Top Surgery: The Keyhole Technique


Over the past couple months, we’ve heard from Dr. Scott Mosser about the double incision approach to top surgery, as well as the circumareolar approach. Today, Dr. Mosser tells us about another popular approach: the keyhole technique.

As with other top surgery techniques, the keyhole approach has some upsides and some downsides. The biggest reason that many trans men and transmasculine folks are interested in keyhole is the limited scarring that results from this surgery. The biggest downside of keyhole is that only folks with a very small amount of breast tissue and excess skin in the chest area are good candidates for this procedure. Very few patients fall into this category, and thus most folks will not be able to pursue keyhole.

One clarification we want to make about the video explanation of the keyhole technique is that the skin flaps that Dr. Mosser describes are simply the patient’s original chest skin — the surgeon does not create these flaps with donor skin or any other technique. The procedure simply involves making a small incision around the areolae and excavating the breast tissue that lies between the skin and the chest wall.

FTM Top Surgery: The Periareolar Technique


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.

Facial Feminization Surgery: An Introduction


Welcome to Informing Consent’s first entry in our video blog on medical and legal gender transition.  This week, we’re taking our first look at a complicated procedure for trans women and transfeminine folks: facial feminization surgery, or FFS for short.

FFS does not refer to a single procedure, but rather a collection of procedures, ranging from hairline advancement to rhinoplasty (nose job) to Adam’s apple shaving and more.  Usually, a doctor will perform multiple procedures in one surgery.  As a result, FFS can mean a lot of time in the operating room: up to 12 hours, in some cases.

In this week’s video, Dr. Thomas Satterwhite gives us an overview of FFS, and discusses how a patient and doctor decide which procedures to include in the surgery.  “I certainly have some patients come in and say, ‘I want everything done,'” explains Dr. Satterwhite.  “And I have other patients who are more concerned with certain aspects of their face.  I recall one patient who said, ‘You can do whatever you want, but don’t touch my nose, because my nose is a part of me, it’s part of my family, it’s part of my heritage.’  It’s what’s important to you and what your particular goals and wishes are that are of utmost importance.”

Check out the video to learn more, and keep an eye out for many more FFS videos in the near future.

Note: our videos are captioned in English. To access the captions, hit the CC button on the bottom right of the video.