Worried About FTM Top Surgery Scars?
Understanding Top Surgery Incision Methods and Scarring
By Dr. Jaewoo Kim, The Plastic Surgery Clinic
Hello, I’m Dr. Jaewoo Kim from The Plastic Surgery Clinic.
Today, I’d like to talk about Top Surgery, specifically incision methods and scarring, which are some of the biggest concerns for patients. Since each surgeon may have their own techniques and preferences, the information I’m sharing is meant to serve as a general guide.
Types of Incisions in Top Surgery
When classifying top surgery incisions, we typically consider the shape and length of the scars. There are two main approaches:
🔹 Double Incision (Full Mastectomy) – Also known as "complete incision" or "full excision", this method is often used for larger chests.
🔹 Periareolar (Minimal Incision) – A less invasive technique used for smaller chests, where only the area around the areola is incised.
How Chest Size Affects the Incision Type
📌 Larger chests (C cup and above) → Typically require full incision to remove excess breast tissue and achieve a masculine contour.
📌 Smaller chests (A or small B cup) → May be suitable for minimal incision, where the scar is limited to the areola.
💡 Why Choose a Full Incision? The main reason for opting for a full incision isn’t just the amount of tissue, but also the need to remove excess skin for a smooth, natural-looking result.
Creating a Masculine Chest Shape
When performing top surgery, the goal is to achieve a natural-looking, masculine chest. This means considering two key factors:
✅ Chest Volume – The amount of remaining tissue should align with the typical male chest.
✅ Nipple & Areola Positioning – The placement should be adjusted to match the male chest structure.
📍 In cisgender men, the nipple and areola are positioned slightly higher and more outward, whereas in cisgender women, they tend to be lower and closer to the center.
To create a more natural look in top surgery, we typically move the areola outward and slightly upward.
How Scars Are Positioned
If a full incision is performed, there are typically two scars left on the chest:
🔸 The lower horizontal scar – Positioned along the natural chest contour, mimicking the pectoralis muscle line.
🔸 The periareolar scar (if nipple grafting is needed) – This is only present if the nipple and areola need to be repositioned.
📌 Optimal Scar Placement: Studies on male chest aesthetics suggest that the ideal scar placement is about 2–3 cm below the pectoral shadow, ensuring the best visual results.
What If Nipple Repositioning Isn't Necessary?
For patients with larger chests but well-positioned areolas, only a single lower scar may be necessary.
✅ In these cases, the nipple is left untouched, avoiding additional scarring around the areola.
Final Thoughts
Choosing the right incision method depends on factors like chest size, skin elasticity, and personal preferences.
Understanding how scarring and nipple placement impact the final result is essential in making an informed decision.
💬 Thinking about top surgery? Consult a skilled surgeon to determine the best approach for your body type and aesthetic goals!
✨ For more insights on gender-affirming surgeries, stay informed and consult an expert!
