As a medical professional with a focus on gender-affirming surgeries, I'm often asked about various surgical procedures that can help individuals align their physical appearance with their gender identity. One such procedure is T surgery, which is a colloquial term for top surgery. Top surgery generally refers to surgical procedures that alter the chest and breast area to better reflect a person's gender identity. It can be performed for both transgender men (FTM) and transgender women (MTF), but the specifics of the surgery differ based on the individual's needs and goals.

For transgender men, top surgery often involves the removal of breast tissue and the reshaping of the chest to create a more masculine appearance. This is sometimes referred to as FTM top surgery. There are several techniques used for this type of surgery, and one of them is the Inverted-T technique, which was developed by Dr. Paul Steinwald.

The Inverted-T technique starts with an inverted-T incision, which is made along the chest. This incision allows for the removal of breast tissue and the repositioning of the nipple-areola complex (NAC). The procedure has evolved from its origins as a breast reduction technique to become a popular form of FTM top surgery. It involves making two horizontal incisions—one at the top and one at the bottom of the pectoral muscle—and then connecting them with a vertical incision that extends from the base of the sternum down to the lower edge of the areola.

The steps of the procedure typically include:


1. Anesthesia: The patient is placed under general anesthesia to ensure they do not experience pain during the surgery.

2. Incisions: The surgeon makes the inverted-T incisions, carefully planning their placement to minimize visibility after healing.

3. Removal of Tissue: The breast tissue is removed, and the surgeon works to create a flat chest contour.
4. **Repositioning of the Nipple-Areola Complex**: The NAC is often repositioned to a more masculine location on the chest wall.

5. Contouring: The chest is contoured to create a masculine appearance, with attention given to the placement and shape of the pectoral muscles.

6. Closure: The incisions are closed with sutures, and a surgical drain may be placed to prevent fluid buildup.

The advantages of the Inverted-T technique include:

- Scarring: The inverted-T scar can provide a more secure hold for the NAC and may be less likely to stretch over time compared to other techniques.
- Tissue Removal: It allows for the removal of a significant amount of breast tissue, which can be beneficial for individuals with larger breasts.
- Contouring: The technique can create a well-defined and masculine chest contour.

However, there are also considerations to keep in mind:

- Scars: The Inverted-T scar is more extensive than the scars from other techniques, which may be a concern for some patients.
- Healing Time: Recovery can take longer due to the larger incisions.
- Complications: As with any surgery, there are risks of infection, bleeding, and other complications.

It's important for individuals considering top surgery to have a thorough discussion with their surgeon about the benefits, risks, and expected outcomes of the procedure. Each person's situation is unique, and the decision about which type of surgery to undergo should be made in consultation with a qualified medical professional.

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Developed by Dr. Paul Steinwald, Inverted-T started as a breast reduction technique and has since evolved into a popular form of FTM Top Surgery. The procedure is similar to Double Incision Top Surgery: skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle.read more >>