Realistic Top Surgery Outcomes

The size and location of your top surgery scars vary depending on the type of surgery you pursue. This article provides information on incision patterns and scarring during liposuction, double incision, buttonhole, inverted T-incision, periareolar, and keyhole top surgery procedures. We also discuss the importance of understanding final outcome expectations and viewing top surgery before and after photos so you can be informed about the realistic results that can be achieved after your gender affiriming surgery.

The goal of chest reconstruction top surgery is to remove excess chest tissue and to create a flat appearing (or more conventionally “masculine”-looking) chest. In our experience, the vast majority of patients are thrilled with their final outcome.

Chest reconstruction top surgery is often the first (and sometimes the only) surgical step some transgender individuals take. If you’re considering surgery, it’s important to have realistic expectations and to consider what may occur during or after surgery, such as what your scars will look like, if you will have any loose skin, etc. 

Incision Patterns and Scarring

Scarring is an inevitable consequence of most surgical procedures. The size, length, and color of your scars can be hard to predict and will depend on several factors such as your genetic makeup, our skin’s inherent ability to heal, and your post-surgical care. The extent of your  chest reconstruction top surgery and the incision patterns used will also impact the size and location of scars.

  • Liposuction requires only a very small incision that can often be concealed near the armpits. Incisions are usually about 4mm in length and result in minimal scarring. The majority of people need more than liposuction to achieve their desired outcome; often, liposuction is done at the same time as other chest reconstruction top surgery procedures. 
  • Keyhole/Periareolar incision is ideal for small-to-moderate chests. The incision pattern runs along the edge of the areola, sometimes just around the lower half (keyhole) or around the entire circumference (circumareolar). Scarring will be visible, but is usually minimal.
  • Double incision is ideal for very large chests or for those with a significant degree of sagging. The incisions runs in a U-shaped pattern just below the pectoral muscles. This pattern results in two visible scars across the lower chest area, near the bottom of the pectoral muscles.
  • Buttonhole and inverted-T incision surgery is best for when the priority is not flatness, but rather an attempt to maintain erotic sensation to the nipple/areola region.

Your scars will be most visible for about 6 weeks post-surgery, appearing raised and darkened in color. They will gradually fade and flatten over time, but will likely always be somewhat visible. Your surgeon will provide you detailed instructions on how to reduce their appearance, if this is something you want.

Final Outcomes 

Chest reconstruction top surgery is a major surgical procedure. It will take time for your chest to heal and settle. It may take up to a year before the final outcome of your procedure is evident, and possibly even longer than that for your scars to fully mature and fade. In some instances, it may be necessary to undergo additional procedures to correct asymmetry or a complication resulting from surgery. This may result in a longer recovery time.

Before and After Photos

No two bodies are the same, which makes it difficult to determine exactly how your chest will look post-surgery. However, looking at  before and after photos can be a good way to gauge your expectations and communicate them to your surgeon.

During your consultation, you will have the opportunity to view a variety of prior patient photos. When viewing these photos, remember that the best way to determine a realistic outcome for your body is to seek out photos of patients with a similar body type to your own.