Frequently Asked Questions
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Frequently Asked Questions About Gender-Affirming Top Surgery
Making the decision to pursue FTM top surgery is exciting, but it’s also natural to have questions. Whether you’re just beginning your research or already scheduled for surgery, understanding the process can help you feel more confident and prepared.
At The Cosmetic Concierge, we believe that patient education is one of the most important parts of exceptional surgical care. Our experienced team is committed to providing compassionate, evidence-based guidance throughout every stage of your gender-affirming journey.
Below are answers to some of the questions we hear most often about gender-affirming top surgery, also known as chest masculinization surgery.
What Is FTM Top Surgery?
FTM top surgery is a gender-affirming surgical procedure that removes breast tissue and reshapes the chest to create a flatter, more masculine appearance.
Depending on your anatomy and goals, your surgeon may recommend one of several techniques, including:
- Double incision top surgery
- Keyhole/Periareolar top surgery
During your consultation, your surgeon will determine which approach is most appropriate for your individual anatomy.
Who Is a Candidate for Top Surgery?
Most healthy adults experiencing gender dysphoria related to their chest may be candidates for top surgery.
Your surgeon will consider factors including:
- Your overall health
- Medical history
- Chest anatomy
- Skin elasticity
- Current medications
- Nicotine use
- BMI and anesthesia safety
- Your personal surgical goals
Every patient receives an individualized evaluation.
Do I Have to Take Testosterone Before Top Surgery?
No.
For most patients, testosterone is not required before undergoing FTM top surgery.
Many transgender men, transmasculine individuals, and nonbinary people undergo chest masculinization surgery without ever taking testosterone.
Your eligibility is based on your health, anatomy, and surgical goals rather than hormone therapy alone.
Do I Need a Letter From a Mental Health Professional?
We do not require a referral letter for top surgery.
How Do I Know Which Surgical Technique Is Right for Me?
Choosing the correct procedure depends on your anatomy—not simply your preference.
Your surgeon evaluates:
- Chest size
- Skin elasticity
- Nipple position
- Amount of breast tissue
- Overall body proportions
- Desired chest appearance
Based on this evaluation, your surgeon may recommend double incision, keyhole, or another appropriate technique.
Will I Have Scars?
Yes.
All surgery results in some degree of scarring.
The location and appearance of scars depend on the procedure performed, your genetics, your skin type, and how your body heals.
Most scars continue to soften and fade throughout the first year after surgery.
Your surgeon will discuss scar care recommendations once your incisions have healed appropriately.
How Long Is Recovery?
Recovery varies from patient to patient.
In general:
- Most patients return to light daily activities within one to two weeks.
- Many patients return to desk work after one to two weeks, depending on how they feel and the nature of their job.
- Strenuous exercise is usually resumed only after clearance from your surgeon.
- Final scar maturation and chest contour continue to improve for many months.
Your surgeon will provide personalized recovery instructions based on your procedure.
Is Top Surgery Painful?
Most patients describe the recovery as soreness, tightness, or pressure rather than severe pain.
Your surgical team will provide medications and instructions to help manage discomfort during the early stages of healing.
Many patients find that their discomfort improves significantly during the first week.
When Can I Shower?
Your surgeon will give you specific instructions about bathing and showering after surgery. You may shower three days after surgery. We simply ask you to not spray water directly at your incisions until they have healed completely closed.
Because healing protocols vary depending on the procedure and your recovery, it is important to follow the guidance provided by your surgical team rather than general advice found online.
When Can I Drive?
Driving should only be resumed after you:
- Are no longer taking prescription pain medications that impair your ability to drive.
- Can comfortably control the steering wheel.
- Can react safely in an emergency.
- Have been cleared by your surgeon if applicable.
Always follow your surgeon’s recommendations before returning to driving.
When Can I Exercise?
Walking is encouraged early in recovery to promote circulation.
More strenuous activities—including weightlifting, running, swimming, and contact sports, should only be resumed after your surgeon determines it is safe to do so.
Returning to exercise too early may increase the risk of bleeding, swelling, or wound complications.
Will I Lose Nipple Sensation?
Changes in nipple sensation are common after top surgery.
Depending on the surgical technique used, some patients experience:
- Temporary numbness
- Gradual return of sensation
- Permanent changes in sensation
Every patient heals differently, and sensation cannot be guaranteed with any surgical technique.
How Long Will Swelling Last?
Swelling is a normal part of healing.
Most noticeable swelling improves during the first several weeks, but subtle swelling can continue to resolve for several months.
Your final chest contour develops gradually as healing progresses.
Why Do Some Practices Have BMI Requirements?
BMI requirements vary among surgeons and surgical facilities.
At The Cosmetic Concierge, we perform surgery in a fully AAAHC-accredited office-based surgical center and maintain BMI eligibility criteria designed to support patient safety and comply with accreditation standards.
BMI is only one part of a comprehensive medical evaluation.
Can I Travel for Top Surgery?
Yes.
Many of our patients travel from throughout North Carolina, across the United States, and from around the world for surgery.
If you’re traveling, our team can help you understand:
- How long you should plan to stay in the area
- Follow-up appointments
- Transportation planning
- Returning home safely
- Recovery considerations while traveling
Planning ahead helps make your experience as smooth as possible.
What Should I Pack for Surgery?
Many patients find it helpful to prepare a recovery kit before surgery.
Common items include:
- Button-up or zip-front shirts
- Comfortable pants
- Slip-on shoes
- Prescription medications
- Toiletries
- Phone charger
- Comfortable pillows
- Healthy snacks
- Water bottle
- Entertainment for recovery
Preparing in advance allows you to focus on healing after surgery.
How Can I Improve My Scar Healing?
While scars are permanent, their appearance often improves significantly over time.
To support healthy healing:
- Follow all postoperative instructions.
- Protect scars from sun exposure.
- Maintain good nutrition and hydration.
- Avoid nicotine.
- Attend all follow-up appointments.
- Use scar management products only if recommended by your surgeon.
Most scars continue to mature throughout the first year after surgery.
Will Insurance Cover Top Surgery?
Insurance coverage varies significantly.
Some insurance plans cover medically necessary gender-affirming surgery, while others do not.
Coverage depends on:
- Your insurance company
- Your specific plan
- Required documentation
- Medical necessity criteria
The Cosmetic Concierge is not in-network with any insurance providers. We are unable to bill insurance, itemize bills, or bill separately for services. The responsibility for seeking reimbursement from your insurance company lies with the patient if they choose to seek reimbursement.
Still Have Questions?
Every patient’s journey is unique, and no website can answer every question.
If you’re considering FTM top surgery or chest masculinization surgery, our experienced team is here to provide clear information, honest guidance, and individualized recommendations based on your anatomy and goals.
We encourage you to write down your questions before your consultation so we can address every concern and help you feel confident in your decision.
Schedule Your Consultation
If you’re ready to learn more about FTM top surgery in North Carolina, we’d love to meet you.
During your consultation, we’ll discuss your goals, review your medical history, explain your surgical options, and develop a personalized treatment plan designed around your individual needs.
Contact The Cosmetic Concierge today to schedule your consultation and take the next step toward gender-affirming chest masculinization surgery.
Common Questions
Our team proudly provides inclusive, affirming, and personalized care for individuals of all gender identities. Explore what to expect from your consultation and the support we offer throughout your journey.
Why Choose The Cosmetic Concierge?
Choosing your surgeon is about more than selecting a procedure—it’s about finding a team you trust.
At The Cosmetic Concierge, we are proud to provide:
- Gender-affirming surgical care
- Individualized treatment plans
- A fully AAAHC-accredited office-based surgical center
- Compassionate, respectful communication
- Detailed education before and after surgery
- Comprehensive postoperative support
Our goal is to provide every patient with safe, personalized care from consultation through recovery.
What are your requirements for Transgender Procedures?
We no longer require a therapy letter or specific time on hormones prior to FTM or MTF top surgery or body sculpting. We use the informed consent model for those procedures.
If there are any doubts about someone’s ability, emotionally or mentally, to give informed consent for a procedure I will ask them to see a licensed mental health provider prior to considering an elective surgery – whether they are gender variant or not.
What do you recommend for out of town arrangements?
Homewatch CareGivers are our preferred post-surgical service provider.
Click here for full recommendations on lodging and caregivers.
What if I have a family history of breast cancer—does that affect my top surgery?
A family history of breast cancer does not prevent you from having FTM chest reconstruction. If you have a first-degree relative (mother, sister, daughter) with breast cancer you should have a mammogram 10 years younger than they were when they were diagnosed or between 40-45 years old – whichever comes first.
There are several breast cancer risk assessment tools you can use to estimate your overall risk. This is an easy one (Cancer.gov). It may help you determine if you want to get a mammogram prior to top surgery. There is also the possibility of sending the tissue from both breasts to pathology for examination. We can get you a price estimate for that. However, it is rarely indicated.
Dr. Sherie’s recommendation for Breast Cancer Screening After Breast & Chest Surgery
I was happy to see Jeff Taylor’s article in Qnotes exploring breast cancer risk and the transgender community. He makes an important point that we all, cis and trans men and women, have breast tissue which extends to the clavicles (collar bones) and into the axillae (underarms) and is retained after mastectomies in cis women and chest reconstructions in trans men.
During ten years as a general surgeon I coordinated the surgeries and oncological care for cis women with breast cancer, as well as 3 cis men with the disease. Now, as a cosmetic surgeon performing “Top Surgeries” for trans men and trans women, I am often the first physician who discusses transgender breast cancer screening with my clients. This is likely because, as Mr. Taylor notes, there are no guidelines for their primary care physicians to follow.
Given the current lack of research, I give my patients the following recommendations based on my own experience and our current knowledge of this disease:
- Trans men who have not had chest reconstruction, and trans women on HRT should follow the same guidelines for breast cancer screening as cis women. These guidelines are evolving; but basically get your first mammogram at 40-50 years old and then annually. This may be continued annually, or reduced to every other year, after the age of 55.
- Trans women on HRT whose anatomy makes mammograms difficult should follow the guidelines above substituting MRIs for mammograms.
- Trans men who have had chest reconstruction, cis men, and trans women who are not on HRT, should have an annual physical exam by a medical professional which includes palpation (careful feeling) of the chest and underarms beginning at 40-50 years old. A CT or MRI should be obtained if, on self-exam or professional physical exam, any lumps, tenderness, nipple discharge, or other abnormalities are found. If there is a lump on palpation, CT, or MRI it should be further investigated by a needle or excisional biopsy.
The original article can be read here: Qnotes Breast Cancer Article. As always, I am happy to answer patient questions about this or other surgical issues in consultation at our private office and surgery center in South End Charlotte.
Why are there little bumps on my nipple grafts?
It is common for top surgery patients to avoid looking at areas of the body which cause dysphoria before surgery and then scrutinize their chests more closely after top surgery. Occasionally, our patients notice small bumps on their areola for the first time after surgery and wonder if they are abnormal.
So, what are these bumps?
1.Montgomery glands: The pigmented area of skin around the nipple is called the areola. On the areola there are little raised bumps called Montgomery glands and they are a normal part of breast anatomy. They are sebaceous glands which produce fluid (sebum) to moisturize the nipple. The actual glands are typically removed with a nipple graft procedure; but the small, raised areas where they connected to the outer skin remain. Incidentally, grafted skin can sometimes be dryer as a result of removal of these glands and require moisturizer. The glands themselves will usually remain in place with the buttonhole technique.
Everyone has Montgomery glands. If you have them and someone else appears as if they don’t, don’t sweat it. As with every other part of your body, there’s a lot of variation between different people. Some may have large, obvious bumps, while others have very small ones that are barely visible.
2. Your Montgomery glands could be blocked: Just like sebaceous (oil) glands on your face and the rest of your body, Montgomery glands can get blocked causing little, red, swollen pimples. As with breakouts anywhere on the body, this is not a problem if it comes and goes. A blocked gland can be treated with warm compresses and exfoliation. If they are persistent and continue to increase in size and tenderness, treatments such as antibiotics, drainage, or steroid injections could be used, but are very rarely needed.
3. You have an ingrown hair: You might also notice strands of hair in bumps on your nipples or areolae. This is also completely normal. As with any other area where there are hair follicles, ingrown hairs are possible on any nipple, areola or nipple graft. When a hair curls back into the skin rather than pushing through, they are “in grown” and look like pimples or blocked glands, except the loop of hair is sometimes visible. This can feel itchy or tender. They sometimes spontaneously resolve; but can also be treated with warm compresses and exfoliation. If they persist and appear infected, a dermatologist can aid in removing the affected hair.
Are there any BMI restrictions?
The Cosmetic Concierge (CC) is an office-based surgical center with AAAHC accreditation. To maintain compliance with the North Carolina Medical Board (NCMB) and American Society of Anesthesiologists (ASA), all patients must have a BMI greater than or equal to 18.5 and below 40.0 to qualify for a surgical procedure at CC. Patients seeking a body lift or abdominoplasty must have a BMI of less than 35.
Do you require a preoperative psychological evaluation for gender-affirming surgeries?
At our practice, we do not routinely require a preoperative psychological evaluation for patients seeking gender-affirming surgeries. We follow surgical standards of care, which emphasize an informed consent model. Our goal is to respect the autonomy and decisions of our patients while ensuring their safety and well-being.
Why might I be asked for a therapist's recommendation?
While preoperative psychological evaluations are not a routine requirement, Dr. Sherie may occasionally request a therapist’s recommendation if she feels it is in the best interest of the patient. This is done to ensure that all aspects of the patient’s well-being are considered before surgery. In such cases, the recommendation helps confirm that the patient is emotionally and mentally prepared for the procedure.
Is there a special requirement for cisgender men seeking an orchiectomy?
Yes, for cisgender men seeking an orchiectomy, we do require a therapist’s recommendation. This is to ensure that the patient is making the decision for discernible personal reasons and is not under external pressure or influence. This added step is a precaution to protect the patient’s autonomy and ensure they are fully informed and committed to the procedure.
What if I don’t have a therapist? Can you help?
If a mental health evaluation is requested and you do not have a therapist, we can assist you by recommending mental health professionals who are familiar with preoperative evaluations and informed consent. We work with trusted professionals both locally and via telehealth, so you can choose the option that is most convenient for you.
How do I know if I need a mental health evaluation?
In most cases, you will not need a mental health evaluation before surgery. However, Dr. Sherie will inform you if a therapist’s recommendation is recommended or required based on your individual situation at the time of your consultation. Any preoperative requirements will be given to you along with your surgical quote at the conclusion of your consultation appointment. Our team is here to guide you through the process and ensure that you have all the information and support you need.
If you have any further questions or need assistance, please don’t hesitate to contact our office. We’re here to support you every step of the way!
Does The Cosmetic Concierge accept insurance?
The Cosmetic Concierge does not accept insurance or process reimbursements. As an office-based practice, our surgical fee includes all associated costs and services. Services are not billed separately, and invoices cannot be itemized.
What To Expect For Your Consultation
Learn what to expect before your appointment. From how to prepare, to what information you’ll need, and how we tailor your experience based on your goals and comfort.
How do I schedule a consultation to start planning for surgery?
The best way to start planning for potential surgery is an official consultation. This can be done on the phone or in person at our office.
If by phone, you will fill out your medical history in our electronic patient portal (we will send you the link) and e-mail us front and side snapshots of the areas we will be discussing before the appointment. We charge $100 for the initial consultation which is paid at the time of scheduling your consultation. This fee is credited towards the price of your surgery and allows us to spend as much time with new patients as needed.
What can I expect during my first consultation?
During this first consultation, we’ll discuss your goals and expectations and also:
- Review your complete medical history (including past and current medications)
- Discuss and evaluate the area(s) you would like treated
- Give recommendations
- Answer any questions you have
- Discuss medical conditions that could affect your procedural outcome
- Clarify surgical risks and benefits
- Establish a typical timeline for resuming normal work and social activities
- What to expect when having a cosmetic procedure
Feel free to give us a call at 980-938-0459 to schedule your consultation or if you have other questions.
What happens after my consultation?
You will leave your consultation equipped with the information to help you decide your next steps and clearly understand your procedure.
When you decide upon a procedure, our concierge team will take care of all the details to schedule your surgery – a date, time, location, what to bring with you to help make your brief stay more comfortable, arrangements to discharge you safely after your procedure, and post-operative instructions and follow-up appointments with our concierge clinical team.
What sets us apart?
- We provide 2 notarized letters on the day of surgery for patients undergoing transgender procedures that may be used for changing gender marker on drivers license and passport.
- We perform all procedures on-site in one of our two operating rooms, and are fully accredited by AAAHC.
- We do not use bulb drains for our procedures, so no measuring or emptying is necessary.
- We are happy to provide a TSA letter upon request to out-of-town patients who may need it for plane travel after surgery.
- All surgery patients and caregivers are given a provider’s direct cell phone number for after hours emergencies.
- We use platelet-rich plasma (PRP) in our fat transfer procedures to aid in healing and cell growth as well as to maximize retention.
- We have an amazing staff! Every member of the Cosmetic Concierge staff is completely committed to providing the best possible care to our patients and making their experience an exceptional one.
- Dr. Sherie is double board certified in General and Cosmetic surgery.
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