Comparing Double Incision, Periareolar, and Keyhole Top Surgery Techniques
By Beverly Fischer on October 30, 2025
Gender Affirmation Surgical Body Top Surgery
Back to Blog
For many transgender men and nonbinary individuals, FTM Top Surgery is a deeply affirming step in their transition journey. Choosing the right surgical technique is an important decision, as each method offers unique benefits depending on your goals, chest size, and anatomy. At the Advanced Center for Plastic Surgery in Baltimore, Dr. Beverly Fischer has over 20 years of experience helping patients feel comfortable and confident in their bodies, offering compassionate care and personalized treatment plans in a welcoming environment.
Understanding Double Incision Top Surgery
The double incision technique is one of the most common procedures for individuals with larger chests or those who would benefit from more significant skin removal. During this surgery breast tissue is completely removed, and the nipple-areolar complex is resized and grafted for a natural, masculine contour.
The double incision method is often recommended for patients seeking a flatter chest with greater symmetry. While this procedure does leave scars that run along the pectoral muscles, they typically fade over time and can be easily concealed. Recovery generally takes about four to six weeks, with most patients gradually resuming normal activities after a few weeks of healing.
Exploring the Periareolar Approach
The periareolar technique, also known as circumareolar or Keyhole technique, is usually an option for patients with a small chest. This method involves completely removing breast tissue through an incision made around the edge of the areola. Because the incision follows the natural border of the areola, the scar often blends in and becomes less visible over time.
One of the main advantages of the periareolar technique is the ability to achieve a masculine chest with minimal scarring. However, this procedure may not allow for as much skin removal compared to the double incision method, making it better suited for those with smaller chests. Recovery time is similar to the double incision technique, with most patients returning to daily routines within a few weeks while avoiding strenuous activity during the early healing phase.
The Keyhole Option for Small Chests
The keyhole technique is designed for individuals with small chests and excellent skin elasticity. Through a small incision under the areola, breast tissue is removed without the need for larger scars. Since there is no significant skin removal, this procedure is best for patients whose skin can naturally contract for a smooth, masculine appearance.
Keyhole Top Surgery offers the least visible scarring of all three methods, but it is only appropriate for a select group of patients. Recovery is often quicker, with many patients experiencing shorter downtime before returning to daily life. As with any surgical approach, final results may take several months as swelling decreases and tissues settle.
Choosing the Right Top Surgery Technique
The best way to determine the appropriate FTM Top Surgery approach is through a personal consultation. Dr. Beverly Fischer takes the time to understand each patient’s goals, evaluate their anatomy, and explain the benefits and considerations of each method. Because every individual has unique needs, she designs a surgical plan focused on achieving a natural-looking, affirming result.
When deciding between double incision or the keyhole technique, factors such as chest size, skin elasticity, desired scar appearance, and nipple placement all play a role. An in-person consultation with Dr. Fischer is the single most important aspect of deciding which technique is appropriate for you. Patients can feel reassured knowing that Dr. Fischer and her team provide attentive care before, during, and after surgery in a comfortable and supportive environment.
Moving Forward with Confidence
Top Surgery is more than a physical transformation. For many patients, it represents alignment with identity and a boost in emotional well-being. At the Advanced Center for Plastic Surgery, Dr. Beverly Fischer is dedicated to making this process as smooth and comfortable as possible, offering FTM Top Surgery in a setting designed for compassion, safety, and world-class results.
If you are considering Top Surgery and want to explore which technique is right for you, reach out to our caring team today. Contact us to schedule your consultation and begin your journey with a surgeon who understands the importance of this life-changing step.
Dr. Beverly A. Fischer is passionate about her role as a leading female plastic and cosmetic surgeon in Baltimore, Maryland and beyond. She believes that plastic surgery makes a positive, life-changing difference, whether you’re renewing your body, face, and skin or embarking on an entire gender transition.
Reach out
We are happy to answer any questions you have. Use the form to request a consultation or more information about specific services. A member of our team will will contact you shortly.
Contact Us