FTM Top Surgery: The Periareolar Technique

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A few weeks ago, we posted about the double incision technique, a common top surgery procedure among trans men and transmasculine folks. This week, we bring you information on another kind of top surgery: the periareolar technique, presented by Dr. Scott Mosser.

First, we need to clarify our terminology a little bit. The procedure that trans folks often refer to as periareolar is more accurately called circumareolar. Within the trans community, periareolar usually refers to top surgery that’s performed by removing skin in a donut shape around the nipple, excavating the breast tissue, and pulling the skin together around the nipple like strings on a purse. Among plastic surgeons, the correct name for this type of surgery is the circumareolar technique, and is only one of many kinds of periareolar procedures (the keyhole technique, which we’ll discuss in a later post, is, medically speaking, another type of periareolar top surgery).

Dr. Mosser explains that, as with the double incision technique, there are pros and cons to choosing the cirumareolar procedure. “The upside of the circumareolar approach is…reduction of the incisions on the chest to just an incision that’s around the areola,” says Dr. Mosser, meaning that the scarring associated with the donut incision is far less obvious than that of the double incision approach. But, this reduced scarring can come at a cost. “You can imagine almost as if we were dealing with fabric, there would be a potential…to end up with a degree of pleating around the edges,” explains Dr. Mosser. By pleating, he means small folds in the skin, which protrude out in a starburst pattern from the nipple.

“In the absolute worst case, [a circumareolar result] can be converted to a double incision,” Dr. Mosser adds, meaning that a patient could potentially have their chest operated on a second time if they were not happy with their result. As more and more of us begin to rely on insurance to cover our surgeries, however, it’s important to note that insurance plans that would otherwise cover chest surgery may deny coverage for a revision.

We’ll continue to bring you information on even more FTM top surgery techniques in the coming weeks, including the keyhole and the T-anchor approaches.

Note: this video is captioned in English. To access the captions, click on the CC button in the bottom right on the video.