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

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 — happy to help!

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

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.