and After two weeks. (Keyhole's Technique)

TOP SURGERY / MASTECTOMY

before and after keyhole incision top surgery

Before and After two weeks surgery. (Keyhole's technique)

Set up an appointment with us

1. Write your question, interest at consult us in program form

enquiry

2. Via email consult@pai.co.th

2.1 list your expectations or procedure that you are interest and give us your detail as possible
2.2 email to us
2.3 We will get back to you shortly after receive your question with recommendation from specialize surgeon

Once you know your planning date for surgery. Here is the next step:

1. Consultation with us via email for details and procedure
2. Plan your available date to be surgery and departure from Bangkok
3. We will confirm you for surgery date
4. You may start to book your airline ticket
5. We will confirm you all detail and hotel booking, if require
6. For transportation to be pick up from the airport, we can do for you as optional

surgical details:

Preparation during direct consultation and surgery.

During direct consultation with our surgeon – the surgeon will evaluate your general health status and any pre-existing health conditions or risk factors such as examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolas, take photographs, discuss your options and recommend a course of treatment and discuss likely outcomes of top surgery and any risks or potential complications


Preparation for Mastectomy

  • Inform us about any allergies, any serious medical condition(s), and all medications you are taking (both prescription and non-prescription). 
  • No Aspirin 2 days before surgery.
  • Stop vitamin E Oil 1 day before surgery.
  • Stop smoking 2 days and a month after surgery.
  • Tell doctor if you have any serious medical condition(s). 
  • Stop meal and water starting from midnight before surgery.
  • Plan to be in Thailand at least 7 days after surgery.
  • Mastectomy/Top surgery doesn’t require psychiatrist or Testosterone approval letter.
  • Age 18 years+.
  • Not require testosterone / psychiatrist letter by Mastectomy
  • An extra charge is 50% from cost of surgery fee, if HIV+

Surgery Schedule (required 10 days after surgery in Thailand)

Day 0 - Arrival date (check in hotel)

Day 1 - Consultation and Prepare for Laboratory Testing

Day 2 to 3 - Surgery and one night in hospital private room after surgery

Day 3 - Discharge from Hospital
Day 3 to Day 7 - Stay in hotel for recovery period and follow up by doctor appointments

Day 7 - Stitches removal and final checkup (5 days, after surgery)
Day 9 or day 10 - Safe to fly


 

Things should bring from home.

  • Button-up shirts in large sizes
  • Slip-on shoes or slippers
  • Phone charger, long phone charger
  • Books, magazines
  • Travel neck pillow

 

During direct consultation with our surgeon – the surgeon will evaluate your general health status and any pre-existing health conditions or risk factors such as examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolas, take photographs, discuss your options and recommend a course of treatment and discuss likely outcomes of top surgery and any risks or potential complications. FtM mastectomy also includes preserving as much sensation as possible and trying to minimize scaring. 

Trans men with smaller breasts, a peri-areolar or “keyhole” procedure may be done where the mastectomy is performed through an incision made around the areola. This avoids the larger scars of a traditional mastectomy.

With moderate to large breast tissues usually require a formal bilateral (Double incision) mastectomy with nipple grafting and reconstruction of the nipple-areola. The result is in two horizontal scars under chest and allows easier resizing of the nipple and placement in a typically male position.

By opinion technique, there are three possible techniques that can be used in Mastectomy (Breast Removal). This is depend upon the size of breast, elasticity of skin and your preferences:

  • Keyhole – Best for small breasts (A or small B cup) with good skin elasticity. Incision/scar – Along bottom border of areola. How’s done – Breast tissue is removed via a small incision across or under the areola. Nipples – Not resized or re-position.  But can be perform as nipple reduction surgery.
  • Drawstring/ Pursestring – Moderate size breast (B or C cup), with good skin elasticity. Incision/scar – Circle around the edge of the areola. How it’s done – Breast tissue is removed via an incision around the edge of the areola.  A ring of skin is then removed in a wider circle around the areolar incision and the skin is pulled toward the centre of the opening and stitched to the edge of the areola. Nipples – Areola may be trimmed to reduce its size.  It may be possible to slightly reposition the nipple.  But preserve sensation.
  • With free nipple graft (Double incision) – Large saggy breasts or inelastic skin. Incision/ scar – Horizontal or U-shaped cuts across each breast, usually just below the nipple.  The aim is to place the incision just under the line of the pectoral muscles so it is not highly visible. How it’s work – The skin is peeled back and the breast tissue and excess fatty tissue are removed.  The excess chest skin is then trimmed and the incisions closed. Nipples – Removed, trimmed to smaller size, and grafted onto the chest to approximate positioning of “male” nipple.

Summary

Step 1: General Anesthesia - Medications are administered for your comfort during the surgical procedure.

Step 2: Mastectomy to remove the breast tissue - A mastectomy will remove the breast tissue present on your chest. Sometimes, excess skin will need to be removed as well.

Step 3: Creating a masculine shape and any excess skin is removed, the remaining tissues must be repositioned to create a masculine contour to the chest.

Step 4: Repositioning the nipple and areola as sometimes the nipple and the areola need to be reduced and/or repositioned on the chest after the mastectomy is performed. The nipple and areola tend to be smaller and lie slightly more lateral and inferior on the male chest.

Postoperative Top Surgery Recovery

After Top surgery, there is some soreness and discomfort which is easily controlled by medication. Following top surgery, gauze or bandages will be applied to your incisions. An elastic bandage will minimize swelling and support the reconstructed chest. A small thin tube may be temporarily placed under the skin to drain any excess blood or fluid.

Dr.Preecha, Dr.Burin and Dr.Sutin will given specific instructions that may include: How to care following surgery, medications to apply or take orally to aid healing and reduce the risk of infection and when to follow up with your plastic surgeon.

There is some soreness and discomfort which is easily controlled by medication. Swelling and skin discoloration around the incisions generally will subside in a few days after surgery. This may be a temporary loss of sensation in the nipples and breast skin. This condition will improve with time. Sutures will be removed within seven days of surgery.

Scars remain highly visible for 8 month or up to a year following surgery, then fade.
Since no two breasts are the same size and shape before surgery, usually a slight variation will exist after surgery.

Everyone will recover from mastectomy surgery differently. But commonly are

  • Discomfort and pain will be most prevalent in the 3  to  4 days following surgery. This is normal.
  • Sleep on your back for at least the first week after surgery.
  • Swelling and bruising will decrease in the first 2 – 3 weeks but may take longer for some people. This is normal.
  • To help the healing process you will want to rest, eat healthily, refrain from smoking and drinking, and listen to your body.
  • To shower the lower part of your body, but only if you can avoid getting your bandages wet. Baby wipes and sponge baths are two of the easiest ways to clean the top of your body.
  • Not to lift your hands above your head for at least 2 to 3 weeks after surgery.
  • After 6 or 8 weeks, you can typically resume physical exercise such as sports, lifting, and running.

Recovery Timeline Mastectomy

  • The day after surgery before discharge hospital. PAI doctor team will visit you
  • Removing Incisions will appointment within 7 days after surgery
  • No heavy exercise 4 weeks after surgery

The decision on when to return to work and normal activities depends on how fast you heal and how you feel.


 

Surgery Schedule (required at least 10 days after surgery in Thailand)

 Day 1 - Consultation and Prepare for Laboratory Testing

Day 2 to Day 3 - Surgery and one night in hospital private room after surgery

Day 3 - Discharge from Hospital
Day 3 to Day 6 - Stay in hotel for recovery period and follow up on doctor appointment

Day 7 to Day 9 - Stitches removal and final checkup (Five to seven days after surgery date)
Day 10 - Safe to fly

For local’s patient - You may resume to work after ten days surgery but must avoid heavy lifting object over the head or fast movement during four weeks after surgery date. Stitches are remove five to seven days after surgery date.

For international patient - Please plan to be in Bangkok at least ten days all together. Stitches will remove five to seven days after surgery date. You may resume to work within a few days but must avoid heavy lifting object over the head or fast movement during four weeks after surgery date.

◊ Any bruising and swelling will usually dissipate within 3 to 6 months after mastectomy surgery.

Treatment after surgery
during the first 7 days

Treatment after surgery during five days of Mastectomy.

While the patient is in hospital our nurse, surgeon will visit you to check your dressings and monitor and empty your drains.  It is normal for the incisions to be red but redness should not go beyond the incision for more than 2 cm.  It is normal to see or feel the knot in the stitches at the end of the incision. Your chest will probably feel sore and swollen for at least a month after surgery.  Feeling of sharp shooting pain, burning pain, or general discomfort are common as part of the healing process and will eventually go away.  Usually serious discomfort passes 1-2 days after the surgery.

To permit proper healing, you should avoid excessive exercise and refrain from overhead lifting for there to four weeks.

surgery info:

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TIME REQUIRED

2 Hours

services icon 2 150x150Anesthesia
Anesthesia

General Anesthesia

Back to work

10 days

services icon 4 150x150 Strenous Activity
STRENUOUS Activity

4 weeks

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Fading of scars

several months to a year

Surgery Schedule

Schedule Appointment Consultation / Surgery / Question Mastectomy (Top surgery) FtM Surgery.

Consultation with doctors via email for details and procedure.

Once you know your planning date for surgery.

Trip's planning for Mastectomy surgery :

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useful information

ADDRESS

PAI (Preecha Aesthetic Institute)
898/1 Sukumvit 55 Wattana, Bangkok
10110 Thailand

Tel: +662-715-0111

Fax: +662-715-0113

Email: consult@pai.co.th

MEETING POINT (AIRPORT)

The driver will be waiting for you at door number 4 (Meeting point) after exit from customs. The driver will stand by with your name and PAI  logo. [Suvarnabhumi International Airport (BKK)]

HOTEL

Hotels are under cooperate and nearby PAI, starting from 50 USD to 100 USD. Rates are quoted in THB, USD/net/included of taxes and service charges. All non-commissionable rate. VISA/Master card is accepted.

  • Special apartment 68 sq.m-131 sq.m with one to two bedroom/1 queen/master size bed, 1 bathroom (shower and bathtub), pantry and dining area, 2 Bottled water – complimentary for daily contract, bathroom (separated shower & bath tub), cable / Satellite TV, free wifi, dining Table/Chairs, Internet Access (wireless), kettle, LCD TV, refrigerator, slipper, toaster, air Conditioner, bath amenities - complimentary for daily, electronic Door Lock, iron & Ironing Board (on request), kitchenette - Full Equipment, microwave, safety box.

 

  • Hotel - studio room 46 - 58 sq.m - Features & Amenities: 40-in LED, sofa, in-room safe, minibar refrigerator, refillable tea/coffee/water, blackout curtain, free wifi, slippers, bathroom with rain shower, 100% natural therapeutic spa toiletries Mt. Sapola, hair Dryer, toothbrush and toothpaste, shower cap as well as a washing machine.

LANGUAGE

Thai, Chinese, Japanese, Italian, Spanish, French, German, Turkish and other languages upon request.

PASSPORT AND VISA

PAI can issue the letter to clarify with your local Embassy or Passport.

COST OF MEAL

Cost of living meal per day is 15-20 USD.

PAYMENT

The payment can be prepared in Cash by US dollar, Euro, Japanese Yen, Hong Kong Dollar, Singapore Dollar, Australia dollar. If using credit cards (VISA/Master card), the hospital will charged 3% for international transaction fee. This is only for surgery fees. Hotels are not charged for international transaction fee. An extra charged for HIV is 50% from total cost.

TOURIST VISA EXEMPTION (30 DAYS WITHOUT VISA)

Australia, Austria, Belgium ,Brazil ,Bahrain , Brunei Darussalam ,Canada, Denmark ,Finland ,France, Germany ,Greece ,Hong Kong ,Iceland ,Indonesia ,Ireland ,Israel ,Italy ,Japan ,South Korea ,Kuwait ,Luxembourg , Malaysia ,Monaco ,Netherlands ,New Zealand ,Norway ,Oman ,Peru ,Philippines ,Portugal , Qatar , Singapore ,Spain ,South Africa ,Sweden ,Switzerland ,Turkey ,United Arab Emirates, United Kingdom ,United States of America ,Vietnam.

AIRPORT IMMIGRATION AND CUSTOMS

Please present the supporting documents confirming the scheduled operation upon request. Please do not carry any unnecessary drugs or dangerous objects in your luggage.

Frequently Asked Questions (FAQs)

Q: How many days after consultation with the surgeon will the surgery be done?

A: Top surgery is able to perform surgery in the next day right after direct consultation + medical health checks (if in good health conditions).

Q: How far in advance can I book the surgery? (I would like to book in the next couple of months)

A: This is depend upon available doctor appointment. So recommend to plan at least four weeks in advance. But if just general consultation, this can write email. All answers will be from the surgeon. Finalize will be again during direct consultation.

Q: What is the name of the surgeon which will do the surgery?

A: Dr.Sutin K, MD and Dr.Burin W, MD. (Board of Cosmetic and Reconstructive surgery)

Q: Will I need to wear a binder after top surgery ? If so, for how long?

A: Binder should wear a week after surgery or no need to wear after stitches remove.

Q: How many months after Top surgery will I be able to return to: an office job, or a job where a lot of physical movement is needed?

A: Normally physical movement, this should off two weeks after surgery date. Heavy lifting, this should off for 3 to 4 weeks after surgery date or depend how fast the body recover.

Q: I will have my Dad traveling with me. If I am staying overnight, will there be meals provided, and will meals also be available for my Dad or not?

A: Your dad is welcome with you and able to stay with you in hospital too. The hospital will provide pillow and blankets with sofa bed for your dad (free of charged). There are many local and international restaurants inside hospital. Your dad will enjoys. But for you, we have all meals included with surgery fee while in hospital (breakfast, lunch, dinner).

Q: Are the staff (nurses, reception, etc) friendly? How well is English spoken?

A: All doctors, nurses, receptions are friendly and well in English. Our patients are 90% foreigners from USA, Italy, Spain, China, Australia, England, Singapore, Malaysia and a few from New Zealand.

Q: What photos should I send or what do I need to know which of the methods is convenient for my type and size of Breast

A: You should firstly attach front and side chest pictures via email and then the doctor is able to provide a general details with technique. The surgery can be quoted. However, you still need to come direct consultation for finalize the technique with doctor as well as completed health exams before surgery. Note: direct consultation and surgery can be perform at the same trip.

Q: Is it possible to do a mastectomy and liposuction at the same time ?

A: It is possible, if minor fat deposit for liposuction.

Q: What is the cost of mastectomy alone ?

A: Depend on technique with size of breast tissues.

Q: If you can do the two procedures together (mastectomy and liposuction) what would be the cost?

A: We will combine both procedures at the same time and set up a special package, if good candidate.

Q: If I travel on my own should I stay near the hospital? Or is it just the hotel package option that you have

A: If possible, we are recommend to stay nearby PAI’s clinic because easier to come for follow ups. There are many hotels nearby clinic under cooperate rates.

Q: How much time do I need to schedule my surgery?

A: At least four weeks.

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Set up an appointment with us.

Write your question, interest at consult us in program form

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