Dr. de Clermont-TonnerrePlastic Surgeon

Paris 16th & Pontoise — Gender-Affirming Surgery

FtM Surgical Masculinisation

Top surgery & masculinisation — Paris 16th & Pontoise

Dr. de Clermont-Tonnerre offers transgender men (FtM) compassionate and expert surgical care in Paris 16th and Pontoise. Bilateral mastectomy (top surgery) is the most requested procedure: it removes breast tissue to reveal a flat, harmonious masculine chest.

All procedures are performed in coordination with your multidisciplinary team. ALD 31 social security coverage is facilitated for eligible procedures.

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Step by step

How FtM mastectomy works

01

Consultation and ALD file

Assessment of breast volume and skin quality. Choice of appropriate technique. Assistance with ALD 31 file compilation if applicable.

02

Pre-operative assessment

Baseline mammography, blood tests, anaesthetist consultation. Mandatory 15-day reflection period.

03

Surgery

Under general anaesthetic. Periareolar technique for smaller volumes or double incision with free nipple graft for larger volumes. Duration 2 to 3 hours.

04

Hospital stay

1 night in clinic. Drains removed on D+2. Compressive dressings maintained for 4 weeks.

05

Follow-up

Suture removal at D+14. Consultations at 1 month, 3 months and 6 months. Final result visible at 6 months.

Practical information

Duration
2 to 3 hours
Anaesthetic
General
Hospital stay
1 night
Time off work
10 to 14 days
ALD 31 coverage
Possible subject to conditions
Final result
At 6 months

Benefits

  • Flat, harmonious masculine chest
  • Major reduction in gender dysphoria
  • ALD 31 social security coverage possible
  • Compassionate multidisciplinary support
  • Well-positioned scars
  • Definitive and lasting results

Risks

  • Post-operative haematoma or seroma
  • Partial areola necrosis (double incision)
  • Hypertrophic or widened scars
  • Residual asymmetry
  • Altered areola sensitivity
  • Insufficient aesthetic result

French Social Security Coverage

FtM mastectomy can be covered under ALD 31. Conditions include: diagnosis of gender dysphoria by a multidisciplinary team, documented transition follow-up, agreement from the CPAM. Dr. de Clermont-Tonnerre assists you throughout this process.

Expected results

FtM mastectomy provides a flat, harmonious masculine chest. The impact on quality of life and the reduction of gender dysphoria is generally very significant. Scars fade progressively over 12 to 18 months.

Before and after photos available during the consultation on request.

Frequently asked questions

Which masculinisation surgeries are available in Paris?+
Dr. de Clermont-Tonnerre primarily offers bilateral mastectomy with masculine chest reconstruction (top surgery), which is the most requested masculinisation procedure. Other procedures can be discussed according to your project: body liposuction, body contouring for a masculine silhouette. Phalloplasty is a separate procedure offered independently.
Is FtM top surgery covered by French national health insurance?+
Yes, bilateral mastectomy within an FtM transition pathway covered under ALD 31 can be reimbursed by the Assurance Maladie (French national health insurance). The conditions are identical to those for MtF coverage: diagnosis of gender dysphoria by a multidisciplinary team, documented follow-up, agreement from the CPAM (local health insurance fund).
Which technique is used for trans mastectomy?+
The technique depends on breast volume and skin quality. For smaller chests, a periareolar technique (scar around the areola) may be used. For larger chests, double incision with free nipple graft is generally preferred. The surgeon selects the most appropriate technique during the consultation to minimise scarring while maximising the result.
Can mastectomy be performed before or without hormone therapy?+
Bilateral mastectomy within an FtM pathway can be performed before or after testosterone therapy. However, testosterone may alter skin quality and breast volume, sometimes influencing the choice of technique. The decision is made in consultation with the multidisciplinary team.
How does the first consultation work?+
The first consultation is a moment for listening and information. The surgeon assesses your anatomy, gathers your expectations, presents available techniques and expected results. He informs you about the ALD 31 coverage process if applicable. A 15-day reflection period is observed before any decision.
What FtM mastectomy techniques are available (periareolar, inverted-T, bilateral double incision)?+
Three main techniques exist. The periareolar technique suits smaller chests with good skin elasticity: the scar is limited to the areola margin and the result is very discreet. Bilateral double incision (DI) with areola reduction and repositioning is indicated for medium to large chests; it leaves horizontal scars below the pectoral muscle. The inverted-T technique, less common, may be proposed in certain specific configurations. The choice is determined during the consultation based on your breast volume, skin laxity and aesthetic objectives.
Is top surgery covered by French social security under ALD 31?+
Yes, bilateral mastectomy within an FtM pathway is eligible for reimbursement by French national health insurance under ALD 31 (long-term condition status for gender dysphoria). Required documentation includes: validated multidisciplinary diagnosis, documented transition follow-up, prior agreement from the CPAM. Dr. de Clermont-Tonnerre assists you in compiling this file from the very first consultation.
Is testosterone required before top surgery?+
There is no absolute hormonal prerequisite for FtM mastectomy. The procedure is technically feasible before any testosterone treatment. However, hormone therapy may slightly reduce breast volume and alter skin quality, which can influence the choice of surgical technique. The decision is made in consultation with the multidisciplinary team according to your personal pathway.
How are nipples managed during top surgery (free graft, pedicle)?+
Nipple management depends on the surgical technique selected. With the periareolar technique, the areola is preserved on a cutaneous pedicle and repositioned without being detached. With double incision, the areolas are harvested as free skin grafts, reduced to the desired diameter and reimplanted in the anatomically masculine position. In the latter case, areola sensitivity may be partially or totally altered. Your surgeon will detail the specific risks during the consultation.
When can I return to sport after top surgery?+
A gradual return to physical activity is recommended. Light walking can resume from the first days. Activities engaging the pectorals (upper body strength training, swimming, CrossFit) should be avoided for 6 to 8 weeks post-operatively. A compression vest is worn for approximately 4 weeks. Your surgeon will provide a personalised timeline based on the technique used and your recovery.
What is the recovery time after top surgery?+
The typical recovery is 10 to 14 days off work for a sedentary role, and 3 to 4 weeks for physical work. Sutures are removed around D+14. Drains, if placed, are removed between D+2 and D+5. The final result is visible at 6 months, when scars have matured and residual swelling has fully resolved.
Are there visible scars after top surgery?+
All mastectomies leave scars. With the periareolar technique, they are limited to the areola margin and are often very discreet over time. With double incision, two horizontal scars follow the inframammary fold and are visible under the arms but hidden under a T-shirt. They evolve favourably over 12 to 18 months and can be improved with scar care or, if necessary, a small surgical touch-up.
What complications are possible after top surgery?+
Like any surgical procedure, FtM mastectomy carries specific risks: post-operative haematoma or seroma (sometimes requiring drainage), partial areola necrosis (especially with the free graft technique), hypertrophic or keloid scars, residual asymmetry, altered areola sensitivity. These complications are rare when performed by an experienced surgeon and post-operative guidelines are followed.

Patient testimonials

★★★★★

“Top surgery with Dr. de Clermont-Tonnerre was a decisive step in my transition. The surgeon was respectful, skilled and genuinely attentive. The ALD 31 process was made easy. I finally live in harmony with my identity.”

Theo

★★★★★

“I was very anxious about the mastectomy but Dr. de Clermont-Tonnerre reassured me at every stage. The result is a natural masculine chest with well-placed scars. I strongly recommend for any FtM person seeking top surgery in Paris.”

Luca

★★★★★

“Perfect follow-up from start to finish. The consultation was direct and professional, the result is exactly what I hoped for. Coordination with my multidisciplinary team was assured. Thank you for this remarkable work.”

Alex

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See also

Gender surgery — all proceduresFacial feminisation (FFS)Vaginoplasty (MtF)Phalloplasty / MetoidioplastyChest feminisationIntimate surgery
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