FTM/N Incision Options for Top Surgery

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involves various incision options that are dependent on factors like the patient’s skin elasticity, chest size, and personal goals. Each of these has its unique advantages and potential drawbacks. Here are the most common FTM/N chest reconstruction incision types:

If you have a medium to large chest (cup size C and above) and significantly sagging skin, a could be the ideal solution for you. This procedure helps reconstruct male chest contours and position the nipples in a natural and appropriate manner. However, keep in mind that sensation may not return in the areola (the pigmented skin around the nipple) or nipple due to the severing of nerves when these areas are removed.

THE INVERTED T (ANCHOR) INCISION

Should you have a medium to large chest with significant sagging skin but wish to retain sensation, an inverted T (anchor) incision could be considered. In the Inverted T (Anchor) procedure, the nipple and areola maintain their blood supply by preserving a thin layer of attached tissue, known as a pedicle. This pedicle extends to the lower part of the breast area, ensuring blood supply to the nipple and areola. While we hope the pedicle also nerves, the extent to which nipple sensation is preserved cannot be ascertained until after the procedure is .

Following the of the pedicle, the remaining skin is folded around it, with excess skin being excised. This leaves an incision around the areola that descends to the lower breast, and a curved incision across the lower breast area. The Buttonhole procedure is very similar, except that less skin is removed, making the small incision redundant.

The Inverted T method ensures that the nipple and areola don’t have to be relocated, unlike the free nipple graft required by the . As a result, the Inverted T might offer a higher chance of maintaining pre-surgery levels of sensation in the nipples, though this outcome is not guaranteed.

However, scarring is a downside due to the extra incision in the central breast area, particularly the vertical region between the areola and the inferior incision. Another disadvantage is the retention of the pedicle to preserve the nipple and areola, which will add volume to the chest, resulting in fullness or a mound.

Furthermore, the lower curvature of the incision isn’t as customizable by the surgeon as it must be located in the lower breast fold. Additionally, the surgeon cannot tailor the horizontal placement of the areola as much as they can with the double-incision approach.

If retaining a high level of nipple sensitivity is your primary concern, the Inverted T or Buttonhole approach might be the best choice. However, remember that the retention of sensation isn’t guaranteed.

If you prefer a chest that is as flat as possible, or if you are keen on having a completely customised placement of the nipple or the incision, then the traditional Double Incision technique might be the preferred procedure for you.

PERIAREOLAR SURGERY TECHNIQUE

For individuals with a chest, good skin elasticity, and a desire to retain areola and nipple sensation, the circumareolar incision is a viable choice. The FTM/N Periareolar Surgery Technique, also known as the ‘doughnut’ or ‘circumareolar’ technique, is a method used in chest masculinization surgery. This technique is characterised by the removal of an intermediate amount of skin using incisions that circle each areola.

Situated between Keyhole surgery and other surgical procedures requiring more extensive skin removal, the Periareolar procedure serves as an ideal choice for those a greater amount of skin removal than the Keyhole surgery can offer, yet desiring a procedure with a relatively limited skin incision. This technique is particularly for patients with minimal surplus skin. However, it is essential to note that due to the inherent challenges, this procedure tends to have a higher revision rate, which should be taken into consideration when deciding on this surgery.

The Periareolar procedure is also known as the Circumareolar and Doughnut Incision techniques. Despite the different names, they all describe the same procedure, with ‘Periareolar’ being the most commonly used term. Some individuals also refer to the procedure as ‘peri’ in short.

The Periareolar procedure entails removing a doughnut-shaped segment of skin around the areola. This is achieved by resizing the areola to a more masculine size (approximately 22 mm in diameter), followed by marking an outer circle of skin for excision. The layer of skin (comprising the epidermis and a superficial segment of the dermis) is then removed. Through this layer of tissue, the surgeon makes an incision and works beneath the skin layers to eliminate the breast tissue.

Once the breast tissue is removed, a ‘purse string’ stitch is employed to bring the diameter of the outer circle down to match that of the inner circle. This may occasionally result in a pleating effect, often termed a sunburst or ripple pattern, due to the mismatch between a large circle and a small one. However, these ripples usually or vanish entirely in the weeks and months post-surgery.

The outcome is a male-appearing areola necessitating only a single incision around the areola’s circumference.

This procedure relies on maintaining a precise margin of error concerning the health of the fat layer on the tissue beneath the skin. Achieving a flawlessly uniform thickness across the entire chest can prove challenging even for the most proficient surgeons. Thus, it is not unusual for there to be subtle undulations in the surface contour of the chest with this procedure. While such minor irregularities can occur with any procedure, they are less common with the Double Incision procedure.

Post-surgery, most patients experience a significant decrease in sensation, although the majority recover most or all sensation over time. This is one of the considerable of this procedure.

Despite its advantages, periareolar surgery is only suitable if the patient requires minimal excess skin removal. Using the Periareolar technique on a patient with excess skin can lead to a loose fold of skin in the lower chest or a pronounced pleating or sunburst pattern of wrinkling around the areola that does not subside.

It is impossible to predict with complete certainty how the skin will react to any surgical procedure. However, certain can assist you and your surgeon in determining the most appropriate procedure for you.

For some patients, chest tightness is a vital consideration. If that is the case, the Double Incision technique will likely yield results compared to the Periareolar. Although the Double Incision procedure does result in a significant horizontal scar, it is the most effective procedure for achieving a uniformly tight and smooth chest appearance.

TOP SURGERY KEYHOLE METHOD

The is a surgical procedure employed for chest reconstruction, characterised by a small incision made along the areolar border. Through this incision, the breast tissue is meticulously removed by the surgeon. However, only a small percentage of the population, about 5%, are suitable candidates for this procedure due to the requirement of minimal breast tissue and firm chest skin.

One of the main attractions of this procedure is its minimal scarring. The surgery results in a small scar, up to half the length around the areolar border. No excess skin is removed during this procedure, thereby making it exclusively to patients possessing minimal breast tissue and relatively taut chest skin.

The origins of the term