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Ioannis Ntanos Top Surgery Transgender.jpeg
  • How many steps are there in the process of getting top surgery?
    There is an initial 45-60 minute consultation followed by a period of reflection to allow for any additional questions that may come up. Then, once the patient is comfortable, the surgery is carried out. A pre-operative assessment is also carried out, closer to the date of the procedure.
  • What is the aim of the consultation
    The consultation is an opportunity for the surgeon to get to know the patient, but also for the patient to get to know the surgeon. The most important thing is to be as open and honest as possible about what you are hoping for, so that the results that best suit your wishes can be achieved.
  • What advice would you give to someone considering top surgery?
    Do your research. Have a basic understanding of the available techniques and which one best suits what you are hoping to achieve. Different surgeons have different speciality skills. Explore what you want and whether the technique is suitable for you, then find the person who can carry that out. YouTube has lots of videos you can watch, many surgeons have their own websites which you can explore. Ask questions in forums such as Reddit about other people’s experiences - this will give you a good frame of reference but be aware that your experience will be unique to you.
  • What advice would you give to someone coming to a consultation?
    Once you have chosen your surgeon and you know their areas of expertise, ask direct questions relating to what you are hoping to achieve, that way the surgeon can focus all their attention on your specific needs, rather than spending the time speaking in more general terms.
  • What key question should I be able to answer in the consultation?
    You should be able to answer the following: What do you expect/want to be able to do after surgery that you cannot do now?
  • How can patients communicate with you throughout the process?
    Patients can access me through the contact form on the website. If the question is easy to answer I will do so in a couple of lines. If the question is more in depth and requires a second consultation this will be arranged at no extra charge.
  • How quickly after my consultation can I expect to have my operation?
    The operation cannot happen immediately – I encourage people to reflect on the consultation to allow any questions to come up. It is important to note that you will not jeopardise the discussion by asking questions.
  • Will I be asked about my family history?
    Yes. Family history is a good indicator of any potential future risk and as such it is really important that you share anything relevant, both about your own history in relation to your chest, and that of your family members.
  • I wear a binder, will this impact my surgery?
    Prolonged binding will stretch the skin. This can reduce the feasibility of certain techniques employed to reduce the chances of scarring. Discuss the options available with your surgeon.
  • Should I quit binding ahead of my surgery?
    Yes. Ideally you should stop binding altogether 2-3 weeks before the procedure, or consciously minimise binding as much as you can.
  • How do I know if it’s the right surgeon for me?
    Express what you want to achieve fully to the surgeon. This is your journey and if the surgeon doesn’t understand or agree with what you are trying to achieve, they are not the right surgeon for you.
  • What if the surgeon I want can’t perform the technique that is best for me?
    If your surgeon is unable to perform the technique that is best for you, they should be able to refer you to another surgeon to see if they are able to help. What is best for you is usually a compromise between your desire and what your surgeon feels they can offer you for the best results.
  • How long does the surgery take?
    While it varies from person to person, allow around three hours for the top surgery itself. Inducing anaesthesia and recovery time also vary.
  • Is top surgery carried out under general or local anaesthetic?
    Top surgery is done under general anaesthetic only.
  • Is there a limit to what size of chest you can operate on?
    No, size is not a barrier to getting top surgery but it will impact which procedure the surgeon will choose. The bigger the chest, the less surgical options are available. Please note that weight fluctuations after surgery can impact the aesthetic outcome.
  • Do you use drains as part of your standard process?
    If I do not feel they are clinically indicated I do not use them. Having said that there are cases where they are needed, for example if the dissection area is very large. Where drains are not used, a compression vest must be worn for 10-15 days.
  • Nipple sensation is important to me. Is this something that can be preserved?
    Absolutely, but only with certain techniques. If this is important to you, make sure you bring it up in the consultation with your surgeon. Not all desires can be met, but if you do not ask the answer is always no.
  • How will my weight impact the procedure?
    BMI is a factor in top surgery. It is recommended that you aim to achieve your target weight prior to having surgery as any significant changes in your weight can impact the effects. The preferred BMI range for top surgery is between 20 and 39 when it comes to the implications of general anaesthetic.
  • How much will I need off from work?
    Although every individual is different and will respond differently to a major operation, there are a few milestones that you – and potentially your employer – need to be aware of: You may require a few days off before your operation in order for the pre-operative assessment to be conducted. Post-operatively you will have dressings that will need to remain in situ for two weeks in the majority of cases. These two weeks are usually the time required before you will be able to take care of yourself and complete everyday tasks, including driving. Heavy weight-lifting and over-stretching should be avoided for 6-8 weeks after surgery. Swimming should also be avoided for this period. If your work involves strenuous physical activity, a sick note will be provided at your request.
  • How will my chest appear after surgery?
    It is impossible to determine exactly how your chest will look after surgery. During your consultation you will be shown drawings and images that will indicate the likely outcome. This will, however, be determined by a number of factors including the skin quality, your healing rate and the intra-operative findings. Sometimes scarring adaptations will need to be made in order to provide you with a flat chest and a masculine projection – if this is what you are after. Individual requests and expectations will be discussed pre-operatively and no decision will be taken during the operation without your prior consent. Building up your chest wall muscles prior to and post surgery through exercise will make an optimum result more achievable.
  • Is there anything I can do to speed up the healing process?
    Everyone’s rate and quality of healing is different. If you had an operation before that resulted in poor healing, such as keloid formation or infection, please discuss this as part of your consultation. Healing is related not only to what you do after surgery, but also to what you do beforehand. Please follow advice on smoking and maintain a healthy lifestyle. Look after the quality of your skin, including any acne. Make sure that any associated medical issues are well controlled (eg diabetes). There are different oils/ creams that can be used to improve scarring with different anecdotal results. Silicone strips or ointment are proven to improve the appearance of scarring, however they should be used only after all the post-operative scabbing has naturally been removed. Avoid direct sun exposure for at least six months. If this cannot be avoided, use a high-factor sun protection (factor 50) and allow it to dry fully prior to sun exposure.
  • Is there anything that I need to be aware of that might impact the surgical techniques available?
    If an individual is at high risk from the general anaesthetic, the surgeon will lean towards a single procedure, with minimal chances of having to carry out further procedures.
  • What is the recommended approach when the operation doesn’t go according to plan.
    It is essential that anyone considering surgery understands the risks and complications of this surgical intervention from the beginning. When something unexpected happens it can be incredibly distressing for the patient so my approach is always to talk though all of the potential things that could go wrong so that it doesn’t come as a surprise and you can focus on the best solution.
  • What are the most common risks and complications?
    Pain - You will be prescribed regular painkillers on discharge and given advice on how to minimise discomfort. Individual pain thresholds vary significantly. Infection - Can occur with any procedure and it may affect the final aesthetic outcome. You will be given antibiotics during the operation, but not routinely afterwards. You should consult your GP at the first sign of any infection. Scarring - Will depend on the type of the procedure you are having. Bleeding - The most common surgical complication may occur at any time following the operation, although it is more common in the first 24 hours. Asymmetry - Uneven appearance which it may (or may not) be possible to correct with further surgery at a later date. A type of asymmetry is known as “dog ears” due to excessive skin on the scar edges. If they are the cause of significant concern they may be corrected with a second operation. Seroma - A collection of fluid that sometimes requires aspiration in an outpatient setting. DVT/PE - Blood clots to your legs that might travel to your lungs. You will wear compression stockings to minimise this risk and a post-op sub-dermal injection of a blood thinner (low molecular heparin) may be given. Re-operation - May be required to treat any complication that may arise. Risks from general anaesthetic will be discussed with your anaesthetist.
  • Am I still at risk of cancer after top surgery?
    A bilateral mastectomy will minimise your risk of developing breast cancer in the future, but it will never eliminate the risk altogether. You need to remain chest aware for the rest of your life and any lumps in the future that might appear in your chest should be properly investigated. The exact risk is unknown but is considered similar to that of cisgender men. If there is any relevant family history, or in the event that you are aware of any BRCA or other gene aberration please discuss this in your consultation. In some cases in order to minimise your future risk, certain techniques will be excluded (as different techniques will allow for more glandular tissue to be removed).
  • Can I keep my nipple piercings?
    If you have nipple piercings, these should be removed prior to your operation. Three to six months after surgery they can be re-inserted, although depending on the technique, nipples may lose part or the majority of their projection.
  • I am keen to get a tattoo to cover my scarring, how quickly after the surgery can I do this?
    You should wait six months to ensure that no surgical revision is needed and allow time for the healing process to complete.
  • How many top surgery procedures have you carried out?
    To date I have carried out more than 700 cases of top surgery.
  • What fuels your passion to help the trans community?
    It takes so much bravery to be trans. I just want to be able to help my patients to fulfil their potential to be themselves. See also 'Why I do what I do'.
  • How much does the procedure cost?
    The procedure costs £7,500 pounds (July 2023) while a consultation costs £200 pounds. Costs for a re-operation, to either treat a complication or improve the overall look (cosmesis), are highly variable, depending on the procedure performed.
  • Do you offer payment plans?
    A 50% deposit is always needed to secure a theatre date. Financing plans can be offered only if the operation is booked via an established organization (e.g THG) and should be discussed directly with them.
  • Will the invoice come directly from Ioannis Ntanos?
    No, we have engaged the services of JW Medical Management Ltd to manage all billing on behalf of Ioannis Ntanos.
  • How will I receive my invoice?
    Invoices for consultation and procedure fees will be emailed directly to you, via the email address you provided on registration.
  • When will fees be due?
    Fees for the Consultation will be invoiced and collected prior to your appointment. Fees for the Procedure will be split into two invoices. The first “Deposit Invoice” will be issued when the procedure date is booked. This must be paid within seven days of issue to confirm the booking. The second “Balance Invoice” will be issued approximately 14 to 28 days prior to the procedure date. This must be paid within 7 days of issue. All fees must be paid in advance of the procedure date.
  • I have a query relating to my invoice, what should I do?
    Please contact the JW Medical team should you have any invoice queries, any problems with making your payment or if you believe you will not be able to make a payment by the Due Date. JW Medical can be contacted via email on Please quote your invoice reference number where possible.
  • Where can I access the full terms and conditions for my procedure?
    Click here for access to the full terms and conditions.


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