For more detailed information about FtM mastectomy surgery and how to proceed with scheduling, please download Dr. Medalie’s informational PDF by clicking on the button below.
Top Surgery Patients Must Read This
If you would like to have a free evaluation of your chest to determine what type of operation may be necessary, please e-mail front and side photos to his secretary at vrowan@metrohealth.org. Before you contact her please download the HISTORY FORM by clicking HERE, and send it along with the photos.She can also answer most of your logistical questions.
Dr. Medalie in Cleveland, Ohio is an internationally recognized expert in the field of Female to Male chest or “top” surgery. He has been featured in several documentaries about transgender surgery including ones on MTV and LOGO tv.
To see him on MTV please click here
To see him on the LOGO network please click here
To see some more of his patient photos please click on this link to Transbucket. You may have to create a free account if you are not already a member.
Female to Male Chest Surgery
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Dr. Medalie explains FtM top Surgery |
Dr. Medalie performs double incision top surgery with nipple and areolar grafting |
Dr. Medalie performs peri areolar top surgery |
The procedure is based on the following:
- Size and shape of breast
- Elasticity of skin
- Patient’s needs and preferences
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| This is an example small subcutaneous mastectomy with peri areolar purse-string closure. | |
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| This is an example of double incision and nipple/areolar Grafting | |
In general, patients who have smaller breasts can have the entire surgery performed by having a small amount of skin removed (in a doughnut pattern , also known as-”peri-areolar or “purse-string” mastopexy”). A subcutaneous mastectomy is performed and then the outer edge of the skin is closed with a purse-string to the newly down-sized nipple. By necessity the edges of the incision around the nipple will be “scalloped” or bunched up initially. This settles down to a great degree over time. If the patient understands that scar revision may be necessary, this is a very reasonable approach. The nipple may experience compromise of its blood supply and also have sensation or erectile capacity changes.
In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, it is usually recommend to remove the excess skin and breast tissue in the crease of the pectoralis muscles (elliptical or double skin excision mastectomy) and put the nipples and areolae back on as grafts. This surgery has the advantage of immediate and predictable results. I can contour the skin flaps and place the nipples where I want to. It has the disadvantage of permanently altering the sensation and erectile capacity of the nipples, and it leaves larger scars on the chest. Over time they fade and flatten out. At each end of the scar, “dog-ears” may form. These are small bunches of tissue created by the closing of the ellipse as a straight line. They tend to settle down over time, but may need to be revised. I can try and address the dog ears at the time of surgery but this can extend the length of the scar.
If you have had FtM “top” surgery and need post-op instructions for the first week
If you have had FtM “top” surgery and need long term care instructions
Scheduling Surgery If You Live Out Of Town
I frequently perform operations on FtM patients who live out of town and are unable to easily to see me in consultation prior to the procedure. I have several requirements for these patients:
1) I must see pictures of them prior to scheduling surgery.
2) They need to go to my website under the transgender top surgery section and download a history form (there is an easily visible link to the form), fill it out, and send it to my secretary, Valerie.
3) I must have a therapist letter.
Typically the patient will come in to town 1 prior to the procedure, and I will see them in my clinic (alternatively I will perform a phone consultation). I will then perform the operation and see them back in my clinic in 5-7 days to remove drains and change the dressing. This means that the patient will spend around 1 week in the Cleveland area. Patients who live far away, but can drive to Cleveland (2-6 hrs.), can go home the next day and drive back to see me for their first post-operative appointment. I will then follow the progress of the patient via e-mailed pictures on a weekly basis. Occasionally I have had patients who have gone home and had their primary care doctor remove the drains and perform the first dressing change. I do not prefer this but do allow it if I the patient can assure me of good care. My secretary has information about hotels in the area as well as financing. For all logistical details she is the best person to contact. Her e-mail is vrowan@metrohealth.org.
Metoidioplasty Surgery
In this operation, the surrounding skin of the clitoris is removed and it is released from the pubis to give the appearance of more length. The glands will appear circumcised in most patients. The final result is a normal appearing, but very small, penis. Actual result will depend on various factors as described below. The outcome is largely dependent upon how much enlargement of the clitoris has occurred with Testosterone. The best results from the metoidioplasty are in patients who are near their ideal body weight and do not have an overhanging mons pubis. In most patients, removal of some skin and liposuction of the fat of the mons will also improve the result. The principal advantage of the metoidioplasty is that it is noninvasive, maintains the sensitivity of the clitoris, and does not create apparent surgical scars. Furthermore, it does not prevent future genital surgery from being done at a later time should one decide. The penis will not, however, appear adult in size, and it is not large enough for vaginal intercourse. Dr. Medalie does not perform urethral lengthening with metoidioplasty. Dr. Medalie typically performs simple metoidioplasty as an outpatient procedure. If a patient desires scrotal construction from the labia majora and insertion of testicular implants, this procedure can be done simultaneously with the non-urethral metoidioplasty.
Click here to view metoidioplasty surgery pictures
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Before Metoidioplasty
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Intra-operative markings
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Labia Minora Incisions and Clitoral Release
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Labia Majora Incisions and Scrotoplasty
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Completed Metoidioplasty with pubic lift and scrotoplasty with testicular implants
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MtF Chest Surgery
In those male patients who desire female breasts the first treatment that can be of benefit is the female hormone, estrogen. The results are extremely variable, but almost all patients have some growth of breast tissues. The more definitive and predictable way to achieve female breasts is through implant surgery. This surgery is no different for genetically male patients than genetically female patients. I encourage readers to see my breast augmentation section as well as examine the information at the American Society of Plastic Surgery at www.plasticsurgery.org.
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| Before Breast Implants |
After Breast Implants |
