The Double Incision Method is the most popular form of chest masculinization surgery. This procedure involves the surgical removal of breast tissue and excess skin, as well as resizing and placement of the areolas as skin grafts to a more masculine position. The result is a male-appearing chest with a horizontal scar on each side of the chest.
The FTM double incision is among the most powerful procedures for chest masculinization, and still accounts for more than 80% of FTM top surgeries performed by Dr. Mosser. It is unparalleled in its ability to achieve the tightest and flattest chest with full customization of areole location relative to the muscle and horizontal scar. The double incision method is suitable for patients with larger bodies, breasts, and more challenging distributions of excess skin.
This method involves placement of the areolas as free skin grafts which has potential for loss of the skin graft or a reduction in sensation. There are visible horizontal scars which, although they fade, are unlikely to fully disappear.
A common misconception about double incision skin grafts is that they are tenuous with a high probability of failure. In Dr. Mosser’s practice this is extremely uncommon. Less than 4% of skin grafts have a considerable degree of loss, and as of the summer of 2016 Dr. Mosser has never lost an entire free nipple graft. However, it is a possibility that should be considered.
An upside of using skin grafts is that the surgeon customizes the location of the areolas. This can be chosen in a very precise symmetrical fashion and in the correct location relative to the muscle edge so that with increased muscle development, the chest will continue to look more masculine.
With certain techniques, nipples which lack sensation are a possible surgical outcome. However, the techniques Dr. Mosser uses allow the patient to maintain a considerable number of nerve endings which Dr. Mosser connects with the sensory nerve within the skin graft material. For most patients, the level of sensation that a nipple has postoperatively is similar to the sensation from scratching the skin on the upper chest with a finger before surgery. Normal skin sensation is maintained, but it is not the hyper sensation of the nipples that one may have experienced before surgery. If a patient is very attached to a high level of sensitivity to the nipples before surgery, it makes sense to consider the Inverted T or Buttonhole procedure as alternatives.
The Double Incision procedure is the most powerful to achieve the highest degrees of flatness and tightness of the chest. Another benefit of this method is that the surgeon is best able to customize the horizontal incision. If any of these outcomes are a priority for you, the double incision procedure is a good choice to consider.
Most patients with a moderate or larger amount of chest tissue will need a significant degree of skin excision. Therefore, horizontal incision is pretty much unavoidable. However, patients with minimal chest tissue or very elastic skin with no overhang of the breast, might consider either the Keyhole or the Periareolar Incision.
Ultimately, there is a reason that the Double Incision has stood the test of time. It is a reproducible and reliable way to achieve a masculine chest. The downsides are minimal and predictable. It’s important to carefully consider the trade-offs of this procedure and to know that postoperative satisfaction rates are extremely high for this procedure.
Here’s an animated video that shows how the double incision FTM mastectomy is done: