DISCLAIMER!!! All medical information is right to best of my knowledge! Apologies if any turns out to be wrong
For a transgender male having ‘Top surgery’, breast removal, is almost a guarantee (for example I am part of a number of group contacting me with over 15,000 transgender males around the world and I have never spoken to a single one who didn’t want their breast removed. Like most Trans male I want top surgery and it is something I can’t wait to finally have, to have flat chest and not worry about it. There are a couple different ways to achieve this. The most common are;
1) would Peri-areolar which is for guys with a chest size of B cup or smaller – in the UK. During this surgery the breast is removed through a small incision at the bottom of the areola, the nipple itself is left intact.
2) Double incision this procedure is ideal for medium to large chested men. During this procedure, the skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. The skin is pulled back and the breast tissue is then removed, Nipples are removed, re-sized and grafted on the chest, this often leads to the person having little to no sensation of the nipple.
3) The Inverted-T Top Surgery procedure is ideal for medium to large chested men who wish to retain the most sensation possible in the nipple. The procedure is similar to Double Incision Top Surgery: skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. (The muscle itself is not touched.) The skin is pulled back and the breast tissue is then removed.
Bottom surgery on the other hand is very different. I would guess that worldwide less in 50% of transmen get any form of bottom surgery. A big reason Trans men don’t get the surgery is the cost (roughly £50,000 for all stages), I would also guess that in countries, like the UK, where there is more funding and help to pay for such an expensive surgery the percentage of guys getting it would be much higher. There are two types of bottom surgery Metoidioplasty and Phalloplasty, they are both very different.
-Metoidioplasty (known as Meta for short) take advantage of the fact that testosterone causes a Trans males clitoris to grow longer. By cutting the ligament that holds the clitoris in place under the pubic bone, as well as cutting away some of the surrounding tissue, the surgeon is able to create a small phallus from the elongated clitoris. In order to further enhance the result, fat may be removed from the pubic mound and skin may be pulled upward to bring the phallus even farther forward. It also includes a urethral lengthening procedure to allow the patient to urinate through the penis while standing. Depending on the goals of the patient, the vaginal cavity may or may not be closed or removed, this is known as a vaginectomy. A phallus created by Meta would not be able to penetrate during sex.
-Phalloplasty (known as Phallo for short) come in a two different forms depending one where one the person’s body the skin comes from, it can come from the forearm or groin.
-Forearm Phalloplasty is the most common, this procedure is considered by many to produce a more realistic-looking, and the forearm skin is shaped into the new penis and grafted into place on the groin, where the nerves and blood vessels are connected. Some surgeons will connect the brachial nerve of the forearm to the pudendal nerve of the clitoris. A urethra is typically created using tissue from the labia shaped into an inverted tube. The clitoris is usually left intact near the base of the penis; the exact placement of the base of the penis with regard to the clitoris should be discussed with the surgeon. Usually, a flexible rod must be inserted into the penis or an implanted pump device used in order to achieve an erection. The vaginal cavity will be closed, in a vaginectomy. Phalloplasty is comprised of three stage, most men also have a hysterectomy during the second stage of Phalloplasty.
Here in the UK we have the National Health Service (NHS) paid for by taxes that means that treatment is free, something we are extremely lucky to have. So when I have top surgery it will be on the NHS and thus free for me, however it is still possible to going privately which is the same quality service but normally quicker but at a cost. The same will be true for bottom surgery, so for me the question of money is THANKFULLY not an issue. Things I need to consider are if I want to be able to pee standing up, penetrate during sex and generally have a penis. I discussed the topic at length with my wife, obliviously the final decision would have to be my own as my wife and I could separate and I would have to live with the decision I had made. At this point in time I have decided that bottom surgery, forearm Phalloplasty, is something I do want to have, there is the chance that, that could change but at the moment I don’t see that happening.
-Honest Trans Guy