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.