For many trans men considering FTM Top Surgery, retaining sensation in their nipples is of significant value. At McLean Clinic, we specialize in two FTM Mastectomy procedures: a Double Incision Mastectomy and the Periareolar (Keyhole Incision) Mastectomy. Both these top surgery procedures involve the removal of breast tissue under the nipple. This can have an effect on the blood flow to the nerves in this area, which may result in some sensation loss. Depending on the type of top surgery being performed, both the amount and type of sensation that remains or is lost will vary.
Types of Procedures and Sensation
The most common FTM Top Surgery performed at McLean Clinic is the Double Incision Mastectomy, which is designed for patients with large or overhanging breasts, or with loose skin. This procedure is particularly advantageous because of the greater precision achieved in the size of the nipple, the nipple position, and scar placement. In this procedure, the nipple-areolar complex is removed completely, resized, and grafted onto the chest in the desired position. This process disrupts the nerves that go into the nipple-areola and because they are not reconnected microsurgically, there is a strong likelihood for patients to experience loss of sensation in the nipples and areola post-procedure. The Periareolar (Keyhole Incision) Mastectomy Procedure, which is designed for those with small breasts with limited or no overhang, does not involve the removal of the nipple-areolar complex. During the surgery, the nipple remains intact; however the position of it is determined by the position on your breast. Its positioning cannot be changed or altered by the procedure. Because of this, it offers a better chance at preserving nipple and areola sensation, however this cannot be guaranteed.
It’s very common to feel numbness in the chest area in the days following your top surgery procedure. You may experience this in smaller “deadspots” or over an entire region.
After 1 to 2 months, you may begin to experience a tingling sensation, which may feel prickly, like a sting, or like a burn. This is very common among transmen and is a completely normal sign of healing. During your procedure, your nerves in this area are stretched and compressed, and the swelling you experience afterwards will impact the nervous system. This prickling feeling is a sign that the nerves are healing.
Generally, you start to regain sensation in your chest area after 6 to 12 months.
While it’s rare for patients to completely lose sensation after their Top Surgery, some who undergo the Double Incision Mastectomy have reported total loss in erogenous sensation. This is the type of sensation that induces sexual response. Patients who are smokers or diagnosed with diabetes or an autoimmune disease are at a higher risk of nipple graft failure, which leads to total loss of sensation. These risk factors will be discussed with you during your consultation with Dr. McLean.
In general, an overwhelming majority of our patients report high satisfaction levels with their decision to undergo Top Surgery. If retaining sensation is important to you, we will make sure to discuss this to determine which option would work best for your needs.