I was recommended tennis racket method FTM top surgery. Why would this be considered over others? Do I have options? (Photo)

Question

He stated this method would be "an incision under the areola and extending a little beyond on each side, like a tennis racket (or a spoon)." I was sent this link for visual: www.researchgate.net/figure/Tennis-racket-method-A-Preoperative-design-with-racket-form-B-Lumpectomy-and_fig5_223974981 I prefer to have minimal scarring because I am prone to keloid development (I have 3 on my shoulder currently). Looking for other method options.

Jaime Caloca, Jr., MD · Answer

A Periareolar approach with an incision located ONLY on the lower half of the areola borders and not beyond them is possible in expert hands. I see no need to extend the incisions laterally.

Anthony Deboni, MD · Answer

Thanks fro your question and photos.  I completely agree with Dr Tholen's excellent answer and explanation.  There is absolutely no place for a vertical incision in transgender female to male chest reconstruction!  You look to be a candidate for periareolar procedure, which would minimize scars, but can leave a bit of skin excess.  A double incision will produce a flatter chest, but come at the cost of additional scarring. Given your concerns about scarring and keloids, I would suggest the periareolar approach.  Please consult with a board certified plastic surgeon who has experience in transgender surgery.  You have only one chance to "do it right the first time".  Best of luck!
Dr Deboni
@drdeboni

Patricia A. McGuire, MD · Answer

There are many options for gender affirming top surgery for trans men. I have not used a “tennis racket” incision on my patients. The most common procedure I perform is double incision, free nipple graft. This allows the most control over shape to achieve a masculine chest in patients with any degree of sagging. In your case, a masculine chest may be possible by removal of breast tissue through an areolar incision and reduction of the size of the areola. Be sure to see a board certified plastic surgeon experienced with transgender patients to discuss your options.

Richard H. Tholen, MD, FACS · Answer

With due respect to the surgeon who has given this advice, I believe this is just plain wrong. The "tennis racket" method is, first of all, not a commonly-recognized name for the procedure being described. It is in the oncology literature regarding female breast cancer. You are receiving information about the circumvertical skin pattern, commonly called the "lollipop" pattern. If the vertical incision is too long, then the surgeon will excise an ellipse of skin at the lower edge of the vertical scar to shorten it, creating the Wise pattern, commonly called the "anchor" pattern. All of these are skin incision patterns used in female breast reduction or lift surgeries. 
You are a male who does NOT want a "female" skin incision pattern leaving permanent scars to remind you that you once had female breasts!
First of all, you MAY be a candidate for periareolar "keyhole" mastectomies, plus nipple reductions, to give you a masculine chest with smooth skin and virtually invisible scars around one edge of your areolas, and in the center, where your protruding nipples are reduced to masculine size. 
If your skin is too loose (or less elastic), you might require double-incision mastectomies, but NOT with vertical scars. These scars would be positioned to simulate the lower edge of your pec muscles. That being said, again, I don't think you need any skin-reducing incisions OR vertical scars for any reason. Physical examination will allow this advice to be given more accurately for your individual anatomy.
Honestly, I believe this recommendation shows inexperience, not "versatility" with other techniques. Your surgeon (like all plastic surgeons) is trained in female breast reduction and breast lift procedures, and I believe is generalizing this to your request for top surgery. But YOU are NOT a female who wants scars of a breast lift/reduction. And forget any balderdash about "saving" tissue to preserve nipple sensation. 
Please click on the web reference link below for examples of both keyhole and skin-reducing transgender mastectomies. They're all my patients over the past nearly 30 years. NOT ONE has a vertical scar or lollipop pattern. They are also not just my best cases--they show how I've modified and improved technique, nipple/areola size and placement, and reduced revisions over the years. 
Please obtain other consultations with experienced ABPS-certified plastic surgeons experienced in transgender mastectomies. Other than myself, there are at least 3 others I know of in the Minneapolis area. See them all and get several opinions. I suspect none will advocate the "tennis racket" method. Best wishes! Dr. Tholen

Babak Dadvand, MD · Answer

Hi,Thanks for the post and photos. Based on the photos you should do well with a keyhole incisional approach.  Depending on your areola position in relation to the lower border of the pectoralis muscle, you may need a periareolar (or circumareolar) lift to ensure the areolas are at the proper height. You never should undergo a vertical incision. This is referred to as a lollipop incision and the vertical component can give projection to the breast mound, which is the EXACT OPPOSITE effect you want in chest masculinization. My advice, seek out a different plastic surgeon who is experienced in chest masculinization surgery.Sincerely,Dr. Dadvand

Alexes Hazen, MD · Answer

I agree with the colleagues who answered.  YOU SHOULD NOT GET A VERTICAL incision, its feminizing and looks not "normal".  Get a second opinion and good luck!!

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