FAQ: Why is the Inverted-T (Anchor) Mastectomy Often Considered Inferior for FTM Top Surgery?
What is an inverted-T (anchor) mastectomy?
An inverted-T (also called “anchor” or Wise-pattern) mastectomy uses:
- a circular incision around the areola
- a vertical scar from the areola down to the inframammary fold
- a long horizontal scar along the breast crease
This pattern is commonly used in breast reduction/lift procedures for cisgender women because it allows reshaping and lifting of a breast mound.
Why do I and many surgeons feel the inverted-T is less ideal for masculinizing chest surgery?
Because the inverted-T was designed to create a lifted breast, not remove it.
Masculinizing top surgery typically prioritizes:
- a flat, contoured chest wall
- wider, more lateral scars that follow male chest anatomy
- male-pattern nipple position and size
- minimal breast mound projection
The inverted-T pattern:
- tends to preserve breast-like shape and projection
- creates central vertical scarring uncommon in male chests
- was developed for a different aesthetic goal (breast lift, not masculinization)
Does the inverted-T technique leave more visible scars?
Usually yes.
Compared to common FTM techniques:
| Technique | Typical scars |
|---|---|
| Double-incision with free nipple graft | 2 lateral scars across the chest |
| Peri-areolar (“keyhole”) | Scar around areola only |
| Inverted-T (anchor) | circular + vertical + long horizontal scar |
The inverted-T adds a vertical scar in the mid-breast area, which:
- is not typical of cis-male chest anatomy
- draws visual attention to the chest center
- can widen over time or become hypertrophic
Many patients seeking masculinization consider these scars aesthetically undesirable.
Does the inverted-T pattern increase the risk of wound-healing problems?
Yes, it often does.
The anchor pattern creates three scar junctions (“T-junctions”), which are well known in breast surgery to be prone to:
- delayed wound healing
- wound breakdown
- widened scars
- increased infection risk
Large skin resections under tension increase those risks further.
Is chest contouring harder with the inverted-T?
Often yes.
The inverted-T approach:
- limits wide exposure of the chest wall
- makes it more difficult to remove lateral fullness (“dog ears”)
- makes it harder to contour the axillary tail of the breast
- increases the chance of residual lower-pole tissue, which can look breast-like
Double-incision approaches typically allow superior visualization and contouring, making:
- flattening
- lateral chest definition
- blending into the axilla
more predictable.
Does the anchor technique increase the chance of “breast-like” results?
It can.
Because it evolved from breast-lifting techniques, it may:
- maintain some projection at the lower pole
- accentuate a tight inframammary fold
- mimic the “breast mound” shape
This can be opposite of the desired male chest contour with diffuse lower-border transition.
What about nipple position and size?
In masculinizing chest surgery, nipple goals usually include:
- smaller nipple–areolar complex (2–2.5 cm typically)
- lateral and inferior male position
- oval or horizontal orientation
The anchor lift pattern:
- often centers the nipple higher and more medially
- uses a donut-type reduction better designed for female aesthetics
- can produce a round areola that appears feminizing
Free nipple grafting with double-incision allows greater freedom to:
- resize
- reshape
- precisely reposition
to male-pattern dimensions.
Are revision rates higher with inverted-T?
Many surgeons report higher revision rates, often for:
- vertical scar widening
- persistent breast fullness
- recurrent inframammary fold definition
- need for additional liposuction or contouring
- nipple asymmetry or feminized shape
Formal published comparative data are limited, but this perception is widely shared among chest masculinization surgeons.
Is sensation preservation better with the anchor technique?
Not reliably.
Some patients assume anchor mastopexy preserves nipple sensation.
However:
- large tissue removal
- pedicle selection
- nerve course variability
mean sensation outcomes are highly unpredictable across techniques.
Free nipple grafting does reduce erogenous sensation, but the anchor pattern does not guarantee preservation.
What techniques are most commonly preferred instead?
I prefer:
- Double-incision mastectomy with free nipple grafts
(most common; best for moderate–large chests and skin excess) - Peri-areolar / keyhole techniques
(small, tight skin envelopes; minimal ptosis)
What is the bottom line?
The inverted-T (anchor) technique is considered less ideal for masculinizing chest surgery because:
- it was designed for breast lifting, not masculinization
- it produces more and centrally located scars
- it carries higher risk of wound breakdown at T-junctions
- it may leave residual breast-like contour
- nipple position/shape may appear feminizing
- chest wall contouring is more limited
However, no technique is “wrong” for everyone.
The best approach depends on:
- anatomy
- goals
- degree of ptosis
- skin quality
- tolerance for different scar patterns
- surgeon experience
Important note
This FAQ is general educational information, not medical advice or a surgical recommendation. The right technique should be determined after an in-person exam and detailed consultation with an experienced, board-certified plastic surgeon such as Dr. Medalie who performs high volumes of gender-affirming chest surgery.
