Lately I've been looking at a lot of top surgery results. The one thing I have never seen discussed by any of the guys who have had the surgery is if they had any choice in nipple size (areolas too) or placement.
I don't want big honking nipples but I also don't want tic tacs either. Something about nickel size (in diameter) would be nice and to have them placed right along the pectoral curve would be preferred.
Anyone know how much leeway a surgeon is willing to give us about having a choice in the matter?
i talked to my surgeon and she said she would make them the average size in a cis-male (can't remember the number, sorry). Definitely speak up when you go to meet your surgeon, they'll probably address that anyways. I wouldn't be too worried :)
I have consulted with three surgeons - all of them show work they have done - discuss body size and what would look good and nipple size & placement.
Good to know. It's just one of those things I've never seen mentioned.
There's one doctor whose name I can't remember right now that literally uses a nickel as a template for nipples when it comes to top surgery. There's also the option of getting nipples tattooed on.
Quote from: Nygeel on April 15, 2013, 02:07:03 PM
There's also the option of getting nipples tattooed on.
I think the tattoo option would be good if (heaven forbid) the grafts don't take. From afar it wouldn't be very noticeable but up close it would be obvious.
I do remember one guy on YouTube years ago that decided not to even have his nipples put back on after surgery. Sadly he was harassed by some in the comments (as is the YT way) and disappeared from the online community. I wonder how many decide not to even have them grafted back on.
I am curious now, and wondering why would you opt not to keep your own nipples? I mean, if this is an option, it would seem to me everybody would pick it, right? Or is the nipple placement very tricky and can fail?
Quote from: Mr.X on April 15, 2013, 03:18:08 PM
I am curious now, and wondering why would you opt not to keep your own nipples? I mean, if this is an option, it would seem to me everybody would pick it, right? Or is the nipple placement very tricky and can fail?
Some people would prefer a tattoo, some people don't care about nipple sensation and don't see much of a point of getting grafts. There might be less down time if you don't have nipple grafts, too.
Quote from: Mr.X on April 15, 2013, 03:18:08 PM
I am curious now, and wondering why would you opt not to keep your own nipples? I mean, if this is an option, it would seem to me everybody would pick it, right? Or is the nipple placement very tricky and can fail?
I don't know, I guess there could very well be guys with nipple dysphoria. Then there are probably some who don't care if they have them or not.
One of my friends had his top done back in 2001 and one of his grafts didn't take. He thought it was funny. I asked him what he was going to do when he went to the pool. He said he was going to draw it on with pink eyeliner, lol.
I've considered not having nipple grafts from looking at the photos on transbucket because to me they look flatter and better. I'm just not sure whether I would want to sacrifice nipple sensation entirely for aesthetics. If the grafts didn't take or I didn't have any nipple sensation -- I don't have that much to start with so losing any would pretty much just give me the sensation of normal skin -- I would be annoyed with myself for not going for surgery without grafts. One of the things that bothers me most with top surgery isn't the scars but the nipple placement.
The scars don't bother me much either but the funky nipples do. When people ask me why I have scars I'm going to tell them because I had tumors so the breast tissue was removed. My weird nipples? I'd rather just have them tattooed
Quote from: Nygeel on April 15, 2013, 02:07:03 PM
There's one doctor whose name I can't remember right now that literally uses a nickel as a template for nipples when it comes to top surgery. There's also the option of getting nipples tattooed on.
I believe that's Brownstein. It wasn't the point of the video, but he does a very nice explanation and compare/contrast of peri and DI somewhere on youtube.
--Jay
I don't think I would care too much re: tattoo vs graft, not like those have proper sensation in them anyway. They have three settings: light touch, cold shock, and cold shock plus pain. So there's not much to miss there.
In order to have my insurance cover the surgery, I'm getting almost all the breast tissue removed and I don't have the option of keeping my original nipples. I have been offered plastic surgery to make fake nipples with tattooing and a little raising of the skin. I'm not impressed by the photos I've seen, but the transguys I've met irl honestly don't have perfect results even with their own original flesh being used.
Quote from: Felix on April 18, 2013, 07:18:31 AM
In order to have my insurance cover the surgery, I'm getting almost all the breast tissue removed and I don't have the option of keeping my original nipples.
Why? The only reason I can think of is your surgeon is trying to "cheat the system" and say you have breast cancer (or something else seriously wrong there).
Quote from: Simon on April 18, 2013, 01:05:22 PM
Why? The only reason I can think of is your surgeon is trying to "cheat the system" and say you have breast cancer (or something else seriously wrong there).
Not cheating the system, just having it paid for the way they pay for it. They have methods for billing preventative medicine but no routine for billing breast removal for a man who shouldn't have breasts. It's OHP CareOregon (temporarily FamilyCare) if you want to look into it. Under mastectomy coding on the prioritized list for the current fiscal year there's no way to bill it as transgender treatment. The codes for trans stuff are vague and very far down on the list. Nobody is being deceptive or cheating anyone, it's just kind of a no man's land in most of the healthcare system.
I get all my blood tests paid for. My doctor codes it for 3 things. ONe of which I actually maybe have. But one of them is "endocrine disorder". Of course maybe I do have that.
I have heard of some guys getting "reductions". They don't weigh the tissue coming out, let's just say. Most of them have very large chests, so there is some medical reason to get a reduction.
--Jay
Quote from: Felix on April 20, 2013, 09:54:45 AM
Not cheating the system, just having it paid for the way they pay for it. They have methods for billing preventative medicine but no routine for billing breast removal for a man who shouldn't have breasts.
Ok, regardless of the billing/payment issues, will you be satisfied with the results? That is the main thing. The reason it sounds deceptive is because they have to perform the procedure in a certain manner (removing most of the tissue and no nipple grafts). It just sounds like a mastectomy they would perform on a cancer patient.
As long as you're satisfied with what they're offering then go for it. I just wouldn't pick something because it was free or reduced cost if the results aren't what you're after. I'm planning on top surgery Summer of next year if everything goes right and will be paying out of pocket. It's a good chunk of change obviously but I figure a few years from now the money I spent will mean nothing compared to the satisfaction of having exactly what I want.
I've actually thought about getting no nipple grafts, and then getting a chest tattoo (not nipples tattooed on) that covers that whole area, including scars. I dunno that I could ever find a tattoo I'd be happy with forever though. The idea of choosing one is daunting. How do people ever settle on one?
And I keep thinking about that news story a few months back where people got the contaminated ink, so even when they picked a clean, safe place, they were still screwed with some weird skin infection. This is really rare I think though, and I know tons of people get tattoos with no issues. Still.
Quote from: spacerace on April 20, 2013, 04:31:07 PM
I've actually thought about getting no nipple grafts, and then getting a chest tattoo (not nipples tattooed on) that covers that whole area, including scars. I dunno that I could ever find a tattoo I'd be happy with forever though. The idea of choosing one is daunting. How do people ever settle on one?
Most chest tattoos I've seen done on post-op guys have been a large piece that incorporates several smaller related tattoos. I think I could design one for myself with enough thought.
You can mention nipple and areola size to your surgeon. He may have a way he does things, but the patient's wishes/concerns should be taken into account.
Quote from: Simon on April 20, 2013, 03:16:38 PM
I just wouldn't pick something because it was free or reduced cost if the results aren't what you're after.
Maybe you wouldn't, but a lot of guys on Medicare/Medicaid just don't have the ability to save up eight thousand bucks or however much it is these days. Sometimes people have to compromise.
Quote from: spacerace on April 20, 2013, 04:31:07 PM
I've actually thought about getting no nipple grafts...
I think being a person without nipples is probably going to get you more weird looks than the scars from your top surgery ever would....
Quote from: JasonRX on April 29, 2013, 03:55:33 AM
I think being a person without nipples is probably going to get you more weird looks than the scars from your top surgery ever would....
They were talking about nipple tattoos. I meant no nipples with a large, detailed chest tattoo across the area covering the scars and nipples instead of nipple tattoo options, not just a blank chest, and it was just a thought experiment, not a serious consideration.
I don't want to get any type of tattoo though, so real nipples it is for me.
Makes me think though about chest hair obscuring any scars and/or weird nipple issues- a smooth hairless chest looks better in my opinion, but I would leave my chest furry to cover scars if I ever got to a point post surgery where I am really hairy with large scar issues I think.
The doc i'm seeing (three weeks!) said it's very important that I tell him of any preferences I may have so he can work them in. I don't know if all surgeons are like this but I was very happy to hear he cared about my preferences as well! Therefore I'm requesting quarter sized nipples with the most OCD 'identical' incision marks he can manage.
Also with regards to scars, I personally love tattoos but obviously could never get them on my chest without this surgery, so once i've have the surgery I will definitely be covering up my scars with tats.
I was talking to my surgeon and he said that with the grafts, the nipple tends to resize itself. With leaving the nipple attached, the areola can be resized but the nipple cannot. Another surgery would need to take place.
Also, grafts are more likely to stay on and not "die" than leaving the nipple attached as the blood flow takes from the area that it is grafted to where the other option leaves the nipples blood flow more restricted.
Hope this helps a bit.
Quote from: xander on May 11, 2013, 06:53:33 AM
Also, grafts are more likely to stay on and not "die" than leaving the nipple attached as the blood flow takes from the area that it is grafted to where the other option leaves the nipples blood flow more restricted.
You might want to rephrase this. I couldn't make out what you meant.
My surgeon said that he would scrape a bit of the excess tissue from behind my nipples, but I don't think he wound up doing that. The surgery before mine ran over, and I suspect that the surgeon didn't want to take the time, or maybe he just forgot. Whatever happened, my nipples are not flattened out the way I was expecting. They are still attached to the nerve stalk, so I wasn't expecting them to be perfect, but I did expect them to be flatter than they are.
What I meant was that risk of the nipple graft not taking to the body is less than the likelihood of losing circulation to nipples that are left on the nerve stalk. I'm saying this because people often worry about nipple "death" due to poor blood flow post surgery and they often assume that a graft increases this risk, where in actual fact it reduces it.
Quote from: Arch on May 11, 2013, 05:14:42 PM
My surgeon said that he would scrape a bit of the excess tissue from behind my nipples, but I don't think he wound up doing that.
The nipples are a separate graft from the areolas.
Here is a video of a complete top surgery operation.
WARNING: If you are squeamish or about to have top surgery I would skip viewing this. For the rest of us who are interested in seeing exactly how it is performed you may find this interesting.
Anyone who views this just be aware that it is the complete surgery. Don't want to hear any whining later if it scared you.
http://www.surgerytheater.com/video/6423/Dr.%20Daniel%20Medalie%20performs%20FtM%20top%20surgery%20%28double%20incision%20mastectomy%20with%20nipple%20grafting#.UY7O-MrDl-9 (http://www.surgerytheater.com/video/6423/Dr.%20Daniel%20Medalie%20performs%20FtM%20top%20surgery%20%28double%20incision%20mastectomy%20with%20nipple%20grafting#.UY7O-MrDl-9)
Quote from: Simon on May 11, 2013, 06:08:28 PM
The nipples are a separate graft from the areolas.
My whole nipple/areola apparatus is still attached to the nerve stalk. They were moved intact, not grafted separately. So to decrease my nipple size, the surgeon apparently had limited options--and I don't think he exercised the option he was supposed to. He did say that he could do only so much, so my nipples might have stayed pretty prominent no matter what.
Quote from: Arch on May 11, 2013, 06:12:13 PM
My whole nipple/areola apparatus is still attached to the nerve stalk. They were moved intact, not grafted separately.
Ahh, ok gotcha. That is the "anchor" style incision (I think) isn't it?
I'm going to definitely go with the separate graft technique. I have "nipple dysphoria". Not to the point where I don't want them. I just want them to be small. Small areolas are preferred for myself also but my gf seems to think they would look funny if they were smaller than the size of a quarter. ::)
Quote from: Simon on May 11, 2013, 06:19:41 PM
Ahh, ok gotcha. That is the "anchor" style incision (I think) isn't it?
No, but I guess it's a variation. He calls it the pedicle technique, but that can involve different types of incisions.
Quote from: Arch on May 11, 2013, 06:12:13 PM
My whole nipple/areola apparatus is still attached to the nerve stalk. They were moved intact, not grafted separately. So to decrease my nipple size, the surgeon apparently had limited options--and I don't think he exercised the option he was supposed to. He did say that he could do only so much, so my nipples might have stayed pretty prominent no matter what.
You can get another surgery to alter the nipples. I asked my surgeon about this. He said the nipple can't handle being resized at the same time as the initial surgery as it is too much stress for it but they can be revised after you heal.
Quote from: xander on May 11, 2013, 07:01:44 PM
You can get another surgery to alter the nipples. I asked my surgeon about this. He said the nipple can't handle being resized at the same time as the initial surgery as it is too much stress for it but they can be revised after you heal.
I'm not sure it's actually possible because of all the nerve attachments. My doc told me that the only thing he could do was to scrape away a bit of excess tissue. He said he couldn't simply resize the nipple. Then again, perhaps I misunderstood and he meant that he couldn't do it straight away. On the other hand, if he knew I wanted smaller nipples and needed another surgery for that, he ought to have said something. After all, it's money in his pocket if I have another procedure.
In any event, I would have to consult with another surgeon and then pay a few thousand...if I had money to burn like that, I would much rather get a little liposuction. Or just save up for bottom surgery...or a newer car. Still, it's on my list of things to investigate eventually.
Quote from: Simon on May 11, 2013, 06:08:28 PM
Here is a video of a complete top surgery operation.
http://www.surgerytheater.com/video/6423/Dr.%20Daniel%20Medalie%20performs%20FtM%20top%20surgery%20%28double%20incision%20mastectomy%20with%20nipple%20grafting#.UY7O-MrDl-9 (http://www.surgerytheater.com/video/6423/Dr.%20Daniel%20Medalie%20performs%20FtM%20top%20surgery%20%28double%20incision%20mastectomy%20with%20nipple%20grafting#.UY7O-MrDl-9)
I ate fruit snacks while I watched that. Haha.
It's so strange to see how top surgery is actually done...I'm still new to all this stuff, so I had no idea how any of this was actually done.
I don't know if I'll ever opt for any type of surgery, and seeing how this is done makes me want it less and less. =___=
Quote from: Arch on May 11, 2013, 09:09:54 PM
I'm not sure it's actually possible because of all the nerve attachments. My doc told me that the only thing he could do was to scrape away a bit of excess tissue. He said he couldn't simply resize the nipple. Then again, perhaps I misunderstood and he meant that he couldn't do it straight away. On the other hand, if he knew I wanted smaller nipples and needed another surgery for that, he ought to have said something. After all, it's money in his pocket if I have another procedure.
In any event, I would have to consult with another surgeon and then pay a few thousand...if I had money to burn like that, I would much rather get a little liposuction. Or just save up for bottom surgery...or a newer car. Still, it's on my list of things to investigate eventually.
I'm not sure how much work can be done to the nipple with this method but something is possible. Although maybe the technique that my surgeon uses is different and does allow for these kind of adjustments in the future and your surgeons technique may be more restrictive? I'm no expert, I'm just reguritating what my surgeon told me.
Out of curiosity, are revisions of surgery (filling of dents etc) free from the surgeons in the US?
Edit: wait, maybe I'm misunderstanding something. When you say scrape off excess tissue, where is the tissue from?
Quote from: D0LL on May 11, 2013, 11:56:25 PM
I don't know if I'll ever opt for any type of surgery, and seeing how this is done makes me want it less and less. =___=
It's really a simple procedure. They don't even cut muscle. You're in and out of the hospital in just a few hours.
Quote from: Simon on May 12, 2013, 12:40:27 AM
It's really a simple procedure. They don't even cut muscle. You're in and out of the hospital in just a few hours.
That's what I thought about the cyst on my spine. =___= Might have been not too bad if the guy had actually numbed me before slicing into my skin with a scalpel...
It's nothing against the procedure, per-se (although actually seeing it rather than just reading about it makes my skin crawl), I've just had some bad experiences with medical "professionals", so obviously I'm not too keen on the idea at this point.
I just feel very weird about the idea of rearranging nipples and what-not. ^^;
Quote from: xander on May 12, 2013, 12:27:36 AM
Edit: wait, maybe I'm misunderstanding something. When you say scrape off excess tissue, where is the tissue from?
He was going to remove tissue in/underneath the nipple so that it would flatten out a bit. I don't know how much extra tissue there is, frankly. Probably not much.
If I'm lucky, I'll have stable employment in just over a year (might not be full time at first) and will be eligible for trans-supportive insurance that will cover most expenses for bottom surgery. If I can get that covered, then I'll think about my chest again. But bottom surgery will likely take a couple of years because I'm free only a few weeks a year and will have to schedule everything carefully.
If I don't get help with bottom surgery, my chest is the least of my worries.
BTW, I got free revisions of my dogtags about six months after my surgery. I had to pay for related expenses, but no surgical fee. It was about $300 all told.