Visage Clinic: Dr. Marc DuPéré
101-133 Hazelton Avenue
Yorkville, ON M5R 0A6
Phone: (416) 929-9800
Fax: (416) 368-3113
Toll Free: 1 (855) 8 VISAGE
Monday-Friday: 8:00 a.m.–5:00 p.m.

Visage Clinic: Dr. Marc DuPéré
114-13311 Yonge Street
Richmond Hill, ON L4E 3L6
Phone: (905) 773-9675
Fax: (416) 368-3113
Toll Free: 1 (855) 8 VISAGE
Monday–Friday: 8:00 a.m.–5:00 p.m.

Top Surgery in Toronto

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“Top surgery” is common language for our Toronto transgender community, more specifically my female-to-male (FTM) patients. It refers to the removal of breast tissue and to the masculinization of their chest, a strong component of gender reassignment surgery.

I have been performing top plastic surgery here in Toronto since 2001.

I offer 6 different techniques of top surgery for my FTM transgender patients, of which there are 3 main versions. The choice of technique is dictated by the patient’s anatomy but also by the patient’s choice of scars and the likelihood of a required second procedure, often called “second stage” when discussing plastic reconstructive surgery.

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Drawings by Dr. Marc DuPéré

The simplest of all 3 techniques is the “keyhole” technique. The term is quite simple to understand for the lay people as it refers to a “small opening”, i.e. a keyhole (yet confusing to non-experienced plastic surgeons as the keyhole technique in breast surgery refers to something different). This keyhole technique in masculinization of the chest refers to a small incision, between 5 and 7 o’clock at the areola’s border. The areola is the flat disk around the nipple. This technique was “borrowed” from our plastic surgery work on males with gynecomastia (breast tissue on males). Via this small incision at the brown-beige areolar line, most of the breast tissue can be removed. This technique is excellent for small breasts, small areolae and young elastic and recoiling skin as no skin and no areolar tissue are removed. A strong advantage is most of the nipple feeling is preserved.

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Drawings by Dr. Marc DuPéré

1 step up would the “periareolar” or “donut” technique. I used this technique for moderate-sized breasts where there is a mild excess of skin to be excised along with small-to-moderate breast tissue. It is done via excision a “donut-shaped” area of skin around the areola  and closing it to a smaller “male-size” areola. There is a limit of extra skin that can be removed with this technique and therefore, it works best for small-to-medium breasts. I sometimes use this technique for larger breasts when patients are very reluctant to the under-the-breast incision of the double-incision technique, yet, a second-stage procedure is often required to deal with some mandatory residual breast tissue required to maintain the viability of the nipple-areolar complex with the mandatory long pedicles (as seen with larger and pendulous breasts). The final scar is a circle around the areola. Because a larger circle is closed to a smaller circle, there are commonly little folds around the areola that tend to efface and disappear over 1 to 3 months, otherwise, a small scar revision might be required. In this technique, if more skin is excised, the tension on the closure with various upper extremity movements is greater and the likelihood of scar widening is greater. If the amount of skin is lesser, then there might be some residual loose skin after surgery. So as an experienced plastic surgeon, I must determine the right balance of skin excision; the patient also knows that a revision might be required. Finally, because the nipple-areolar tissue is not completely severed, there is a very small possibility of maintaining some sensation.

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Drawings by Dr. Marc DuPéré

By far the most common technique is the so-called “double-incision” technique.  This is what I recommend for larger breasts. It allows for the removal of all breast tissue and the resizing of the areola. Revisions are rare. The drawbacks are an incision in the small fold under the breasts and the time required for the new areola-nipple complexes to heal since those are grafted. The sexual feeling in the grafted nipples is also lost, but the “pressure” feeling and the ability to detect “cold/warm” usually returns to the nipples over time. The loss or necrosis of nipples (failed to “take” and heal) is possible but very rare.

A 4th technique would be liposuction alone but it rarely provides an excellent masculine result.

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Drawings by Dr. Marc DuPéré

Finally, the old-style anchor reduction can be applied here too with complete excision of the breast tissue and preservation of a pedicled nipple-areolar complex. There is an added vertical scar which may seem very unsightly over the chest in a male. It is an “added” scar and does not serve much purposes over the double incision technique, except for the small theoretical chance of maybe saving some sensation to the nipple. I reserve this for patients who want to do anything to preserve some feeling, with large breasts and with hairy chest where the vertical incisions will be harder to see.

Adding a pectoral implant (a 6th procedure!) is another powerful procedure in masculinizing one’s chest. Pectoral augmentation will instantly give a patient’s chest a muscular, manly look. Pectoral implants can be added easily during “top surgery”, using either the conventional underarm incision or the IMF incision of the double incision technique.

In summary, TOP surgery is often the first procedure my FTM patients will undergo here in Toronto in their journey through gender reassignment. Following this, the next most common procedures will be masculinizing the face and the body, often with liposuction and etching, fillers to face, chin implant, jaw angle implants, calf implants, pectoral augmentation, etc.

Dr. Marc DuPéré

31 Responses to Top Surgery in Toronto

    • Dr. Marc DuPéré says:

      Thank you for your question. Transgender surgery is an important part of my practice, for more than 13-14 years now and I am a leader in the LBGTQIA community. My office is also very comfortable with my patients and I see patients from all over Canada.
      I perform most transgender-procedures (MTF and FTM) – including your request for TOP surgery (bilateral mastectomies and male chest wall contouring). It would be easy to add liposuction to your outer thighs/hips.
      For TOP surgery: I do all techniques: the keyhole, the periareolar approach for smaller breasts, the anchor (inverted T) and the free nipple grafting (often referred to as double-incision) for larger breasts. Liposuction is often needed to get a nice smooth contour and recreate the masculine pectoral shape (it is included in the fees). I commonly ‘etch’ the pectoralis muscle for enhanced definition.
      I will email you more details!
      Dr. D.

    • Dr. Marc DuPéré says:

      Good morning,
      Thank you for your interest in our services at VISAGE Clinic, Dr. Marc DuPéré, Board-Certified Plastic Surgeon for more than 16 years.
      We are proud to announce that Visage Clinic was again recently voted TOP plastic surgery clinic in Toronto for 2017, 2016, 2015, 2014 and 2013 – voted by GTA (greater Toronto area) customers! See press release: http://www.visageclinic.com/news/top-clinic-2015.cfm
      Transgender surgery is an important part of my practice, for more than 14-15 years now and I am a leader in the LBGT community. My office is also very comfortable with my patients and I see patients from all over Canada.
      I perform most transgender-procedures (MTF and FTM) – including your request for TOP surgery (bilateral mastectomies and male chest wall contouring). It would be easy to add liposuction to your outer thighs/hips.
      For TOP surgery: I do all techniques: the keyhole, the periareolar approach for smaller breasts, the anchor (inverted T) and the free nipple grafting (often referred to as double-incision) for larger breasts. The technique will also dictate how long you should stay in Toronto and the number of follow-ups. Liposuction is often needed to get a nice smooth contour and recreate the masculine pectoral shape (it is included in the fees). I commonly ‘etch’ the pectoralis muscle for enhanced definition.
      Transgender-male patients often consider adding some liposuction, etching and sometimes a pectoral implant. We can discuss this further during our meeting, if interested.
      I have performed over 1000 such procedures over 15 years. You will be happy to know that we have a short 4-6 weeks wait time for surgery on average as we operate several days a week when required.
      We would love to have the opportunity to meet you for a consultation. Call us at: 416.929.9800.
      Prices varies depending on the technique. My assistants will email you details about pricing shortly.
      I look forward to meeting you.
      Kind regards,
      Dr. DuPere

    • Dr. Marc DuPéré says:

      Thank you for your comments. The inverted T is not often performed in a male because the vertical line is not aesthetically pleasing. In a lady, that line is common and becomes hidden under the heavier breasts. I perform the inverted T only if the FTM is chubby, hairy or if the patient is gender-neutral and we are performing a more significant breast reduction (but not male chest results). Hope this helps! Best would be to come and visit me. We doing offer SKYPE-camara as well! Dr. D.

  • Bryton bastien says:

    How much is top surgery f to m is it covered under ohip and when do the drains come out i live in new Liskeard ont so it is i good dive a way form you

    • Dr. Marc DuPéré says:

      Good evening.
      We do accept new people.
      Transgender surgery is an important part of my practice, for more than 15 years now and I am a leader in the LBGT community. My office is also very comfortable with my patients and I see patients from all over Canada.
      I perform most transgender-procedures (MTF and FTM) – including your request for TOP surgery (bilateral mastectomies and male chest wall contouring). It would be easy to add liposuction to your outer thighs/hips.
      For TOP surgery: I do all techniques: the keyhole, the periareolar approach for smaller breasts, the anchor (inverted T) and the free nipple grafting (often referred to as double-incision) for larger breasts. The technique will also dictate how long you should stay in Toronto and the number of follow-ups. Liposuction is often needed to get a nice smooth contour and recreate the masculine pectoral shape (it is included in the fees). I commonly ‘etch’ the pectoralis muscle for enhanced definition.
      I work solely in private practice and cannot work with OHIP as OHIP will not fund private clinics.
      Hope this helps.
      I look forward to meeting you!
      Dr. D.

    • Dr. Marc DuPéré says:

      Thank you for your request. An email will be sent to you with some information. Kind regards, VISAGE Clinic.

    • Dr. Marc DuPéré says:

      Sorry Jason, I do not do the genital components. Most patients go to USA, Belgium or Thailand for the phalloplasty. Maybe the Montreal group can guide you where to go as they do perform the vaginoplasty procedure for MTF. Dr. D.

    • Dr. Marc DuPéré says:

      Good morning, my assistants will be emailing you details later today. I look forward to meeting you. Dr. D.

    • Dr. Marc DuPéré says:

      Good morning, my assistants will be emailing you details later today. I look forward to meeting you. Dr. DuPere

    • Dr. Marc DuPéré says:

      Hi Kai, I am not sure exactly of what is the pie-wedge procedure but often, people have different names for the same procedure. For eg. the double incision technique does remove a large paddle of skin, resembling a piece of pie… Online, it says: “The pie wedge technique employs a curved incision that runs from the areolar edge all the way towards the underarm”. It seems “less anatomical” to me as far as scars are concerned. Would you have more information or a different term for the procedure you are looking for? Dr. D.

  • Cheryl says:

    What is the youngest you will do FTM surgery.
    I need help with my daughter , i dont know proper steps to take for FTM.. Please help me/us

    • Dr. Marc DuPéré says:

      Good morning, my surgical center can do surgery on patients 14 and older. Patient’s consent would be essential for age 14-16, and helpful age 16-18. As long as it is clear your child is firm about the decision to transition and with my consultation with him and yourself, I would be happy to help. Next step would be to contact us – 416-929-9800. My office will also send you an email. We also offer Skype and Facetime virtual consultation if you live far away. Dr. D.

    • Dr. Marc DuPéré says:

      Good day Kris, my assistants will be emailing you tomorrow after the Labour Day Holiday. I look forward to meeting you. Kind regards, Dr. D.

  • Bobbie says:

    Hi there! I was wondering what the requirements your clinic needs for someone to be eligible for top surgery, and how I might go about getting a referral?

    • Dr. Marc DuPéré says:

      Good morning. First requirement would be to meet. Age is important also. How old are you? We do not need parents’ consent if you are 18 or older; 16-18 would require me to assess your maturity in your decision if no parents is involved; that being said, having your parents on board is recommended, whenever feasible. 14-16 requires parents’ consent and multiple visits to confirm your decision. The reasons for your decision, your understanding of the procedure and of its relative irreversability would be assessed. To be on hormone replacement is not a requirement and it is a decision you and your hormone doctor (family MD or endocrinologist) would take. For very young people, having been assessed by endocrinologist/pediatrician/psychologist or psychiatrist would be an important component to assure you are ready for this permanent change. I find nowadays my patients are very well informed about transitioning, have many friends who have done so, have seen results, are involved in chat groups, etc.

      We don’t officially require a referral for a non-OHIP procedure (I work only in a private facility). Please call our office when ready to meet. 416-929-9800.

      Hope this helps. I look forward to meeting you.

      Dr. D.

    • Dr. Marc DuPéré says:

      Thank you for your enquiry. My assistants will be emailing lots of information later this morning! I look forward to seeing you! Dr. D.

    • Dr. Marc DuPéré says:

      HI and thank you for your interest in our services! My assistants will be emailing you shortly with some information! I look forward to meeting you! Dr. D.

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