The double incision method is the most popular form of chest reconstruction top surgery (formerly called FTM/N Top Surgery). This procedure involves the surgical removal of chest tissue and excess skin, as well as resizing and placement of the areolas as skin grafts. The result is a flatter chest with a horizontal scar on each side, generally on or around the bottom of the pectoral muscles.
The double incision is among the most common procedures for chest reconstruction top surgery, accounting for more than 80% of top surgeries performed by our surgeons . It is unparalleled in its ability to achieve the tightest and flattest chest with full customization of areolar size and location relative to the muscle and horizontal scar. The double incision method is suitable for patients with larger bodies, chests, and greater excess skin.
This method involves placing the areolas as free skin grafts. This method has the potential for loss of the skin graft or reduced sensation in the nipples/areolas. . There are visible horizontal scars which, although they fade, are unlikely to fully disappear.
A common misconception about double incision nipple skin grafts is that they have a high probability of failure. In our practice, this is extremely uncommon. However, it is a possibility that should still be considered. The upside of using skin grafts is that the surgeon customizes the size and location of the areolas.
With certain techniques, loss of nipple sensation is a possible surgical outcome. However, the techniques our surgeons use allows the patient to maintain a considerable number of nerve endings, which are connected with the sensory nerve within the skin graft material. For most patients, the level of sensation that a nipple has after surgery 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, they may want to consider the inverted-T or buttonhole procedure as alternatives.
The double incision method has the highest probability of achieving 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 unavoidable. However, patients with minimal chest tissue or very elastic skin with no overhang of the chest might consider either the keyhole or the periareolar methods.
Ultimately, there is a reason that the double incision method has stood the test of time. It is a reproducible and reliable way to achieve a flat, conventionally “masculine”-appearing chest. The downsides are minimal and predictable. It’s important to carefully consider the trade-offs of this procedure, and to also know that postoperative satisfaction rates for this procedure are extremely high.