The Right FTM Top Surgery Technique for You

Little tissue & good skin condition (Inframammary angle > 135°)

If you have little breast tissue and only minimal excess skin, minimally invasive procedures may be suitable, e.g.:

• Keyhole technique – small incision below the areola
• Periareolar / Circumareolar technique – around the nipple

These methods usually leave smaller scars, but do not remove larger amounts of excess skin. They are best suited for people with a small chest and firm, elastic skin

Moderate tissue & moderate excess skin (angle approx. 110° – 145°)

If there is slightly more skin and breast tissue, but no pronounced excess skin yet, additional options come into consideration:

• Periareolar / Donut technique
• Fishmouth technique
• Lollipop technique (extension of the periareolar technique with a vertical scar)

These procedures can help to remove more skin than the minimal methods while usually keeping scarring lower than a full double-incision surgery. For some people, however, despite available minimally invasive methods, a double incision can deliver the most reliable results – especially if a very flat chest is desired.

More tissue & significant excess skin (angle < 110°)

If there is significant excess skin and tissue, or if the chest clearly "overhangs," techniques with greater removal capacity are usually necessary:

• Double-incision technique
• Inverted-T technique (with a vertical component)
• Buttonhole technique

These methods enable extensive removal of tissue and skin and provide good control over the shape and contour of your chest. With the double incision, the nipples and areola are usually reduced and repositioned as free grafts.

Important: The decision between double incision and inverted-T / buttonhole can also depend on your priorities – e.g., how important sensitivity or scar appearance is to you in the end.

Some methods can help preserve part of the natural nipple sensitivity because they leave the nipple and areola connected to tissue pedicles with nerve connections:

• Keyhole
• Periareolar techniques
• Inverted-T
• Buttonhole

With double-incision techniques, a free graft is often performed, which can change sensitivity – however, some people still retain good sensation or regain it over the course of healing.

Consultation & decision-making

The categories described here serve as orientation, but are not a substitute for a personal consultation with an experienced surgeon. During the consultation, factors such as:

• Your body type
• Your aesthetic goals
• Skin elasticity and chest shape
• Wishes regarding scars and sensitivity

are discussed together in order to develop a tailored plan. A specialist assessment is crucial, as even two people with seemingly similar body types can have different optimal options.

In the case of a lot of excess skin or a larger chest, this is the safest way to achieve a flat contour. Here, two horizontal incisions are made (usually in the chest fold), the tissue is removed, and the nipple is reduced and repositioned.

In the case of a lot of excess skin or a larger chest, this is the safest way to achieve a flat contour. Here, two horizontal incisions are made (usually in the chest fold), the tissue is removed, and the nipple is reduced and repositioned.

In the case of a lot of excess skin or a larger chest, this is the safest way to achieve a flat contour. Here, two horizontal incisions are made (usually in the chest fold), the tissue is removed, and the nipple is reduced and repositioned.