Top surgery includes several techniques, including double-incision, buttonhole, inverted-T or anchor incision, and periareolar and keyhole approaches. The technique that works best for you depends on your existing anatomy (chest size, skin elasticity, tissue distribution) and embodiment goals (nipples, scar preferences, and the chest contour) you want to achieve.
No single technique is right for everyone. Some patients want a traditionally masculine chest shape, while others may prefer a gender-neutral appearing chest. Each patient may have specific priorities around sensation, scars, or shape.
What Is Top Surgery?
Top surgery, also known as gender-affirming chest mastectomy, is a chest procedure that removes breast tissue to create a flatter chest. Depending on the technique, surgery may also include:
- Skin reduction
- Nipple resizing
- Nipple repositioning
- Nipple grafting
- Contour refinement
At Align Surgical Associates, our surgeons perform top surgery for transmasculine, nonbinary, and other gender-diverse patients seeking a flatter, more masculine, or more gender-neutral chest appearance.
Although the procedure is often searched for as “FTM top surgery” and associated with masculinizing goals, it can also support nonbinary and gender-neutral embodiment. Our surgeons understand that wanting a flatter chest does not necessarily mean a patient wants to be understood within a binary transition framework. That is why individualized top surgery planning is central to our care approach at Align Surgical Associates.
What Are the Main Types of Top Surgery?
The main types of top surgery include double incision, buttonhole, inverted-T or anchor incision, and periareolar or keyhole techniques. Each approach differs in how tissue is removed, where incisions are placed, whether the nipples are grafted or preserved, and the degree of contouring control it provides.
At Align Surgical Associates, Dr. Breanna Jedrzejewski guides our clinical review process, ensuring your treatment plan aligns with your vision and priorities.
Double Incision Top Surgery
Double incision top surgery is often recommended for patients with more chest tissue, looser skin, or a need for more significant reshaping. This technique allows your surgeon to remove tissue, reduce excess skin, and reshape the chest with a high degree of control.
Things to know:
- Typically creates two horizontal scars across the lower chest
- Often involves resizing and repositioning the nipples as grafts
- May reduce or change nipple sensation
- Often offers the most predictable contouring for patients who need more reshaping
Buttonhole Top Surgery
Buttonhole surgery is a variation of double incision surgery that allows for changing the size and location of the nipples, but unlike free nipple grafts, the nipples are preserved on their native blood supply. It is often considered for patients who need more contouring than a limited-incision approach can provide, but who want to prioritize native nipple appearance when possible.
Things to know:
- Involves visible horizontal chest scars (like double incision)
- May better preserve nipple sensation in select cases
- Candidacy is more selective
- May not be appropriate in patients who prioritize a flatter contour, as preserving the nipple blood supply involves leaving some breast tissue connected to the chest wall
Inverted-T or Anchor Incision Top Surgery
Inverted-T top surgery, also called anchor incision top surgery, may be used when more skin reduction is needed and nipple preservation remains part of the surgical goal. It combines horizontal and vertical incision components to enable more reshaping of the lower chest. It also allows for preservation of a “mound shape” of the breast.
Things to know:
- Creates an anchor-shaped scar pattern
- May preserve the nipple in select cases
- Can be a middle-ground option for some patients
- Usually involves more scarring than periareolar or keyhole techniques
Periareolar and Keyhole Top Surgery
Periareolar and keyhole top surgery are typically reserved for patients with smaller chests and good skin elasticity. These techniques use more limited incisions, often around or near the areola, and rely on the skin’s ability to retract after tissue is removed.
Things to know:
- Usually creates less noticeable scarring
- Often preserves the nipple and areola position
- Offers less control over skin reduction and contouring
- May not be ideal for patients with more chest tissue or looser skin
Which Top Surgery Technique Is Right for Me?
Scar length alone should not determine your choice, as a smaller incision does not always mean a better result. For some patients, a technique with more visible scarring may create a flatter, smoother, and more natural-looking chest.
What Should I Expect From Top Surgery Scars?
Top surgery scars vary by technique:
- Double incision and buttonhole surgery usually create 2 horizontal scars across the lower chest.
- Inverted-T surgery includes horizontal, vertical, and areolar scar components.
- Periareolar and keyhole approaches usually create more limited scarring around or near the areola.
Techniques that involve longer incisions often give your surgeon greater control over tissue removal, skin reduction, nipple positioning, and overall chest shape.
During your consultation, your surgeon will discuss the trade-offs associated with each approach, including scar visibility, contouring goals, nipple preservation, and sensation.
What To Expect During Recovery
Recovery depends on the technique used and the extent of tissue removal and contouring. Most patients can expect:
- Swelling and soreness
- Use of compression garments
- Temporary activity restrictions
- Follow-up visits to monitor healing.
Some patients will also require drains during early recovery. Our providers will explain what to expect based on your specific surgical plan, including how to prepare, what support you may need after surgery, and when you can return to daily activities, work, and exercise.
Does Align Surgical Associates Also Offer Chest Feminization?
Yes. Align Surgical Associates offers a full spectrum of gender-affirming chest surgery, including chest mastectomy and breast augmentation (chest feminization). Chest feminization (sometimes searched for as “MTF top surgery”) is typically a different procedure focused on creating or enhancing breast volume with implants, fat transfer, or a combination of techniques.
If your goals involve adding fullness or creating a more feminine chest contour, our providers can guide you through breast augmentation and chest feminization options.
Explore Your Top Surgery Options With Align Surgical Associates
During your consultation, our team will explain which techniques are appropriate for your anatomy, discuss the benefits and trade-offs of each approach, and help you choose the option that best aligns with your goals.
If you are considering a gender-affirming procedure such as top surgery, we invite you to request a consultation by completing the online form or calling us at (415) 530-5335.
Reviewed for medical accuracy by Breanna Jedrzejewski, MD, MPH.
Editor’s Note: Language is ever evolving, and some terms people use to search for care may now be considered culturally outdated. When we reference these phrases, we are doing so to help more people find accurate, patient-first information. We remain committed to using the most current, respectful terminology whenever possible and continually revise our content as language changes and as we learn from the communities we serve.