Joining top surgery scars in the middle of the chest is a technique requested by some patients to ensure chest flatness by taking out excess skin. If the appearance of a joined scar is not appealing to a patient, other techniques can be used to tighten skin and reduce the chance of dog ear formation. For example, surgeons can extend the incision under the armpit, use chest liposuction and/or curve the incisions upward in the middle of the chest.

Many insurance plans will cover the costs of gender-affirming top surgery. To secure coverage, you will likely need a letter from a mental health provider that states you meet WPATH guidelines or a referral from a licensed primary care provider. Requirements depend heavily on your individual plan, and it can be helpful to reach out to your insurance provider. At the GCC, you can leave the insurance worries to us. Our insurance advocacy team has a 90% success rate in securing approval for patients

Top surgery generally varies in cost from $8,500-11,500 and includes surgeon’s fees, anesthesia fees, operating room fees and post-operative garments. This accounts for buttonhole technique and you can expect your procedure to fall within this range. The cost of your individual surgery can vary, and your surgeon can give you a more specific quote after your free consultation. Insurance coverage or grants can significantly reduce the cost of surgery.

The double incision and buttonhole techniques both leave one or two horizontal scars at the base of the chest. However, the buttonhole incision differs in two key aspects: (1) complete chest flatness cannot be achieved and (2) there is a greater possibility of maintaining nipple sensitivity. Double incision will create a flat chest presentation, while buttonhole creates two “mounds”. The “mounds” of tissue left behind can help ensure that the nipple stays attached to its original nerve and blood supply. Note that if you wish to undergo double incision to achieve complete chest flatness, sensitivity may be preserved through nipple-sparing or nerve reconstruction methods.

Periareolar technique is dependent on skin elasticity and how much excess skin you have around the chest. Patients with good skin elasticity are good candidates, as the skin can more easily mold to the new shape of the chest without resulting in skin folds. Periareolar does not change nipple placement, and patients with larger chest sizes may not qualify due to where the nipples sit on the chest. If you have more excess skin and chest tissue your surgeon may recommend double incision, which allows for more control over final results and nipple dimensions.

With periareolar top surgery, it is more likely that you will maintain the same level of nipple sensitivity that you had pre-op. This is because your areola is still attached to its original blood supply and nerves on the chest. Patients may feel temperature and pressure, and have potential to retain erotic sensation. Immediately after surgery, numbness in the nipples and chest is very normal. Most patients will recover most or all sensation back.

Using the inverted-T method means the nipple and areola do not need to be placed as a free nipple graft, as it does with double incision.  As a result, inverted-T may result in a better chance of maintaining pre-surgery levels of nipple sensation, though this outcome is not certain. As a tradeoff, the double incision is ideal for patients who want flatter results. That said, patients that are interested in a flat chest while maintaining heightened nipple sensation may be good candidates for the double incision with nerve reconstruction. Another factor to consider if deciding between these two procedures is the location of postoperative scars.  The double incision sometimes leaves …

The deciding factors to help a patient choose between these two procedures are (1) the amount of excess skin that needs to be removed and (2) the patient’s desired aesthetic goals. First, the inverted-T, as opposed to the buttonhole, is recommended in patients with greater amounts of breast tissue and/or excess skin to remove. The vertical incision made between the areola and the lower, horizontal incision is what allows for excess skin removal and is the only factor that differentiates this procedure from a buttonhole. Second, the inverted-T tends to result in more teardrop shaped results, whereas the buttonhole procedure leaves a more moundlike shape.

Yes, the inverted T technique is generally recommended for individuals with a medium to large amount of tissue they would like to be removed.

While some loss of nipple sensation is common after any top surgery procedure, the inverted T technique is designed to preserve as much nipple sensation as possible. Many individuals report retaining some degree of nipple sensation, although the level of sensation can vary.