The Transgender Dictionary

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Double Incision

(also: mammaplasty, mastectomy, top surgery)

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Introduction

For most transmasculine people (as well as some transneutral individuals) having breasts is a major source of gender dysphoria. It's rare for transgender men to be comfortable with a pair of those things attached to his chest. They are a big, uncomfortable reminder that his body is sending a message to the world that does not match who he truly is inside.

Many transmasc individuals will wear binders or use trans tape to bind their chests prior to undergoing top surgery. Binding is a non-permanent method of appearing to be flat chested. This can help those who are too young for surgery (as well as those who cannot yet afford surgery) achieve some level of gender euphoria. Binding can also help some guys figure out if they even want surgery in the first place. Seeing oneself in the mirror with a flat chest often helps untangle potential uncertainties regarding such a permanent change.

If you are reading this in the hopes of learning if you should absolutely for sure undergo surgery or not, I am sorry to say that that is not a decision that anyone else can make for you. You are the one who is living in your body, no one else. Only you are able to determine what will make you feel happy and comfortable in your own body. If you are spending your time researching double incision top surgery, and have come to the conclusion that this surgical procedure would make you feel more at home in the vessel you use to interact with the world, then go for it! You only live once, and you should make the time during which you are alive happier and more comfortable for yourself.

Do not avoid or pursue surgery for the comfort of others. If you have a gender identity that is not typically associated with those who undergo top surgery, do not let that discourage you from seeking it out if that is what you wish. This world is full of so many people with unique experiences and transition goals. All that should matter is that you are putting in the time and effort to make informed decisions regarding your body. However, if your transition goals are atypical, you may experience more difficulty finding a willing surgeon (or getting insurance to cover the procedure) compared to binary transgender men (depending on your location).

Just a forewarning to any binding individuals, yes, you do have to wear a surgical binder after surgery. Swelling is a common side effect that most people will experience in the few weeks immediately after undergoing double incision top surgery. Please keep the binder on until directed otherwise according to your surgeon. I understand that it can be frustrating to do this when you think you're finally done having to deal with those things, but they are important for the healing process.

Once the healing is over, the results of top surgery are a great source of gender euphoria for those who need it or want it. Being able to live life without worrying about those unwanted fat sacks, and feeling clothing finally fit properly is a great thing to experience.

This page is not a replacement for a consultation with a medical professional. Please seek out a licensed and reputable plastic surgeon for an actual consultation. This is just general information to help you learn more about double incision top surgery.

Clicking on underlined words/phrases/etc throughout this page will lead you to other parts of The Transgender Dictionary with relevant information, such as definitions or dedicated pages with more detailed information. Clicking on links under "external links" will lead you to other parts of the internet with more information. I would suggest doing this if you are confused regarding how the scars caused by this surgery look, as those are best explained via diagram.

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General Information

Of the various methods of FTM top surgery, double incision is the most common. Unlike other versions, which are typically reliant on the patient meeting certain skin elasticity requirements, double incision can be performed on pretty much anyone with breasts. For those who have a C cup or larger, double incision is often the only available option.

Due to either the commonality of this surgery, or how easily recognizable the scarring produced by this surgery is; double incision is often what those who know about mastectomies think about when they think about mastectomies. Aka, it is more well-known than others and the scars are generally easier to clock when compared to other incision types such as keyhole or peri. That being said, there are cisgender men and women who have similar scars from similar procedures (ex. cis women recovering from breast cancer and cis/intersex men with gynecomastia).

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How Its Done

Double incision top surgery is performed by a plastic surgeon while the patient is under general anesthesia.

First, two incisions are made; one above, and one below the breast. Next, breast tissue is removed. Some remaining material is kept, and reshaped in a more masculine manner. This process is repeated on the other breast. Once this process is complete, the incisions are sewn together.

The finished result of this surgery typically consists of two long horizontal or diagonal scars across the chest. The scars typically extend from the center of the chest out to (or near) the armpits. (Some surgeons may require that you shave your armpits prior to surgery.) These scars can connect, or be separate. Shape can also vary depending on preference, or depending on one's body type. Some lines may be curved. These variations depend on variables such as patient anatomy, patient preference, or the surgeon's preferred technique. If you are picky about what your scars will look like, keep an eye on scar shapes when researching the results of your surgeon.

Some people will use products such as silicone scar strips to manage scarring, but this varies depending on personal preference. Some people heal quickly. Some people's bodies produce raised scars called keloids. Some people prefer to have visible scars.

Drains are long tubes that are inserted into the body underneath the skin during surgery. These tubes empty into small bulbs which collect excess fluids. It is not uncommon to have drains (one on each side of the upper abdomen) for the following week or so after surgery. Drains, and instructions to go along with them will vary from surgeon to surgeon. The purpose of these drains is to prevent the buildup of fluid inside the body after surgery. Typical instructions include emptying the bulbs ever so often and tracking the quantity and color of the fluid to monitory the body's healing process.

The chest typically feels numb immediately after surgery. It can take months to years for the nerves to fully reconnect and gain full sensation of the chest. This will vary from person to person. Full and/or permanent numbness is extremely rare.

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About The Nipples

Standard double incision top surgery is highly customizable in terms of the nipples. Typically, during the stage of this surgery where the incisions are being made, an incision is made to remove the nipples. The nipples are set to the side and are cut/reshaped to be smaller/more masculine. Once the main incisions have been sewn together, small holes are cut into the skin to make way for the nipples. This is called a free nipple graft.

There are various issues that can occur with nipple grafts. Some surgeons do not resize the nipples properly, causing an uneven appearance. Sometimes the nipples are not oriented properly. Showering too early into the healing process can result in all or part of one or both nipple(s) to slide off down the drain. Please keep in mind that it is more common on the internet to hear "they messed up my nipple(s)!!!!" than "my nipples are flawless". It gets more clicks and attention, and it is within the nature of humanity to complain about things.

That being said, yes weird things can and do happen regarding nipples during top surgery. Most nipples end up as they should. If you want to keep your nipples, don't let fear of nipple weirdness discourage you. Look up surgical results of the surgeon you seek out ahead of time to determine if you trust that particular individual with the future of your nipples.

Some people decide to go without nipple grafts. Some people get 3D medical tattoos in place of nipples, or seek out adhesive prosthetics. Plenty of others don't bother, and live the no-nip life. Really, it all depends on personal preference. Don't let societal pressure discourage you from abandoning your place as a person possessing nipples.

Click to jump to [R] section [Reasons] page [Why I Chose Not To Have Nipples] subheading.

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T-anchor/Inverted T-anchor

This is a variant of double incision surgery which leaves the nipple stalk intact. Unlike with standard double incision, these results will have 2 vertical scars, one below each nipple and connecting to the bigger incision scar. Unlike regular free nipple grafts, this version does not come with the risk of loss of nipple sensation. However, it is a lot more difficult to resize the nipples/place them in a more typically masculine spot.

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Inclusion of links to various surgical facilities is not an endorsement of the surgeons included. The thoughts/feelings/opinions/etc expressed by those linked below may not reflect those of The Transgender Dictionary and vise versa. None of these links are sponsored or endorsed.

Prior to getting any surgery, please do as much research as you possibly can. Search for as many photo results and reviews of a surgeon prior to getting surgery. Do not rely on this page or the links below as your primary or only source of information on this or any surgery. Do as much research as possible before making alterations to your body. This page is intended to provide general/basic information on this procedure, and the links below are intended to provide additional information in various formats to help readers learn more.

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See also the pages for; mastectomy, testosterone, & transmasculine.

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