If you are transitioning, you know just how much dysphoria you feel when it comes to your chest! In fact, dysphoria drastically reduces once you go through top surgery.

Top surgery or Mastectomy, is a surgical procedure aimed at removal of breast tissue in order to masculinize the chest.

Top surgery allows you to feel:

• more comfortable with your body

• helps you feel more body congruency

• increases self esteem

• increases confidence

• and decreases dysphoria!

There are a number of surgical techniques avaiable. Each come with both benefits and costs so a through discussion with a surgeon is important.

Keep in mind that one year of hormone therapy is NOT a requirement to obtain top surgery!

Picking the right surgeon, Dr. Mosser or Dr. Gallagher for example, that is experienced in trans care is a key!

If you are planning on getting top surgery and need help finding a doctor, I highly recommend checking out my comprehensive resource page for a skilled surgeon.

It is important to keep in min that most surgical techniques are dependent on the size of your chest and its level of elasticity or firmness.

The location of incision is also highly important. As well as your desire for preservation of nipple sensitivity.

Let’s have a closer look at the pros and cons of the 6 most common options available today.

#1 KEYHOLE PROCEDURE

• Offering minimal scarring, keyhole procedure is the most coveted technique.

• Ideal for people with small breasts and good elasticity, this technique offers a small incision under or across the lower border of the areola.

• The breast tissue is removed through this incision.

PROS

1. Due to the nipple stalk usually being left intact, nerve sensation is maintained.

2. Minimal scarring.

3. No grafts required.

CONS

1. This procedure cannot address excess skin.

2. Only people with small breasts and good elasticity qualify.

#2 PERIAREOLAR PROCEDURE

• This technique works best on people with moderate breast tissue and good skin elasticity.

• Consisting of two incisions: one made around the border of the areola, and another larger circle incision to remove excess skin.

• A skin is pulled toward the center with a “drawstring” technique.

• Sometimes, another vertical incision extending below the areola may be necessary to remove additional excess skin.

PROS

1. Due to the nipple stalk usually being left intact, nerve sensation is maintained.

2. Minimal scarring.

3. No grafts required.

CONS

1. May require another vertical incision to remove excess skin resulting in additional scarring.

#3 DOUBLE INCISION PROCEDURE

• For people with larger breasts size or breast tissue that sags, a double incision if often the way to go.

• During this procedure, a horizontal U-shaped incision is made on the lower border of the pectoral muscle.

• Breast and fatty tissue is removed.

• A second incision is made to remove nipples.

• If necessary, nipples are re-sized and then placed in position to give the chest a more masculine appearance.

PROS

1. Less incision scarring compared to techniques with three incisions.

2. Offers most flatness to the chest.

3. Surgeon has most control over lateral positioning of the nipple.

CONS

1. Loss or lack of sensation in nipple area.

2. Noticeable scarring.

3. Nipple grafts have a risk of infection and loss.

#4 INVERTED-T (ANCHOR) PROCEDURE

• Similar to the above double incision procedure, an Inverted-T is ideal for people with larger breast size.

• Especially those wanting to retain the most sensation possible in the nipple area.

• This procedure keeps the nipple and areola intact, avoiding the need for a nipple graft.

• However it requires an additional vertical incision.

PROS

1. Preservation of sensitivity.

2. No risk of graft loss.

3. Having a nipple and areola that is more full in appearance.

CONS

1. Additional vertical incision resulting in more scarring.

2. Cannot achieve the same level of flatness as the double incision (due to the tissue left behind to supply blood to the nipple area).

3. Surgeon may not have full control over the lateral positioning of the nipple.

#5 BUTTONHOLE PROCEDURE

• Similar to the Inverted-T procedure in many ways, two horizontal incisions are made.

• Breast tissue and excess skin is removed.

• Instead of free nipple grafts, the nipple area is re-sized and left attached.

• This enables for blood supply to remain intact, preserving sensitivity.

• A circular incision is made in the chest wall at the location for nipples.

• The nipple is brought from under the skin though this opening like a button trough a buttonhole, hence the name.

• Due to less skin needing to be removed than with the Inverted-T procedure, the Buttonhole technique does not require a vertical incision.

PROS

1. No nipple grafts.

2. No vertical scars.

3. Preserved sensitivity of nipple area.

4. More natural appearance than free nipple grafts.

CONS

1. More tissue may potentially remain in the chest area.

2. Surgeon may not have full control over the lateral positioning of the nipple.

#6 FISHMOUTH PROCEDURE

• A less common procedure, the Fishmouth technique is more popular with nonbinary identified individuals.

• This because the horizontal scars radiating out from the areola create a non-anatomic layout.

• Therefore, people who do not wish to have a male or a female appearing chest, prefer this technique.

• This procedure combines elements of Double Incision and sometimes elements of Inverted-T or Buttonhole technique.

PROS

1. Preserved sensitivity of nipple area.

2. Enhanced ability to obtain a considerable degree of flatness and tightness.

CONS

1. Non-anatomical appearance that may be an advantage to nonbinary individuals and disadvantage to transmale identified people.

WHICH OPTION IS BEST FOR YOU?

As you can see, each one of the above procedures comes with benefits and costs. Thats why a detailed discussion with a skilled trans experienced surgeon is paramount.

Curious to determine which procedure may be right for you? I highly recommend checking out The Mosser Method by Dr. Mosser to figure out which option may be best for you.

You may also find the following helpful:

• Phases of Denial & Reality When You Start Transition.

• Psychological Effects of Facial Feminization or Masculinization Surgery.

• What is The Biggest Fear When it Comes to Coming Out?

• Afraid to Come Out to Your Partner?

WATCH EXPERT VIDEOS ON GENDER DYSPHORIA

REFERENCES & SOURCES

https://www.topsurgery.net/procedures/

https://www.genderconfirmation.com/surgery/

http://cosmeticconciergemd.com/transgender-procedures/buttonhole-chest-technique/