Surgical Techniques
Top Surgery Techniques
Double incision, periareolar and keyhole: how each technique works, when it's generally considered, and how the right one is chosen for you.
Introduction
There isn't one top surgery technique that suits everyone
Top surgery reshapes the chest by removing breast tissue for a flatter, more masculine contour, and there is more than one way to do it. At Top Surgery Care we work with three techniques: double incision, periareolar and keyhole. They differ mainly in where the incisions are placed and in how the chest is reshaped.
This page explains each technique in turn, compares double incision with keyhole side by side, and describes how the choice is made. For the wider picture, see our guide to FTM top surgery.
Double incision top surgery
Double incision is the most common approach for larger chests. Two horizontal incisions are made across the chest, through which breast tissue is removed and the chest is reshaped, and the nipple-areola complex is repositioned.
Because the final contour doesn't depend on the skin retracting on its own, this technique allows a fuller reshaping than those that do. That's why it's generally considered where a chest is larger or skin elasticity is lower.
At a glance
- Incisions
- Two horizontal incisions across the chest
- Nipple-areola complex
- Repositioned
- Generally considered for
- Larger chests, or chests with less skin elasticity
Periareolar top surgery
Periareolar surgery is performed through an incision around the areola, with no separate incision across the chest.
Without that second incision, the flatter contour comes from the skin retracting naturally afterwards. Skin elasticity therefore plays an especially important part in whether this technique is considered: it's generally considered for smaller chests with good skin elasticity rather than for larger or less elastic ones.
At a glance
- Incision
- An incision around the areola
- Contour
- Depends on the skin retracting naturally afterwards
- Generally considered for
- Smaller chests with good skin elasticity
Keyhole top surgery
Keyhole is a more minimally invasive option. A small incision is made at the base of the areola and combined with liposuction to remove tissue.
The nipple is left largely intact, since the nipple-areola complex isn't repositioned or resized. It's generally considered for smaller chests, where less tissue needs to be removed.
At a glance
- Incision
- A small incision at the base of the areola
- Tissue removal
- Combined with liposuction
- Nipple-areola complex
- Left largely intact: not repositioned or resized
- Generally considered for
- Smaller chests, where less tissue needs to be removed
Side by Side
Double incision vs keyhole
The two differ in how they're performed and in the kind of chest they're generally considered for. Here is how they compare on the points described above.
| Feature | Double incision | Keyhole |
|---|---|---|
| Incisions | Two horizontal incisions across the chest | A small incision at the base of the areola |
| Tissue removal | Breast tissue is removed through the incisions | Liposuction, combined with the small incision |
| Nipple-areola complex | Repositioned | Left largely intact; not repositioned or resized |
| Approach | Allows a fuller reshaping of the chest | A more minimally invasive option |
| Generally considered for | Larger chests, or chests with less skin elasticity | Smaller chests, where less tissue needs to be removed |
Neither is better in itself. Which one is considered depends on your chest size and shape, your skin elasticity and the contour you want, and it's decided together with your surgeon.
Choosing a Technique
How technique selection is discussed
Your technique isn't picked from a menu or by a fixed formula.
In your consultation, your goals, medical history and chest anatomy are reviewed together, and the technique is decided with Dr. Serkan Dinar based on the factors below.
Book a consultationKey considerations
- Chest size and shape
- Skin elasticity
- Your desired final contour
If you're travelling from abroad, this conversation happens before you travel: an initial consultation over WhatsApp, and a surgical plan agreed in advance.
You can follow the full process on the Patient Journey page.
Considering surgery in Istanbul? Read about top surgery in Turkey.
Get in Touch
Start with a consultation, not a commitment
Message us on WhatsApp or send a consultation request. Every plan starts with your goals, your anatomy, and your questions.