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Our Locations / TEL: 201.449.1000 / FAX: 201.399.2433

FTM / Transmasculine Procedures

Conveniently located to serve Hoboken, Ridgewood, Livingston, Pompton Plains, Manhattan/NYC, and Nyack

FTM Top Surgery

Top surgery or chest masculinization is the most commonly performed surgical procedure for transmasculine patients in our practice. Dr. Keith is a world-recognized pioneer in the techniques and concepts of masculinizing chest surgery for transgender and gender non-conforming patients. He is widely published on the topic and has been an invited speaker at national and international surgical conferences. Chest masculinization refers to a range of procedures aimed at masculinizing the chest. This is done through removal of breast tissue, repositioning the nipple to a more male anatomic appropriate size, position and shape and redraping the skin to conform to the underlying pectoralis major muscle. Dr. Keith is an expert in these procedures. Call us at 201.449.1000 or use our online form to schedule an appointment right now.

Double Incision

The “double incision” top surgery technique results in a horizontal scar across the chest situated along the anatomic lines of the pectoralis muscle. The Nipple Areola Complex (NAC) is then removed and transported to its new, more male-anatomic position on the chest as a graft. This is the most commonly performed procedure for FTM top surgery.

Periareolar or Keyhole

These procedures result in a limited scar situated around the areola. This is best suited for patients with a smaller volume of breast tissue and skin. The nipple can be resized and repositioned to a moderate degree via this approach as well.

Top Surgery and patients under 18

ECAPS treats patients who are less than 18 years old and follow the current World Professional Association for Transgender Health (WPATH) guidelines. Parental consent is required and referral letters from a mental health professional will be required.

Click here to download the requirements document.  
Chest Masculization:

Chest Masculization:

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FTM Bottom Surgery

Dr. Jonathan Keith has assembled a world-class team of health professionals to perform gender affirming genital masculinizing surgery. In addition to the expert microsurgeons of ECAPS, Dr. Keith routinely works with board-certified experts from urology and gynecology to safely perform these procedures.


Metoidioplasty creates a phallus from the hormonally-enlarged clitoris. The size is limited to the amount of growth of the natal clitoris in response to hormone therapy. The average size range is 1-3 inches. A neo-urethra and scrotum area created during this surgery as well. Testicular implants can be placed at a later date.


At ECAPS, our group of microsurgeons, led by Dr. Jonathan Keith, excel at performing “free flap” phalloplasty utilizing microsurgery. This requires meticulous, expert microsurgical technique to safely transfer tissue that will have a robust blood supply and reconnect erogenous nerves to the constructed phallus. Dr. Keith is one of a handful of surgeons in the United States with fellowship training and expertise in these techniques. In 2018, he was the first surgeon to successfully perform a phalloplasty in the state of New Jersey. Phalloplasty refers to construction of a male anatomic appearing phallus from transported autologous tissue. This means there will be an additional scar from the donor site where the tissue came from. Generally, some of the goals of phalloplasty are to stand to urinate, retain erogenous sensation and penetrative intercourse. Dr. Keith routinely offers Radial Forearm Free Flap Phalloplasty (RFFF) and Anterolateral Thigh Flap Phalloplasty (ALT). Other options such as groin flap, SCIP flap, musculocutaneous latissimus dorsi (MLD) among others are available. There are many options available in phalloplasty and Dr. Keith will construct an individualized plan for your reconstruction.

Review from A. | Source: Healthgrades | Dec 4, 2018

“Dr. Keith is simply one of the most caring and compassion surgeons I’ve ever met. He explained my procedure and recovery very throughly. Pre and postop he was reassuring and attentive. Removal of breasts and chest masculinization (involving large breasts): outcome is even better than I expected. Virtually no pain and a speedy recovery. His staff works hard to handle insurance approval and claims. He is very supportive and proactive for his transgender patients. I can’t recommend him enough.”


  • Urethroplasty
  • Scrotoplasty and Testicular Implants
  • Phalloplasty Revision
  • Penile Implant
  • Body Masculinizing Surgery

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