Mastectomy - Top surgery

FTM mastectomy removes the breast gland and, when needed, excess skin, then reshapes the chest into a masculine contour. Liposuction of the sides of the chest is often added to refine the result.

The Different Mastectomy Techniques

Double Incision with Free Nipple Grafts (DI / FNG)

Two horizontal incisions along the lower border of the pectoral muscle allow removal of breast tissue and excess skin. The nipples are removed, resized and grafted back in a masculine position.

• Best for: medium to large chests, less elastic skin
• Advantages: the flattest chest, precise nipple placement
• Drawbacks: two long scars, nipple sensation often reduced or lost

Inverted-T (or Anchor)

Similar to double incision, but the nipple stays attached to a pedicle (a bridge of tissue that keeps its blood supply and nerves). A short vertical scar is added below each nipple.

• Best for: medium chests
• Advantages: better chance of keeping nipple sensation
• Drawbacks: additional vertical scar

Buttonhole

Horizontal incisions as in double incision, but the nipple stays attached to a pedicle and is brought out through a small opening made in the skin.

• Best for: medium to large chests with good skin quality
• Advantages: sensation preserved more often, no vertical scar
• Drawbacks: the pedicle can leave slight fullness below the nipple

Periareolar (or "Donut")

Two concentric incisions around the areola: the ring of skin between them is removed, breast tissue is taken out through this opening, and the skin is gathered around the areola.

• Best for: small to medium chests, elastic skin
• Advantages: scar limited to the edge of the areola, nipple kept attached
• Drawbacks: limited skin removal, possible puckering, revisions more common

Keyhole

A small incision along the lower half of the areola is used to remove breast tissue, often with the help of liposuction. No skin is removed.

• Best for: very small chests, excellent elasticity, nipples already well positioned
• Advantages: minimal scarring, nipple kept attached
• Drawbacks: suitable for few patients, no nipple repositioning

Non-Binary and Custom Options

Depending on your goals, the surgeon can perform a closure without nipples, keep some volume, or adapt the shape and size of the areolas.

How to Choose?

The technique is chosen with the surgeon during the consultation, based on photos or an examination: chest size, skin elasticity, nipple position, and how much weight you give to scarring and sensation.