FTM top surgery is typically performed using either the double incision technique, the most versatile option suitable for a wide range of chest sizes, or the keyhole technique, best suited for smaller, more elastic chests. Each approach differs in scarring, recovery time, and nipple sensation outcomes.
Choosing the right top surgery technique depends mainly on your chest size and skin elasticity, and understanding how the two main approaches differ can help you have a more informed conversation with your surgeon.
The Double Incision Technique
More versatile doesn’t mean more invasive; it means appropriate for more body types.
The double incision technique is the most commonly performed FTM top surgery method because it’s versatile and produces reliable results across a wide range of chest sizes, including larger breast volumes. It involves two horizontal incisions along either side of the chest, through which breast tissue is completely removed and the nipple-areolar complex is resized and grafted into a natural, masculine position.
The Keyhole Technique
The keyhole technique works best for patients with minimal, elastic chests, often younger patients whose skin can contract well after tissue removal. It uses a single small incision around the areola to remove excess breast tissue, leaving the nipple stalk intact, which helps retain some sensation, though numbness in the nipple-areola area is still common due to the nerve pathways affected during the procedure.
Comparing Recovery Timelines
Double incision recovery generally allows a return to light activity after about one week, with swelling and bruising taking up to six weeks to fully resolve. Keyhole recovery tends to be quicker, often permitting light activity within just a few days, with swelling and bruising resolving within about three weeks.
Comparing Scarring and Sensation
Double incision surgery results in more visible scarring along the chest but offers more predictable results for larger or less elastic chests, along with generally more natural nipple positioning. Keyhole surgery produces minimal visible scarring since it uses a single small incision, but carries a higher likelihood of nipple-areola numbness.
How Your Technique Gets Determined
The right technique for you depends on your chest size, skin elasticity, and personal priorities around scarring versus sensation. Your surgeon will evaluate your anatomy in person to recommend the approach most likely to give you the natural, masculine chest contour you’re looking for.
If you’re exploring FTM top surgery, board-certified plastic surgeon Dr. Siamak Agha can walk you through which technique fits your anatomy during a respectful, thorough consultation in Newport Beach.
Ready to discuss FTM top surgery? Schedule a consultation with board-certified plastic surgeon Dr. Siamak Agha at The One Plastic Surgery Center in Newport Beach to discuss your goals and options.
Results and candidacy vary by patient. A consultation is required to determine your individual suitability for any procedure discussed in this article.
FAQ
What’s the difference between double incision and keyhole top surgery? Double incision uses two horizontal incisions and suits a wide range of chest sizes, while keyhole uses a single small incision and is best for smaller, more elastic chests.
Which technique has a shorter recovery? Keyhole generally has a shorter recovery, with light activity often possible within a few days, compared to about a week for a double incision.
Will I retain nipple sensation after top surgery? It varies by technique. Keyhole leaves the nipple stalk intact, which can help retain some sensation, though numbness is still common with both techniques.
Am I a candidate for keyhole top surgery? Keyhole works best for patients with minimal, elastic chests, since the technique relies on the skin’s ability to contract after tissue removal.
How is my top surgery technique decided? Your surgeon evaluates your chest size, skin elasticity, and priorities around scarring and sensation during an in-person consultation to recommend the right approach.
