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FTM top surgery is a gender-affirming procedure designed to create a flatter, more masculine chest for transgender, non-binary, and gender-nonconforming individuals. There are several surgical techniques available, each tailored to different body types, chest sizes, and personal goals. Choosing the right procedure depends on factors such as breast size, skin elasticity, and the desire to preserve nipple sensation. Below is an overview of the five main types of FTM top surgery to help you determine which option is best suited for you.
Double Incision Mastectomy
Double incision mastectomy, also known as bilateral top mastectomy, is a surgical procedure designed to remove breast tissue, excess fat, and skin from the chest to create a flatter, more masculine or non-binary appearance. This type of chest reconstruction is particularly suited for individuals who have a medium to large chest size and reduced skin elasticity. It is one of the most commonly performed gender-affirming procedures for transmasculine and non-binary individuals seeking a more traditionally masculine chest contour.
The procedure involves making two horizontal incisions across the chest, usually positioned along the natural contours of the pectoral muscles. These incisions allow the surgeon to carefully remove breast tissue and reshape the chest to achieve a smoother and more defined appearance. In many cases, the nipples and areolas are surgically resized and repositioned to align naturally with the new chest shape. This may involve grafting techniques to ensure optimal placement while reducing the overall size of the areolas to create a more proportionate look.
One of the key benefits of the double incision technique is the ability to remove a significant amount of tissue while also tightening the skin for a more sculpted outcome. This makes it an ideal choice for individuals with larger chests or those with insufficient skin elasticity to achieve a good result with other methods, such as keyhole or periareolar techniques. The double incision method provides a high degree of precision, allowing for a well-defined chest contour with minimal irregularities.
Nipple sensitivity is often a concern for those considering chest surgery. Due to the nature of this procedure, nerve connections to the nipple-areola complex are typically severed during the resizing and grafting process, which means there is a high likelihood of reduced or complete loss of nipple sensation. While this may be a drawback for some, it is an expected aspect of the surgery that many patients are willing to accept in exchange for achieving their desired chest shape.
RELATED: What Kind of Nipple Sensation Can I Expect After FTM/N Top Surgery?
Recovery from a double-incision mastectomy varies from person to person, but most individuals can expect some degree of swelling, bruising, and discomfort in the initial weeks following surgery. Compression garments are often recommended to support healing, reduce swelling, and help the skin adhere properly to the underlying chest structure. Full recovery typically takes several weeks, with most patients resuming normal activities within four to six weeks. Scarring is an inevitable part of the healing process, but over time, these scars often fade and become less prominent, especially with proper aftercare and scar management techniques.
RELATED: FTM/N Top Surgery Scars – Treatment, Healing and Fading
Nipple-Sparing Double Incision Mastectomy
Nipple-sparing double incision mastectomy is a surgical procedure designed for individuals seeking a flatter, more masculine or non-binary chest while retaining their natural nipple-areola complex. This technique closely resembles the standard double incision mastectomy but differs in its approach to nipple preservation. By carefully detaching the nipple-areola complex from the underlying breast tissue while maintaining its blood supply, this method allows for a more natural-looking result while minimising the risk of complete loss of nipple sensation.
During the procedure, the surgeon makes two horizontal incisions along the lower border of the pectoral muscles, allowing for the precise removal of breast tissue. This strategic incision placement ensures an aesthetically pleasing contour while providing access for thorough tissue removal. Unlike traditional double incision surgery, where the nipple may need to be resized and grafted into a new position, the nipple-sparing approach maintains the original structure of the nipples. This reduces the likelihood of significant pigmentation changes and provides a more seamless appearance after healing.
This technique is particularly suitable for individuals with smaller to medium-sized chests, as excessive breast volume may increase the difficulty of preserving both nipple sensation and proper positioning. Those with good skin elasticity typically achieve the best results, as their skin can naturally conform to the new chest shape without requiring additional surgical adjustments.
One of the most appealing aspects of this procedure is the possibility of retaining some degree of nipple sensation. Because the nipple stalk remains connected to the surrounding tissue, there is a higher chance of preserving nerve function compared to nipple grafting techniques. However, it is important to note that some degree of sensation loss is still possible, and the level of retained sensitivity varies between individuals.
Recovery from a nipple-sparing double incision mastectomy is similar to other chest masculinisation procedures. Patients can expect some swelling, bruising, and discomfort in the first few weeks, with compression garments often recommended to support healing and help shape the chest. The incisions typically heal well over time, and while scarring is inevitable, proper aftercare can help reduce its visibility. Since the nipples are not grafted, they generally heal more naturally, avoiding the flat or slightly raised appearance sometimes seen in grafting techniques.
RELATED: What Is The Risk of Losing My Nipple In an FTM Top Surgery?
Keyhole Top Surgery
Keyhole top surgery is a specialised chest masculinisation procedure designed for individuals with smaller chests who wish to achieve a flatter, more traditionally masculine or non-binary chest contour. This technique, sometimes referred to as the periareolar approach, is a minimally invasive method that involves making a small, semi-circular incision along the lower edge of the areola. Through this incision, breast tissue is carefully removed, often using liposuction, to sculpt a natural-looking chest while preserving the nipple structure.
RELATED: Is A Keyhole Mastectomy The Best Option For Me?
One of the most significant advantages of keyhole top surgery is that it does not require large incisions or the removal of excess skin, making it an ideal choice for those with smaller chest sizes, typically within the A to B cup range. Additionally, this method allows the nipple stalk to remain intact, which increases the likelihood of retaining some degree of nerve sensation in the nipple-areola complex. This aspect is particularly important for individuals who prioritise maintaining nipple sensitivity as part of their surgical outcome.
Despite its many benefits, keyhole top surgery is not suitable for everyone. It is only recommended for a small percentage of individuals, roughly 5-10% of the general population, who meet the criteria for this procedure. The best candidates are those with good skin elasticity, as this ensures the skin can retract and conform smoothly to the new chest contour without requiring additional excision or reshaping. For individuals with larger chests or reduced skin elasticity, other techniques, such as double incision mastectomy, may provide a more effective and aesthetically pleasing result.
Because this technique does not involve skin removal or repositioning of the nipples, there is typically no need for grafting, and scarring is minimal. The only visible scars are the fine incision lines around the base of the areolas, which usually fade significantly over time. Since keyhole top surgery is less invasive than other chest masculinisation procedures, recovery is often faster, with reduced swelling, discomfort, and scarring. Most individuals can resume light activities within a couple of weeks, though strenuous exercise should still be avoided for several weeks to allow for proper healing.
Although keyhole top surgery offers a subtle and natural-looking outcome, it does have some limitations. Because only breast tissue is removed, rather than excess skin, there may be a slightly less defined contour compared to other surgical techniques. Additionally, for individuals with more breast volume or less skin elasticity, there is a risk of the skin not fully retracting, which may result in some residual tissue or an uneven appearance.
Periareolar Top Surgery
Periareolar top surgery is a chest masculinisation technique designed for individuals with smaller chests who desire a flatter, more masculine or non-binary appearance while preserving the natural nipple-areola complex. This method is particularly well-suited for those with good skin elasticity, as it allows the skin to retract smoothly after the removal of breast tissue.
The procedure involves making a circular incision around the outer edge of the areola, providing access for the precise removal of breast tissue. Unlike the keyhole technique, which only removes tissue through a smaller incision, the periareolar approach allows for additional modifications, including resizing and repositioning the areola if necessary. This ensures a more proportionate and aesthetically balanced chest contour.
One of the key benefits of periareolar top surgery is its ability to preserve the nipple-areola complex in its natural state, rather than requiring grafting. Because the nipple stalk remains connected to the surrounding tissue, there is a greater likelihood of retaining some degree of nipple sensation. While sensation may still be reduced after surgery, many individuals experience at least partial preservation of nerve function over time.
Ideal candidates for this procedure typically have smaller amounts of breast tissue—generally in the A to small B cup range—and minimal skin excess. Those with good skin elasticity tend to achieve the best results, as their skin can conform naturally to the new chest shape without requiring additional excision or tightening.
Scarring from periareolar top surgery is generally minimal, as the incision follows the natural pigmentation border of the areola, making it less noticeable. Over time, the scar usually fades and blends with the surrounding skin, creating a subtle and natural appearance. Because this method involves a circular incision rather than a larger horizontal one, the overall impact on chest aesthetics is less dramatic than in double incision mastectomy, making it a preferred choice for those seeking a more understated transformation.
Recovery from periareolar top surgery varies depending on individual healing factors, but most patients experience mild to moderate swelling and discomfort in the first few weeks. Compression garments are often recommended to support the chest during the healing process and help minimise swelling. Since the nipple and areola remain intact, healing in this area is generally more predictable than in procedures that involve nipple grafting.
While periareolar top surgery provides an excellent option for those with smaller chests and good skin elasticity, it may not be suitable for individuals with larger breast volumes or significant skin laxity. In such cases, alternative techniques such as double incision mastectomy may offer a more effective and aesthetically pleasing result.
Inverted T Top Surgery
Inverted T top surgery, also known as T-anchor or Wise-pattern mastectomy, is a specialised chest masculinisation procedure designed for individuals with larger chests who wish to achieve a flatter, more masculine or non-binary appearance while preserving the nipple-areola complex. This technique is particularly beneficial for those who have excess skin or lower skin elasticity, as it allows for precise contouring and reshaping of the chest while maintaining nipple placement.
This surgical method involves making three incisions: one around the areola, a vertical incision extending downward from the lower edge of the areola, and a horizontal incision along the inframammary fold. This “inverted T” or anchor-shaped incision pattern enables the surgeon to effectively remove excess breast tissue and skin while ensuring that the chest retains a smooth, natural contour. Unlike standard double incision mastectomy, which requires free nipple grafting, the inverted T technique allows the nipple-areola complex to remain attached to the chest, increasing the likelihood of preserving blood supply and some degree of sensation.
One of the key advantages of inverted T top surgery is its ability to provide a well-defined and aesthetically balanced result for individuals with larger chests. Because this method removes excess skin more effectively than other techniques, it helps prevent sagging and allows for better nipple positioning without the need for grafting. Additionally, the ability to reshape the areola ensures a proportionate and natural-looking outcome.
Ideal candidates for this procedure are those with significant breast volume who require additional skin removal to achieve a masculine chest contour. Individuals who prioritise nipple preservation and sensation retention often find this method preferable to traditional double incision surgery, which typically results in complete sensation loss due to nipple grafting. However, while this technique improves the chances of maintaining nipple sensation, some degree of sensation loss may still occur.
Recovery from inverted T-top surgery follows a similar timeline to other chest masculinisation procedures, with initial swelling, bruising, and discomfort expected in the first few weeks. Compression garments are commonly recommended to support healing, reduce swelling, and help the skin conform to the newly contoured chest. The scars from this procedure are more extensive compared to periareolar or keyhole techniques, but they tend to fade significantly with proper aftercare and time.
Why Choose Centre for Surgery for FTM Top Surgery?
At Centre for Surgery, we are dedicated to providing world-class FTM top surgery in a safe, inclusive, and supportive environment. As a specialist plastic surgery clinic based in London, we understand the profound impact that gender-affirming surgery can have on an individual’s confidence and well-being. Our team of highly skilled surgeons has extensive experience in performing FTM and non-binary top surgery, ensuring each patient receives a personalised approach tailored to their unique goals and body type.
We take pride in offering state-of-the-art surgical techniques, cutting-edge technology, and an unwavering commitment to patient safety and satisfaction. Whether you are considering double incision mastectomy, keyhole top surgery, periareolar top surgery, nipple-sparing mastectomy, or inverted T top surgery, we will guide you through every step of the process to achieve the best possible results.
Expert Surgeons with Extensive Experience
Our team comprises some of the UK’s leading plastic and reconstructive surgeons, all of whom specialise in gender-affirming chest surgery. With years of experience, we have helped countless individuals transition with natural-looking, high-quality surgical outcomes. We focus on ensuring the best aesthetic results while prioritising nipple preservation, symmetry, and minimal scarring wherever possible.
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A Safe, Inclusive, and Supportive Environment
At Centre for Surgery, we recognise that undergoing FTM top surgery is a significant and life-changing step. We foster an environment where every patient feels valued, respected, and supported throughout their surgical journey. From the initial consultation to post-operative care, our compassionate team is here to provide guidance, answer any questions, and ensure you feel comfortable at every stage.
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What Our Patients Say About Us
💬 Sam R. – “From the first consultation to the final follow-up, the care I received at Centre for Surgery was outstanding. My surgeon took the time to understand my goals and delivered results that exceeded my expectations. The whole team made me feel at ease, and I couldn’t be happier with my new chest.”
💬 James L. – “I was nervous about surgery, but the team at Centre for Surgery made the entire process seamless. They provided me with all the information I needed, answered every question with patience, and supported me throughout my recovery. My scars have healed beautifully, and I finally feel comfortable in my own skin.”
💬 Alex M. – “I did extensive research before choosing Centre for Surgery, and I’m so glad I made the right choice. The results of my double incision mastectomy are amazing, and the aftercare has been exceptional. The surgeons are truly experts in their field, and I felt reassured from start to finish.”
Finance Options Available – Affordable Surgery with 0% APR
We believe that FTM top surgery should be accessible to everyone. That’s why we offer flexible finance options, including 0% APR financing through Chrysalis Finance, to help you spread the cost of your procedure. Our team can guide you through the process to find a payment plan that suits your budget.
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We want every patient to feel fully informed and confident in their decision. That’s why we offer a range of resources, including our plastic surgery blog, where you can find detailed articles on gender-affirming procedures, recovery tips, and expert insights. Additionally, our clinic FAQs cover everything you need to know about preparing for surgery and post-operative care.
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Visit Our London Baker Street Clinic
Our state-of-the-art clinic is conveniently located at 95-97 Baker Street, London W1U 6RN, providing a discreet and comfortable setting for consultations and surgery. Our expert team is committed to delivering the highest standard of care in a welcoming and professional environment.
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Book Your Consultation Today
If you’re considering FTM top surgery and want to take the next step, we’re here to help. Our experienced team is available to answer your questions and guide you through the process.
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Take the first step towards achieving the chest contour that aligns with your identity—book your consultation with Centre for Surgery today!
