Why Choosing the Right Technique Matters
Every chest is unique — and so are every patient’s goals for top surgery. Selecting the right surgical technique is one of the most important steps in achieving the flat, natural-looking chest you envision.
At Jandali Plastic Surgery in Trumbull, we personalize surgical planning for patients from Bridgeport, Fairfield, Stratford, Milford, Shelton, Westport, Norwalk, Easton, Monroe, Derby, Ansonia, Seymour, Oxford, Newtown, Bethel, Weston, Wilton, and Southbury.
Choosing the wrong approach can lead to dissatisfaction, longer recovery, or the need for revisions. The right one balances your anatomy, desired scar placement, nipple sensation goals, and lifestyle.
The Main Techniques for Top Surgery
While variations exist, most top surgery techniques fall into three main categories:
1. Double Incision with Free Nipple Grafts
Best For:
- Medium to large chest size
- Moderate to poor skin elasticity
- Need for maximum reshaping and contouring
Approach:
Two horizontal incisions are made along the lower chest. Excess skin and breast tissue are removed, the chest is contoured, the upper skin is pulled down, and nipples are resized and repositioned as grafts.
Advantages:
- Complete control over contouring
- Ability to resize/reposition nipples to masculine proportions
- Effective for removing significant tissue and excess skin
Considerations:
- Straight or slightly curved scar line in the bottom border of the breast
- Often results in reduced nipple sensation but flattens nipple nicely
Patient Perspective (Milford):
“I had a larger chest and was worried about scars. Dr. Jandali explained how they’d fade over time, and now they’re barely noticeable.” — Casey, Milford
2. Periareolar Technique (Keyhole Variant for Very Small Chests)
Best For:
- Small chest size
- Good skin elasticity
- Minimal sagging or excess skin
Approach:
Incisions are made around the areola’s edge (and possibly slightly beyond), allowing removal of breast tissue and reduction of the areola.
Advantages:
- Minimal visible scarring
- Preserves more natural anatomy
- Can maintain more nipple sensation
Considerations:
- Limited skin tightening capability
- May require revisions for contour irregularities or residual skin laxity
3. Buttonhole or Nipple-Preserving Variants
Best For:
- Patients prioritizing nipple sensation preservation
- Moderate chest size with decent skin quality
Approach:
Keeps nipples attached to tissue during reshaping, but allows for significant contour improvement.
Advantages:
- Better potential for sensation preservation
- Maintains natural nipple pigmentation
Considerations:
- Not suited for very large chests or significant skin excess
- More technically complex
Patient Perspective (Norwalk):
“Sensation was important to me. We chose the buttonhole technique, and I’m so glad we did.” — Alex, Norwalk
Factors We Consider When Choosing Your Technique
Choosing your procedure isn’t a one-size-fits-all decision. During consultation, Dr. Jandali reviews:
- Chest Size and Skin Elasticity
- Larger chests or stretched skin benefit from double incision.
- Smaller chests with elastic skin can consider periareolar.
- Desired Nipple Position and Size
- Lowered or enlarged nipples may need repositioning via grafts.
- Scar Placement Preferences
- Some patients prioritize less visible scars over maximum contour change.
- Sensation Goals
- Certain methods preserve more nerve pathways.
- Lifestyle and Activity Level
- Athletes may prefer techniques with shorter downtime.
Scar Patterns by Technique
- Double Incision: One straight or slightly curved lines across lower chest and one around the nipple/areola
- Periareolar: Circular scar around nipple/areola
- Buttonhole: One straight or slightly curved lines across lower chest and one around the nipple/areola
We’ll show examples during your consult so you understand what to expect.
How Body Type Affects the Decision
- Lean, small chest: Often best for periareolar or buttonhole
- Medium chest with mild sagging: Could go either way depending on skin quality
- Large chest with loose skin: Double incision almost always preferred
Risks & Revision Rates by Technique
Double Incision:
- Lower revision rate for contour
- More visible scars
- Higher chance of reduced sensation
Periareolar:
- Higher revision rate for contour irregularities
- Minimal scarring
- Better chance of sensation preservation
Buttonhole:
- Moderate revision rate
- Balanced scarring and sensation outcomes
Role of BMI and Health in Choosing a Technique
- Higher BMI may favor double incision for optimal contouring.
- Smoking, uncontrolled diabetes, or poor circulation may limit some options.
Patient Stories: Finding the Right Fit
Sam, Fairfield:
“I was a borderline case between periareolar and double incision. Dr. Jandali laid out pros and cons clearly — I went with double incision for the flatter contour.”
Jordan, Shelton:
“I wanted to keep as much sensation as possible, so we chose buttonhole. I’m thrilled with the balance we achieved.”
Local Considerations
Choosing the right technique also involves ensuring you can easily attend multiple follow-ups. Our Trumbull location makes this convenient for patients in:
- Bridgeport, Fairfield, Stratford, Milford, Shelton
- Westport, Norwalk, Easton, Monroe
- Derby, Ansonia, Seymour, Oxford
- Newtown, Bethel, Weston, Wilton, Southbury
Internal Links for the Series
- Top Surgery 101 – Understanding the Procedure
- Top Surgery Recovery – Timeline, Scar Care, and What to Expect
- Insurance & Coverage for Top Surgery in Connecticut
- You are here: Choosing the Right Top Surgery Procedure
- Top Surgery FAQs – Expert Answers from Dr. Jandali
Call to Action
The right top surgery technique depends on your body, goals, and lifestyle. At Jandali Plastic Surgery, we take the time to match you with the procedure that gives you the best results for both form and function.
Jandali Plastic Surgery
5520 Park Ave, Suite WP-2-300, Trumbull, CT 06611
Phone: (203) 374-0310 | Website: jandaliplasticsurgery.co
