Gender Confirmation top surgery via a double incision with nipple grafting

Individual results may vary.

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Front: Gender Confirmation top surgery via a double incision with nipple grafting-note that the after image is a mirror image taken 2 years post-op

Front: Gender Confirmation top surgery via a double incision with nipple grafting. The picture on the left is 1 week post op and the one on the right is at 3 weeks

Front: Gender Confirmation top surgery via a double incision with nipple grafting. The picture on the left is 6 weeks post op and the one on the right is at 2 years.

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Gender Confirmation top surgery via a double incision with nipple grafting. This series demonstrates the evolution of scarring over time. The middle image set shows the early results of the top surgery and the last picture set shows the medium and late results. It is clear that the final results show excellent placement of the scar in the pectoralis major shadow. The patient with a combination of diet and exercise has also lost a great deal of weight and gained impressive musculature. He has transformed his body into a very masculine appearance.

Double Incision: In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, it is usually recommend to remove the excess skin and breast tissue in the crease of the pectoralis muscles (elliptical or double incision mastectomy) and put the nipples and areolae back on as grafts. This surgery has the advantage of immediate and predictable results. I can contour the skin flaps and place the nipples where I want to. It has the disadvantage of permanently altering the sensation and erectile capacity of the nipples (and sometimes the pigmentation), and it leaves larger scars on the chest. Over time they fade and flatten out. At each end of the scar, “dog-ears” may form. These are small bunches of tissue created by the closing of the ellipse as a straight line. They tend to settle down over time, but may need to be revised. I always try and address the dog ears at the time of surgery but this may extend the length of the scar. Dog ears are more likely in patients who are heavier and have more tissue to start with. I always perform liposuction of the central and lateral chest (to flatten the dog ears) as well as the area in front of the armpit. I have been asked why a scar may meet in the center of the chest on some top surgery results but not on others. This is dependent on pre-existing anatomy. If the tissue meets in the middle, then the scar by necessity will meet in the middle.