Your photos are not helpful (clothed), though they suggest that skin-reducing mastectomies may indeed be required due to the size of your breasts seen in the lateral views. Photos of your chest unclothed may allow an online answer, but in "borderline" cases, a physical examination and personal assessment will be required, not to mention a surgeon who has years of experience doing top surgeries for transgender patient of all anatomic types. (I have been doing both periareolar and skin-reducing (double incision) mastectomies (top surgery) for 3 decades, and now do this operation dozens of times per year, in addition to hundreds of other non-transgender breast operations).Of course, every patient wants the fewest incisions and least scars, but please search "botched transgender surgery" on this (RealSelf) site for a few examples of keyhole surgeries (because the patient "really had to have periareolar incisions" or "really important for my dysphoria to not have any horizontal scars") gone bad, rather than what their second operation will require--double-incision skin-reducing total mastectomies with nipple/areola grafts in proper size and position.Unfortunately, there are well-trained, ABPS-certified plastic surgeons with years of experience (even decades) who will refuse to admit they have little experience with transgender mastectomies. They think lots of cis-gender breast surgeries "automatically confers transgender wisdom" and perform Wise-pattern breast reductions or near-total mastectomies, and then rationalize bad results with "preserving tissue so nipple sensation is preserved," or positioning the lower double incision above your present inframammary creases (leaving both a scar AND your old crease), or simply telling you what you want to hear, doing the surgical procedure you want rather than what is needed, and end up surprising both you and themselves! (Can you imagine ANY ethical and reputable plastic surgeon who has results like these "botched cases" and doesn't avoid ever doing that again?I fear you will end up like these examples if you are unwilling to accept the reality of your own anatomy. Double-incision top surgery is ALWAYS required with breasts above a certain size, and these sizes will differ with age, skin thickness, skin elasticity, and healing. "Finding the right surgeon" cannot supersede the biophysics of skin stretch and healing, regardless of what someone with "special skills" may tell you. And, of course, you really WANT to be told this, so you will pay thousands of dollars (insurance may not cover this surgery--again, regardless of what some surgeons may tell you), undergo the WRONG surgical procedure, and end up here on RealSelf asking how this can be "fixed."Then you have the surgery you should have had in the first place (more cost, another surgery, another time off work and social activities, another year for scars to mature and fade), not to mention your final result may not be as good as the one you might have had if you had received the PROPER advice and surgical procedure as your FIRST operation. Some things can be improved, but not always completely "fixed."So please have a more open mind, see experienced top surgery experts who are also ABPS-certified plastic surgeons. and get a couple of opinions. The wisdom of my advice will then become apparent. BTW, for a few examples of my own top surgery patients (some non-binary like you), click on the web reference link below (all of the top surgery patients are mine) or refer to my FTM Chest Masculinization Surgery photos (drop-down menu under Photos) here on RealSelf. Best wishes! Dr. Tholen
