Gender Affirmation or Sex Reassignment Surgery in Atlanta and Alpharetta, GA

North Atlanta Plastic Surgery provides a warm and caring environment for patients with gender dysphoria who are seeking gender affirmation surgery.  Patients often feel stress and anxiety when their assigned sex at birth is not their self-identified gender.  Surgery is aimed at helping patients physically transform to their self-identified gender.  

If you’re ready to explore surgical options for gender affirmation, visit Dr. Amy Alderman in the Buckhead area of Atlanta and Alpharetta, GA.

What is the Difference Between Transgender and Nonbinary?

A transgender individual feels as if the assigned sex at birth does not match their gender. A nonbinary individual feels as if their gender identity does not fit into the traditional male and female gender categories. Both transgender and nonbinary individuals may suffer from gender dysphoria and seek surgical and non-surgical options.

What Types of Transgender Surgery are Provided at North Atlanta Plastic Surgery?

Many surgical options are available to help patients physically align with their gender identity.

Options can include facial, chest, and genitalia surgery. At North Atlanta Plastic Surgery, Dr. Alderman specializes in “top” surgery that provides a more feminine or masculine appearance to the chest and breast area. 

Who is a Good Candidate for Gender Affirmation Surgery?

Patients should be 18 years of age or older and living as the true gender for at least two years. We encourage patients to be followed by a mental health specialist. It is also essential for patients on hormone therapy to wait a few years before surgery. Hormones result in physical changes to the chest and breast area, and these changes should stabilize before surgery. 

What are the Benefits of Gender Affirmation Surgery?

Strong data suggests that gender-affirming surgery, for individuals who desire it, significantly reduces mental health issues. A recent study out of Harvard looked at the outcomes of gender affirmation surgery among transgender and nonbinary individuals. Gender-affirming surgery was associated with a 42% reduction in psychological stress and a 44% reduction in suicidal ideation. They also found a significant decrease in tobacco use among surgical patients. 

What is Involved with Male to Female Top Surgery?

The surgical goals of male-to-female top surgery are to create a more feminine breast appearance for the patient. Breast implants are used to create a feminine shape and desired volume. Dr. Alderman will discuss in detail the surgical scars and pocket location of the implant. For most patients, the incision location is at the lower breast fold and is only a couple of inches in length. Most commonly, the implant is placed under the chest muscle to provide more soft tissue coverage over the implant. However, the implant could be placed above the muscle in patients with more tissue in their chest area. Dr. Alderman will discuss the best options for you, given your particular anatomy.

What are the Available Options for Breast Implants?

There are three different types of implants, and each has its own advantages and disadvantages:

Saline Implants

Saline implants are FDA-approved for patients who are at least 18 years old. They come in fewer size options and are only available in round shapes. They feel less natural, which is only a consideration if you will not have much natural breast tissue to cover the implant.

The shell is filled with saline after it has been inserted into the breast pocket, which allows for a smaller incision.

They are slightly more prone to rippling, but should a rupture occur, you will know fairly quickly without the need for medical detection.

Silicone Implants

Silicone implants are FDA-approved for patients who are at least 22 years old. They feel natural, even if you have little natural breast tissue to cover the implant. They come in a variety of shapes and sizes.  They are less prone to rippling but harder to detect a rupture.  Dr. Alderman offers annual follow-ups for all of her breast patients and advises that the implants should be replaced in about 15 years before they become prone to rupture.

Meet Dr. Alderman

Dr. Amy Alderman is a nationally known, board-certified plastic surgeon located in Buckhead near Atlanta.  As a female surgeon and mother of two children, she provides a unique perspective to patient care.  Each surgical plan is individually tailored to each patient’s needs and lifestyles and is aimed at enhancing her patient’s natural beauty and restoring confidence. She is known for her personal approach to patient care and has unparalleled commitment to patient safety, which can be attributed to years of education, professional experience and involvement in national patient safety initiatives.

How is the Breast Implant Size Chosen?

Dr. Alderman will take measurements of your current breast width, the width of your chest, and the width of your shoulders. Implants look most natural if they are close to the same width as your natural breasts. Projection is another consideration. This refers to how far the breast projects outward from the chest while you are in profile. Dr. Alderman will personally size you with different sizes and styles of implants to see what looks best on your particular frame.

How Long Do Implants Last?

Dr. Alderman’s top priority is your safety. She recently asked for data on her personal experience with Mentor implants over the past 12 years. She is happy to report that her implant rupture and contracture rate is one of the lowest in the country and far below what is reported as the national average.

She has used well over 3,500 implants and has had only two patients with an implant rupture (0.0005 % rupture rate) and only 26 patients with contracture (0.007 % contracture rate).

However, she does stress that implants are not lifetime devices. She encourages patients to come see her about 10-15 years after surgery and consider implant replacement.

Implant Surgery with a Keller Funnel – Safe, Minimally Invasive Treatment

A funnel is an insertion sleeve that facilitates the insertion of a silicone gel implant into the breast pocket. The Keller funnel was the first insertion sleeve available, but a few more are now available. The funnel provides three main benefits: 

  • A smaller incision can be made.
  • The implant won’t touch the skin, which minimizes bacterial exposure 
  • There is less trauma on the implant during insertion, thus prolonging the longevity of the implant.

What Happens During Male to Female Breast Surgery?

Breast augmentation is usually performed using general anesthesia, but hospitalization is not required. Most augmentations take about 1 hour.

After the incisions are made, a pocket is created inside the breast, and the implant is placed within the pocket (either in front of or behind the chest muscle). Dr. Alderman will shape your breasts and move the nipples, if necessary, to give you a beautiful result.

The incisions are then sutured with dissolvable stitches and dressed. After some time in recovery, you can go home, but someone must drive you, as you will be groggy for a period of time.

What is Involved with Female to Male Top Surgery?

The goal of FTM top surgery is to create a more masculine appearance to the breast. The breast tissue is removed to create a flat chest contour. The excess chest skin will be addressed with a variety of techniques depending on the among of skin present. And the size and location of the nipple areolar complex will be addressed. Liposuction is often incorporated to create the optimal chest contour and masculine appearance.

What are the Incision Options for Female to Male Top Surgery?

Dr. Alderman balances the goal of minimal scars with recontouring excess skin. An incision around the areolar can be made for patients with small breast sizes.

This incision fades nicely at the transition of the chest skin and areola, creating a very natural result.

For patients with larger breast sizes, a double incision approach will be necessary to recontour the excess skin. In these cases, the nipple-areolar complex is removed, made smaller, and repositioned as a skin graft. An incision is made in the lower breast fold to remove excess skin.

What Can I Do to Optimize my Scar Results from Female to Male Top Surgery?

Dr. Alderman knows that the appearance of the scar is very important to her patients, and she is consistently known for having optimal scar results. All of your sutures will be dissolvable below the skin, and she will have you in 6 months of intensive scar care. Her team will provide specific instructions and be available for any questions. Dr. Alderman will monitor your scars and give additional laser options as needed.

What Can I Expect During Recovery from Male to Female or Female to Male Top surgery?

After MTF or FTM surgery, most patients can return to work within 3-7 days, as long as their job is not physically strenuous. Most resume exercise and lifting in about a month.

You will feel more comfortable sleeping on your back for the first few nights, and you will wear a surgical bra or compression garment for a few weeks.

Superior Quality Breast Surgery with Dr. Alderman

Dr. Alderman has always made breast surgery the primary focus of her practice. At the University of Michigan, her focus was on reconstruction for women with breast cancer. She transitioned from breast reconstruction to cosmetic breast surgery when she moved to Atlanta, which was motivated by her need to have a better work-life balance and spend more time with her children. The same dedication to excellence she had for her reconstruction patients has been transferred to her cosmetic breast patients. She strives to deliver the most advanced techniques in the safest manner possible. And, most importantly, she spends a lot of time listening to her patients so that she can fully understand their desired results.

Dr. Alderman is nationally recognized as an expert in breast surgery. 

She has:

  • performed “live” breast surgery at the prestigious Atlanta Breast Symposium
  • taught several courses on breast augmentation at the American Society of Plastic Surgery Annual Meeting
  • given countless talks at professional meetings on cosmetic and reconstructive breast surgery
  • more than 75 scientific publications mostly involving breast surgery
  • been involved in several national initiatives related to breast surgery, such as the National Breast Implant Registry. 

There is no doubt that breast surgery is a significant passion for her.

Do you want to explore gender-affirming top surgery? Call us today to schedule a consultation to find out more about gender-affirming top surgery in Atlanta or Alpharetta, GA, with Dr. Alderman.

Atlanta Male to Female Top Surgery FAQs

Breast implants vary in several ways, ranging from the material used to fill the device, the shell’s texture, and the implant’s overall shape. The material used to fill the implant is either saline (salt water) or medical-grade silicone. Both are great options, and the outcomes of each will vary by the patient’s anatomy and amount of soft tissue coverage. The outside of the implant, known as the implant shell, can be smooth or rough in texture. There are pros and cons of each, which Dr. Alderman will review with you. Lastly, implants come in a round and teardrop shape with different widths and projections. During your exam, Dr. Alderman will take specific measurements of your breast anatomy to determine which implant best suits you.

There are several options for scar location with Male to Female Top Surgery that Dr. Alderman will discuss with you. All are very small in size, usually just over an inch in length. Scars are designed to blend with your natural anatomy to minimize visibility. After surgery, you will be placed in 4 to 6 months of scar care to optimize your results. Over time, the scars tend to fade to a faint white, thin line.

Implants are not lifetime devices. They need to be replaced every 10-15 years. Over time, the shell of the implant may weaken, resulting in a rupture. A saline implant deflation is easy to determine as the patient will immediately lose volume in the breast. The rupture of a silicone implant usually changes the shape or feel of the breast. Dr. Alderman recommends that her patients follow up with her in 10 years to determine the best time to schedule the replacement.

Breast implants generally last 10-15 years, after which they will need to be replaced. Different technologies are available to evaluate the integrity of the breast implant shell, such as ultrasound, mammogram, and MRI. Although MRI is the most accurate way to visualize the breast implant, it is also the most expensive test. Therefore, most physicians in the US do not recommend routine monitoring of the implants with MRI and try less expensive modalities first. Dr. Alderman always offers her patients complimentary annual exams for her patients with breast implants and highly encourages them to start thinking about an implant. Implant exchange should occur about ten years after breast implant surgery.

Breast implants do not cause breast cancer and, in fact, are often used in women with breast cancer for reconstruction after mastectomy. Breast implants also do not impair the detection of breast cancer, especially if the implant is placed under the muscle, which allows better visualization of the breast with mammograms.

There is a very rare form of lymphoma, called ALCL, which has been associated with breast implants that have a rough texture of the outer shell. Worldwide, there are less than 500 cases of ALCL, and the lymphoma is easily treated with the removal of the implant and associated capsule. However, despite the extremely low incidence of ALCL, Dr. Alderman does not use textured implants. ALCL has never been found in a patient with the type of implants she uses, which have a smooth, not rough, outer implant shell.

Breast implant surgery results greatly depend on the patient’s amount of natural breast tissue.

A patient who has very thin skin with little breast tissue will look more natural with a silicone gel breast implant. The silicone implants are softer and ripple less. Patients who have more soft tissue coverage can do well with a saline implant because the overlying tissue is thicker and provides more coverage over the implant. Dr. Alderman will evaluate your specific anatomy and discuss which implant option is best for your particular anatomy and aesthetic goals.

Nipple sensation is rarely diminished with breast implant surgery. The majority of the nerves that supply nipple sensation are located on the outer side of your breast. During surgery, the dissection is limited in this area in order to protect the nerves. 

No. Drains are not used with routine breast augmentation.

Most likely, yes. Drains are used to remove excess fluid and help the skin recontour appropriately over the chest wall. Drains are typically removed one week after surgery.

All of your sutures are dissolvable and, therefore, will not need to be removed. The sutures stay in place under your skin for several months to provide support while your body heals.

Most patients require about one week off of work. If your job is mostly desk work, you should be able to return after 4-5 days. Jobs that are physically more demanding may require some initial limitations while you are healing.

You can start doing light cardiovascular work at three weeks after surgery and return to full activity at six weeks.

Your breasts will feel tight and swollen after surgery because the tissue over the implant is being stretched. This feeling will lessen over the first couple of weeks. Dr. Alderman does advise her patients to limit arm motion for the first couple of weeks in order to avoid tearing any internal sutures or chest muscles.

You will wear a bra provided to you by Dr. Alderman designed to provide support during the initial healing phase. This bra is to be worn day and night. At six weeks, patients are allowed to wear any type of bra they prefer, including underwire bras.

You will wear compression that helps to minimize swelling and expedite drain removal. Dr. Alderman’s team will provide different compression options.

The procedure is performed under general anesthesia in order to optimize your experience.  Dr. Joiner, a board-certified anesthesiologist, has years of experience with outpatient aesthetic surgery and provides the safest, most advanced anesthesia techniques available.

Anytime a patient has general anesthesia, Dr. Alderman wants an adult to be with the patient the night after surgery. That person can help you have ice packs for your chest and ensure you have food to take with your pain medication.

Breast implants last, on average, 10-15 years and will need to be replaced at that time. The replacement surgery is less painful than the original procedure since the chest muscle and breast tissue overlying the implant have already been stretched. Most patients can return to work 3-4 days after an implant exchange procedure.

Breast growth can result from changes in hormones or changes in weight. Dr. Alderman advises waiting on surgery until your weight and hormone statuses are stable. Significant changes in breast size after surgery are rare if hormonal and weight status remain relatively consistent.

Request a Consultation

If you’re in the Atlanta area and have any questions about gender-affirming surgery or wish to schedule a consultation for gender-affirming surgery with Dr. Alderman, please contact our office.

Dr. Alderman’s National Efforts on this Topic:

Leadership Positions

Subject Matter Expert for the FDA’s ALCL Implant PROFILE Study

Subject Matter Expert for American Society of Plastic Surgery initiative for U.S. National Breast Implant Registry

Surgical Editor, Cochrane Breast Cancer Group

American Society of Plastic Surgery Representative on the Plastic Surgery Foundation’s National Breast Implant Registry

American Society of Plastic Surgery Breast Subcommittee

American Society of Plastic Surgery Patient Safety Committee

American Society of Plastic Surgery & Plastic Surgery Education Foundation Breast Surgery Task Force

Vice Chairperson, ASPS Education Aesthetic Council

Instructional Courses

Alderman, A., Hall-Findlay, B. Breast Augmentation: Overview and Pearls for Practice. American Society of Plastic Surgeons Annual Meeting, San Diego, Oct 2013.

Alderman, A., Hall-Findlay, B. Breast Augmentation: Overview & Pearls for Practice. American Society of Plastic Surgeons Annual Meeting, Chicago, Oct 2014.Alderman, A., Hall-Findlay, B.

Breast Augmentation: Analysis & Outcomes. American Society of Plastic Surgeons Annual Meeting, Chicago, Oct 2014.

Alderman, A., Gutowski, K, Schwartz, M. Breast Augmentation: Analysis, Execution, and Outcomes. American Society of Plastic Surgeons Annual Meeting, Los Angeles, Sept 2016.

Alderman, A. Live surgery telecast: Breast Augmentation. SESPRS 2017 Atlanta Breast Surgery Symposium, January 20-22, 2017 Atlanta, GA

Lectures at National Plastic Surgery Meetings

The Future of Breast Augmentation: The Breast-Q in Aesthetic Breast Surgery.  2012 Atlanta Breast Symposium, Atlanta, GA

Management of Early and Late Periprosthetic Fluid Collections.  Challenging Complications in Plastic Surgery Symposium: Successful Management Strategies.  Washington, DC, July 2012.

Augmentation Mastopexy Panel.  Challenging Complications in Plastic Surgery Symposium: Successful Management Strategies.  Washington, DC, July 2012.

Managing the Unfavorable Scar: When to Perform Surgical Revision.  Challenging Complications in Plastic Surgery Symposium: Successful Management Strategies.  Washington, DC, July 2012.

Periprosthetic Redness/Infection: Strategies for Treatment.  Challenging Complications in Plastic Surgery Symposium: Successful Management Strategies.  Washington, DC, July 2012.

Improving Outcomes and Reoperations in Breast Augmentation Surgeries:  Minimizing Infection and Capsular Contracture. American Society of Plastic Surgeons Annual Meeting, New Orleans, Oct 2012.

American Society of Plastic Surgery Presidents Panel: The PIP Crisis and International Perspectives on Implants and Registries: ASPS/PSF Vision for the National Breast Implant Registry.  American Society of Plastic Surgeons Annual Meeting, New Orleans, Oct 2012.

Reconstruction Bowl: Academic vs. Private Practice.  American Society of Plastic Surgeons Annual Meeting, New Orleans, Oct 2012.

American Society of Plastic Surgery/Plastic Surgery Education Foundation’s Vision for a National Breast Implant Registry. Georgia Society of Plastic Surgery Annual Meeting, Dec 2012, Atlanta, GA.

VTE Prevention in Cosmetic Surgery.  Georgia Society of Plastic Surgery Annual Meeting, Aug 2013, Brasstown Resort, GA.

Patient Safety: Prevention of VTE in Cosmetic Surgery.  QMP Aesthetic Surgery Symposium, Nov 2013, Chicago, IL

Prevention and Management of Capsular Contracture in Breast Augmentation.  QMP Aesthetic Surgery Symposium, Nov 2013, Chicago, IL

Management of the Late Periprosthetic Fluid Collection.  ASPS Management of Complications in Plastic Surgery Symposium.  March 28-29, 2014, Chicago, IL

Management of Complications in Augmentation Mastopexy Panel: panel participant.  ASPS Management of Complications in Plastic Surgery Symposium.  March 28-29, 2014, Chicago, IL

DVT Prophylaxis in the Breast Patient.  ASPS Management of Complications in Plastic Surgery Symposium.  March 28-29, 2014,Chicago, IL

Moderator: Fat Grafting to the Breast.  ASPS Management of Complications In Plastic Surgery Symposium.  March 28-29, 2014, Chicago, IL

Webinar: ASPS Dueling Perspectives in Breast Surgery: “Subglandular Augmentation: The Good Often Outweighs the Bad”.  May 13, 2014.

Optimizing Outcomes in Breast Augmentation.  Ohio Valley Society of Plastic Surgeons, Greenbrier, West VA, June 6 – 8, 2014.

Alderman, A.  Preoperative Evaluation for Aesthetic Breast Surgery.  Georgia Society of Plastic Surgeons, Callaway Gardens, GA, Aug 2, 2014.

Aesthetic Breast Surgery: Preoperative Analysis and Markings: How I Do It.  ASPS Dueling Perspectives in Aesthetic Plastic Surgery Symposium, Washington, DC, June 20-22, 2014.

VTE Prophylaxis in Breast Surgery.  SESPRS 2015 Atlanta Breast Symposium, Atlanta, GA Jan 23-25, 2015.

Management of Late Breast Seromas.  SESPRS 2015 Atlanta Breast Symposium, Atlanta, GA Jan 23-25, 2015.

Subpectoral Device Placement: Minimizing Complications.  Aesthetica 2015, Las Vegas April 30-May 2, 2015.

Patient Safety and DVT Prophylaxis with Breast Surgery.  Aesthetica 2015, Las Vegas April 30-May 2, 2015.

The Complex Scar: New Strategies to Improve Appearance.  Aesthetica, June 2016, Washington, DC.

Tips and Tricks: Where to set your fold with form-stable implants.  Aesthetica, June 2016, Washington, DC.

To texture or not to texture: deconstructing what we know about implant surface characteristics.  Atlanta Breast Symposium, Jan 2018.

Strategies for setting appropriate NAC position with cosmetic breast surgery.  Atlanta Breast Symposium, Jan 2018.

VTE and breast surgery: current recommendations for chemoprophylaxis.  Atlanta Breast Symposium, Jan 2018.

Book Chapters

Alderman, AK, Kerrigan, CL, Lemaine, V, Pusic, AL, Vidal, DC.  Evidence-Based Medicine &Health Services Research in Plastic Surgery.  In Plastic Surgery  1st Edition

Alderman, AK, Chung, KC.  Outcomes for Surgical Guidance in Plastic Surgery: Measuring Outcomes in Aesthetic Surgery.  Clinics in of Plastic Surgery, 2013:297-304.

Alderman, AK, Kerrigan, CL, Lemaine, V, Pusic, AL, Vidal, DC.  Evidence-Based Medicine &Health Services Research in Plastic Surgery.  In Plastic Surgery 4th Edition

Pannucci, C, Alderman, AK.  Venous Thromboembolism and the Aesthetic Surgery Patient.  Essentials of Aesthetic Plastic Surgery.

Scientific Publications

Alderman, AK, Collins, ED, Streu, R, Grotting, JC, Sulkin, AL, Neligan, P, Haeck, PC, Gutowski, KA.  Benchmarking outcomes in plastic surgery: national complication rates for abdominoplasty and breast augmentation.  Plastic and Reconstructive Surgery 2009;124:2127-33.

Alderman, AK.  Discussion: A Multi-Institutional Perspective of Complication Rates for Elective Non-Reconstructive Breast Surgery: An Analysis of NSQIP Data from 2006 to 2010, Aesthetic Surgery Journal: 33(3): 387-388, 2013.

Alderman, AK, Bauer, JB, Fardo, DF, Abrahamse, PA, Pusic, AL.  Understanding the Impact of Breast Augmentation on Quality of Life: Prospective Analysis Using the BREAST-Q.  Plastic and Reconstructive Surgery, April 2014.

Alderman, AK, Pusic, AP, Murphy, DK.  Prospective Analysis of Primary Breast Augmentation on Body Image Using the BREAST-Q: Results from a Nationwide Study.  Plastic and Reconstrustive Surgery, 137:954e, 2016.