Should I go with periareolar or double incision top surgery? (Photos)

Question

If I get peri top surgery will the nipples be able to be on/above the pec muscles? (not under) if not, is there a way to revise that later on?

Mario Arturo Moran Romero, MD · Answer

Hi! Based on your photos, I would recommend a double incision top surgery.This technique would allow me to remove the breast tissue, reduce the size of the nipple-areola complex, and reposition the nipples to a more masculine and natural location on the chest.It also allows me to create a flatter, more contoured torso, and place the scars low on the chest, following the natural line of the pec muscle, so they stay in a more hidden position over time.I believe this approach would give you the best aesthetic result and the most control over shape and nipple position.Let me know if you have any questions &mdash; happy to help!

Krishna Vyas, MD, PhD, MHS · Answer

Based on your photos and breast size, the double incision top surgery seems to be the most suitable option for you. This technique is ideal for individuals with medium to large breasts or excess skin, as it allows for more effective tissue removal and provides better chest contouring. The procedure also gives you the flexibility to position the nipples above the pectoral muscles, achieving a more masculine chest appearance. While the double incision does leave scars across the chest, they improve over time, and the overall results are often more satisfying for individuals with larger breasts.

On the other hand, periareolar (keyhole) surgery is typically recommended for those with smaller breasts and less excess skin. It involves an incision around the areola, which may not always allow for nipple placement above the pec muscles. Given your goals for nipple positioning, this may not be the best choice. Consulting with an experienced gender-affirming plastic surgeon specializing in top surgery will help ensure you choose the most appropriate technique to meet your desired outcome.

Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained 
Aesthetic Plastic Surgeon
New York, New York

Jaime Caloca, Jr., MD · Answer

Your Breast Volume is too large for Periareolar Mastectomy. You need the Double incision Mastectomy if it is a FTM procedure. With the Double incision, the areolas and nipples can be placed where you want them to be.

Irena Karanetz, MD · Answer

Hello, 
And thank you for the question.
Based on your photos, you are a good candidate for Double Incision Top Surgery which is ideal for patients with medium to large size breasts. During this procedure, the breast tissue is removed through the incision at the breast fold and the second incision ends up being around the nipple, because the nipples are removed, re-sized and then grafted on the chest, in order to create a masculine chest.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Transgender Top surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
I hope this helps.Good luck!
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Franziska Huettner, MD, PhD, FACS · Answer

Dear Peincess1,

Thank you for your question and photos. It is difficult to say for sure without an in-person consultation, but from looking at your photos, you may potentially be a good candidate for a double incision top surgery.  Utilizing this method may help to remove breast tissue, as well as, excess skin, while potentially providing improved chest contour and positioning of the nipples in a male pattern with respect to the pec muscles.  I suggest that at this current time, you schedule an in-person or virtual consultation with a board-certified Plastic Surgeon to discuss you specific goals and to develop a unique plan to best achieve them.  Best wishes and stay safe!

Giancarlo McEvenue, MD, FRCSC · Answer

Hello due to your fairly large breast size and amount of excess skin you would be an ideal candidate for a DIM technique with free nipple grafts.sincerelyDr.G

Should I go with periareolar or double incision top surgery? (Photos)

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