There are several techniques that can be employed in FTM and FTN gender affirming top surgery. The most common approaches used are the:
- Keyhole
- Concentric Circle
- Double Incision Free Nipple Graft
- Double Incision without Nipple-Areola Complexes
- Anchor (Inverted-T)
Several factors do play a role in determining what technique is used. These include breast size, breast configuration, presence and extent of skin laxity, nipple-areola complex size and location, patient preference and plastic surgeon recommendation.
Generally, only relatively small breasts like an “A” or “B” cup are good candidates for either the keyhole or the concentric circle approach. The incisions involved with these techniques are limited in size, usually heal very well and relatively quickly and can be difficult to detect longterm .
This is opposed to the double incision mastectomies with or without nipple-areola complexes. These incisions are lengthy, far more noticeable and take longer to better “blend in”. They can, however, be used in all types and sizes of breasts – large as well as small ones.
The double incision does have several advantages over the keyhole and concentric approaches but that is a discussion for another time.
The following patient of mine is a good example of the results that can be obtained in a relatively short period of time with the concentric circle approach. Similar outcomes can also be expected with the even more limited length keyhole incision.
This is an 18 year old transman who has been living as one for four years (photos A, C and E). Testosterone has been taken for 5 months. He does not bind.
A. Before Concentric Circle Mastectomy
B. After Concentric Circle Mastectomy
C. Before
D. After
E. Before
F. After
Based on multiple factors, I recommended the concentric circle mastectomy approach to him. This also was his preference.
Results are seen at just 4 months postoperatively (photos B, D and F). The scars are virtually imperceptible already. This would not be the case with the double incision free nipple graft technique.
The patient is incredibly happy with the outcome which has been quite life changing for him. The fact that the scars are imperceptible and are this way so early on makes it even more positive.
Your Consultation
If you have any questions about top surgery or would like to schedule your consultation with me, you can either call the Arizona Center for Aesthetic Plastic Surgery at (480) 451-3000 or contact us by email.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
