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Sensation and Chest Reconstruction  Top Surgery

There are different tenchniques and types of top surgery and it is best to consider the potential effects in bodily sensations prior to pursuing these procedures. This article provides information on what contributes to changes in nipple sensation including incision technique, nipple grafts, and medical histories. Chest reconstruction top surgery, formerly known as FTM top surgery, may also affect chest tenderness during menstrual cycle and sexual intimacy, both of which are also discussed in this content.

The goal of chest reconstruction top surgery is to create a flatter and often more conventionally “masculine”-looking chest. The reconstructive process often involves removing chest tissue and excess skin, and resizing or repositioning the nipples. In addition to obvious physical transformations,  chest reconstruction top surgery also produces changes in bodily sensations.

Prior to undergoing chest reconstruction top surgery, you should fully understand the scope of the procedure and feel comfortable with the potential resulting outcomes of potential sensation retention and loss. Your consultation with your surgeon  will cover these topics in-depth.

Nipple Sensation after Chest Reconstruction Top Surgery

Ultimately, changes in nipple sensation will depend on the type of surgery you have and your body’s unique ability to heal. Patients with a significant amount of chest tissue often require a procedure that uses free nipple grafts to obtain their desired outcome. This technique gives the surgeon the flexibility to remove a significant amount of chest tissue while also contouring the chest to the desired shape.

Something to consider with nipple grafts is that the nipple and areola (pigmented area around the nipple) must be removed as skin grafts and relocated on your chest. Their blood supply and nerve endings are disturbed during this process, which often results in some loss of sensation. The degree of sensation after surgery is usually similar to the sensation of the upper chest before surgery. Thus , sensation is still present, but is diminished from the sensation in  the nipples that is usually present before surgery.

Though very uncommon at The Gender Confirmation Center, it is possible to lose all nipple sensation following chest reconstruction top surgery. Patients who smoke or those who have  diabetes or an autoimmune disease run an increased risk of partial or total nipple graft failure. During your consultation you can discuss your medical history with your surgeon so they can help you form realistic outcome expectations.

Sensation Preservation through Neurotization

The cost of undergoing a double incision (DI) top surgery with free nipple grafting (FNG) is often a loss of heightened, erotic sensation to the nipple-areola complex. At the GCC we are proud to announce a collaboration with Dr. Ziv Peled (he/him) that will allow us to offer patients the option to retain heightened nipple sensation after top surgery. Many of our patients experience a dilemma in wanting a flat chest, but not wanting to sacrifice nipple sensation in the process. Thanks to Dr. Peled, we’re able to offer a nerve or sensation preservation DI so that patients can have a flat chest while maintaining heightened sensation in their nipples.

Patients can undergo a neurotization or sensation preservation DI, which involves connecting the grafted nipples to nerves, if maintaining erotic levels of sensation in their nipples is a priority for them. After surgery, patients can expect to recover heightened levels of sensitivity in the nipples by around 3 months post-op. It may take some patients longer for this to start happening. In the initial stages of nerve healing, it is normal for patients to experience uncomfortable sensations, like itchiness and tingling. Sensation in the nipple-areola complex should improve through the first year after surgery.

Chest Tenderness and the Menstrual Cycle

Chest tenderness is a common premenstrual  symptom. Most of this discomfort is related to the chest tissue, which means that it will be significantly diminished or completely gone following chest reconstruction top surgery. If you choose to have a chest or breast reduction rather than a chest reconstruction, you may still experience some tenderness or discomfort during your cycle unless you begin hormone therapy, have your ovaries removed, or initiate other treatment that would discontinue your menstrual cycle.

Sexual Intimacy Following Chest Reconstruction Top Surgery

Though nipple sensation is likely to be diminished following chest reconstruction top surgery, most patients report increased sexual satisfaction. Studies have shown that sexual satisfaction is often intimately connected to feeling comfortable in one’s own skin and most trans men, transmasculine and non-binary people experience greatly enhanced body confidence following chest reconstruction top surgery.