FTM Top Surgery in Bellevue — Expert Transmasculine Chest Surgery
FTM and transmasculine top surgery — the surgical removal of breast tissue to create a flat, masculine chest — is one of the most meaningful and life-changing procedures performed at Pacific Sound Plastic Surgery. Dr. Kristopher M. Day, MD, FACS, is a double board-certified plastic surgeon with deep experience performing gender-affirming chest surgery in Bellevue, Washington. His boutique practice is welcoming and inclusive, and most major insurance plans — including Apple Health (Medicaid) — are accepted.
Double Board-Certified (ABPS + ABS)
Ivy League Trained
Highly Rated Bellevue Plastic Surgeon
Proudly Serving Bellevue, Seattle, Kirkland, Redmond, Mercer Island, Issaquah, Renton
What Is FTM / Transmasculine Top Surgery?
FTM top surgery (also called transmasculine chest surgery or gender-affirming mastectomy) is the surgical removal of breast tissue and reshaping of the chest to create a masculine contour. For many transmasculine and non-binary individuals, top surgery is a pivotal step in aligning their body with their gender identity — reducing gender dysphoria, eliminating the need for chest binding, and enabling a more comfortable, authentic life.
Unlike traditional mastectomy for cancer treatment, gender-affirming top surgery is specifically designed with aesthetic goals in mind — preserving sensation where possible, repositioning or resizing the nipple-areola complex, and sculpting natural, masculine chest contours. Dr. Day’s meticulous approach to tissue precision and symmetry drives every gender-affirming chest procedure he performs.
Surgical Technique Options
Dr. Day selects the most appropriate technique based on chest size, skin elasticity, body shape, and individual goals:
Technique | Best For |
|---|---|
Double Incision Bilateral Mastectomy | Most common technique. Ideal for larger chest sizes. Horizontal incisions along the chest crease allow maximum tissue removal and precise contouring. Nipple-areola complex is resized and repositioned as free grafts. |
Periareolar (Keyhole / Peri) | Best for smaller chest sizes with good skin elasticity. Incisions circle the areola, leaving minimal visible scarring. Nipple sensation is more often preserved. |
Double Incision with No Free Nipple Graft | Elected by some patients who prefer to remove the nipple-areola complex entirely. Removes additional variables and simplifies healing. |
“I went to Dr. Day for gender affirming top surgery... Dr. Day was kind, straightforward, and honest when discussing surgical options and set realistic expectations for what a potential final result would look like based on my body shape and the amount of tissue that was being remove. In the end, I'm very happy with my results.”
— Erin B., Top Surgery Patient • Google Review
Life After Top Surgery: What Patients Experience
Top surgery outcomes extend far beyond physical appearance. Patients consistently report profound improvements in multiple dimensions of well-being:
- Freedom from chest binding and associated discomfort, breathing restrictions, and skin irritation
- Significant reduction in gender dysphoria and improved mental health outcomes (supported by peer-reviewed research)
- Ability to wear fitted clothing, swim shirtless, or exercise without concealment
- Greater comfort and confidence in day-to-day social interactions
- Alignment of physical self with gender identity — described by many patients as life-changing
- Reduced anxiety and improved quality of life in professional and personal settings
Am I a Good Candidate for Top Surgery?
Dr. Day evaluates each patient individually during a private consultation. The following general criteria help determine readiness:
- Ideal Candidates
- Consistent, persistent gender dysphoria related to chest
- 18 years of age or older (or parental consent if minor)
- Referral letter from a qualified mental health provider
- Overall good general health and able to undergo anesthesia
- Non-smoker or willing to quit 4–6 weeks before surgery
- Realistic expectations about scarring, healing, and final results
- When to Wait
- Active smoker within 4–6 weeks of planned surgery date
- Uncontrolled medical conditions (diabetes, hypertension, etc.)
- Still seeking or updating mental health documentation
- Undergoing significant changes in BMI or body composition
- Insurance pre-authorization not yet secured (scheduling may be delayed)
- Recent changes to hormone therapy that could affect tissue healing
Not Sure If You're a Candidate?
What to Expect: From Consultation to Results
Step 1 - Initial Consultation
Dr. Day reviews your goals, chest anatomy, and health history in a private, judgment-free setting. He will explain which technique is most appropriate for your anatomy and goals, set realistic expectations for scarring and results, and outline the documentation needed for insurance pre-authorization (letter from a therapist or primary care provider, insurance referral if applicable). Our patient care coordinator assists with insurance paperwork and scheduling.
Step 2 - Pre-Operative Preparation
You will have a pre-op appointment approximately 1–2 weeks before surgery. Labs and medical clearance are completed. Smoking cessation must be confirmed 4–6 weeks prior.
You will receive specific pre-operative instructions including any medications or supplements to stop before surgery. Arrange for a trusted person to drive you home and stay with you the first night.
Step 3 - Day of Surgery
Top surgery is performed under general anesthesia, typically 2–4 hours depending on technique and complexity. The procedure is performed at one of Dr. Day’s accredited surgical facilities in the Bellevue area. You will go home the same day in most cases.
Step 4 - Recovery Timeline
Day 1: Low-grade activity encouraged — walking is fine. Avoid any activity that causes grimacing, straining, or sweating. Days 2–7: Sedentary and desk work resumes for most patients this week. Continue walking; avoid lifting and upper-body exertion. Weeks 2–4: Gradual return to baseline activity. Start exertional activities at 50% of pre-operative capacity and increase by approximately 5% per day. Week 6: Most upper-body restrictions lifted at post-op clearance visit. Month 3+: Scars begin to flatten and fade; final results visible at 6–12 months.
Step 5 - Follow-Up Care
Dr. Day personally calls patients post-operatively to check in. Scheduled follow-up visits at 1 week, 3 weeks, 6 weeks, and 3 months. The team is available by phone and email throughout recovery.
“I don't even know where to start with this review because my whole experience with Dr. Day was exceptional. I got top surgery with no free nipple grafts, a surgery I had wanted for years... I am so beyond grateful and my chest looks amazing. My recovery went super smooth and my results look better than I could have anticipated.”
— Mars C., Top Surgery Patient • Google Review
Does Insurance Cover FTM Top Surgery?
Yes — gender-affirming top surgery is covered by many insurance plans, and navigating coverage is one of the most important aspects of the process. Pacific Sound Plastic Surgery accepts a wide range of insurance plans and our team has experience with pre-authorization for gender-affirming procedures.
What Insurance Typically Requires
- A letter of support from a licensed mental health provider confirming diagnosis of gender dysphoria
- Primary care provider documentation of gender-affirming care or hormone therapy history (in many cases)
- Insurance pre-authorization — our team handles submission on your behalf
- Some plans require 12 months of consistent hormone therapy prior to surgery (verify with your insurer)
Apple Health (Medicaid / Washington State)
Apple Health (Washington State Medicaid) covers gender-affirming surgery including top surgery. If you are an Apple Health member, our team will work with you to navigate prior authorization. Please contact our office at (425) 818-8991 for guidance specific to your plan.
“From the first consultation, Dr. Day was very clear and honest with me about what I could expect from the procedure. His explanations were extremely thorough and he answered all of my questions thoughtfully. Dr. Day went out of his way to make me feel comfortable and accepted, going as far as politely correcting nurses at the hospital on my pronouns on multiple occasions... Dr. Day is a very professional and experienced surgeon, and I highly recommend him to anyone looking for gender-affirming surgery.”
— Alex T., Top Surgery Patient • Google Review
Top Surgery Results: What to Expect
Results from FTM top surgery are both visible and long-lasting. Here is a realistic timeline for what patients experience:
- First weeks: Swelling and bruising are normal; the chest is worn in a compression garment following the 23-and-3 Rule — worn 23 hours per day, removed only to shower, for a minimum of 3 weeks and encouraged until optimal healing is achieved. The initial shape gives a preview of final results.
- 3 months: Swelling largely resolved; chest contour is visible. Scars are still pink and raised.
- 6–12 months: Scars continue to flatten, soften, and fade to silvery-white. Final result is visible.
- Long-term: Results are designed to be long-lasting. Significant weight gain, weight loss, or aging may affect chest appearance over time.
Dr. Day uses precise tissue contouring techniques to create a natural, masculine chest profile. His double board certification and extensive experience in gender-affirming surgery inform an exacting approach to symmetry, nipple placement, and scar positioning.
“I went to Dr.Day for a double mastectomy with no nipple graft. The process was very straightforward, they were communicative + professional, and I am very happy with my results. I had no complications medically or aesthetically, and was kept informed throughout. It was also my first time getting an operation, the staff were kind and assuring. I would recommend Dr.Day for anyone seeking similar surgeries!” — Ashen W., Top Surgery Patient, Google Review
— Ashen W., Top Surgery Patient • Google Review
Top Surgery Cost in Bellevue
Unlike most cosmetic procedures, FTM top surgery is frequently covered — partially or fully — by health insurance. Your specific cost will depend on your insurance plan, deductible, and out-of-pocket maximum. Our team will work with you on insurance pre-authorization before any surgery is scheduled.
✨What's Included
- Surgeon's fee
- Facility / operating room fee
- Anesthesia (administered by a board-certified anesthesiologist or certified registered nurse anesthetist)
- Enhanced Recovery After Surgery medication (Exparel)
- Cosmetic surgery insurance coverage (Cosmetasure)
- High-end compression garment (Isavella)
- High-end scar ointment (Biocorneum)
- Swelling and bruising ointment (Arnica)
- Post-operative recovery and follow-up care
- Clara Recovery Supplements
💰What Affects Your Total Cost
- Surgical technique selected (double incision vs. periareolar vs. no nipple graft)
- Whether liposuction for contouring is performed at the same time
- Anesthesia type and facility fees
- Your individual insurance plan's deductible, co-insurance, and out-of-pocket maximum
- Whether prior authorization requires additional documentation
Financing Options
Pacific Sound Plastic Surgery accepts financing through two trusted healthcare lending partners:
- CareCredit — 6-month financing available
- Alphaeon Credit — flexible credit lines designed for healthcare procedures
Ask our patient care coordinator about financing during your consultation.
Why Seattle-Area Patients Choose Dr. Kristopher Day for Top Surgery
Pacific Sound Plastic Surgery has become one of the most trusted gender-affirming surgical practices in the Bellevue and greater Seattle area. Here’s why transmasculine patients choose Dr. Day:
✓ Double Board-Certified (ABPS + ABS)
Certified by both the American Board of Plastic Surgery and the American Board of Surgery — the gold standard in plastic surgery credentials.
✓ Insurance Experience & Coordination
Our team has navigated insurance pre-authorization for gender-affirming surgery across multiple plans including Apple Health. Our patient care coordinator will guide you through every paperwork step.
✓ Boutique Practice — Personal Attention
Every patient works directly with Dr. Day from the first consultation through post-operative follow-up — not delegated to PAs or assistants for surgical care.
✓ Advanced Surgical Training — Unique Anatomical Precision
Dr. Day completed his surgical training at Ivy League–affiliated institutions, building a technical foundation in precise tissue handling, anatomical awareness, and surgical judgment that directly informs every gender-affirming chest procedure he performs.
✓ Inclusive, Judgment-Free Environment
Dr. Day’s practice has earned a reputation for welcoming LGBTQ+ patients with respect and dignity. Patients consistently describe feeling heard, accepted, and treated with exceptional care.
✓ Surgical Facilities at Top-Tier Centers
Dr. Day operates at accredited surgical facilities in the Bellevue area.
“Dr. Day was able to fit me in so soon for a consultation, and not a month later a surgery date! He made my experience incredibly easy and created a safe space to express what I was looking for in my procedure. Definitely would be recommending him to a ton of my friends seeking gender affirming care.”
— Ryanne C., Top Surgery Patient • Google Review
Conveniently Located for Bellevue & Greater Eastside Families
Pacific Sound Plastic Surgery is centrally located in downtown Bellevue, making Dr. Day’s expertise accessible to families throughout Bellevue and the greater Eastside — without the stress of navigating Seattle traffic. Our patients enjoy a private, boutique surgical experience with convenient parking, just minutes from the communities they call home.
Seattle
~15 minutes
World-class plastic surgery results without the downtown Seattle parking hassle. A quick drive across SR-520 or I-90 to our private Bellevue office.
Kirkland
~10 minutes
Just minutes from downtown Kirkland and the Juanita waterfront via I-405 or surface streets.
Redmond
~10 minutes
Convenient for the Redmond tech community via SR-520 or surface streets.
Mercer Island
~10 minutes
A quick drive across I-90. Our discreet, private environment is ideal for discerning Mercer Island residents.
Issaquah
~10 minutes
Convenient for Issaquah Highlands and Gilman Village area families via I-90.
Renton
~5 minutes
Easy access from Renton and the Landing via I-405 North. Boutique care and personalized attention just minutes away.
Frequently Asked Questions
Does insurance cover FTM top surgery?
Many major insurance plans cover gender-affirming top surgery, including Apple Health (Washington Medicaid). Requirements vary by plan but typically include a referral letter from a mental health provider and insurance pre-authorization. Our team handles pre-authorization on your behalf. Call (425) 818-8991 to discuss your specific coverage.
What documentation do I need before scheduling surgery?
In most cases, you will need a letter from a licensed therapist or mental health provider supporting gender dysphoria and recommending surgery, a referral from your primary care provider (depending on insurance requirements), and completion of insurance pre-authorization through our office. Our patient care coordinator will walk you through every step.
How do I know which surgical technique is right for me?
Dr. Day determines the best technique based on your chest size, skin elasticity, body shape, and aesthetic goals. Most patients with larger chest sizes are candidates for double incision; smaller chest sizes may qualify for periareolar techniques. This is discussed in detail during your consultation.
How long is the recovery from top surgery?
Walking is encouraged starting the day after surgery. Most patients return to desk and sedentary work within the first week. Physical activity and lifting restrictions typically ease beginning at weeks 2–4, with a gradual return to full baseline (starting at 50% and increasing by about 5% per day). Upper-body clearance is typically given at the week 6 post-op visit. Full healing — including scar maturation — takes 6–12 months. Dr. Day provides a detailed recovery guide specific to your procedure at your pre-op appointment.
Will I lose nipple sensation?
Nipple sensation outcomes depend on the technique used. With periareolar approaches, sensation is more commonly preserved because the nipple-areola complex remains attached. With double incision free nipple grafts, some sensation is typically lost but can return partially over time. Some patients elect to proceed without nipple grafts. Dr. Day will discuss realistic expectations specific to your anatomy.
What are the scars like after double incision top surgery?
Double incision creates two horizontal scars along the chest crease. Scars are typically pink and raised for several months, then gradually flatten, soften, and fade to a silvery-white over 1–2 years. Scar care instructions (silicone sheets, massage) are provided post-operatively. Placement is designed to be as low and as inconspicuous as possible.
Can I combine top surgery with other procedures?
In some cases, liposuction for chest contouring can be performed at the same time as top surgery. Dr. Day will advise whether any combination is appropriate based on your anatomy, surgical complexity, and anesthesia time considerations.
How soon can I be scheduled for surgery?
Wait times vary based on insurance pre-authorization timelines and OR availability. Some patients have been scheduled within 4–6 weeks of their initial consultation. Insurance approval timelines are the most common scheduling variable. Starting the paperwork early is the best way to minimize delays.
Do I need to be on hormone therapy before surgery?
Hormone therapy is not a universal surgical requirement — it depends on your insurance plan’s criteria and your personal situation. Some insurers require documented hormone therapy history; others do not. Dr. Day evaluates each patient individually. Discuss your hormone therapy status at your consultation.
Is Dr. Day experienced with high-BMI or larger-bodied patients?
Yes. Dr. Day evaluates each patient’s individual candidacy and has performed top surgery on patients across a range of body types. He provides honest, transparent counseling about potential complications and realistic outcomes based on your specific anatomy. Each case is discussed individually.
What is the cost if insurance doesn't cover it?
If your procedure is not covered by insurance, our team will provide a detailed cost estimate during your consultation. Financing options are available through CareCredit and Alphaeon Credit. We do not post cash-pay pricing online, as costs vary by technique and complexity. Call (425) 818-8991 for a personalized discussion.