Buttonhole top surgery is a gender-affirming procedure that gives you a flatter chest with more attention to keeping nipple sensation. It’s often a solid choice for people with a moderate amount of breast tissue who want clean results without heavy scarring.
This method differs from the double incision technique or inverted T technique in its approach to handling the nipple-areola complex. It focuses on better placement, fewer scars, and more preserved feeling across the chest.
What Is Buttonhole Top Gender Affirming Surgery
The buttonhole technique is a form of top surgery designed to create a flatter, more masculine chest while preserving key elements of the nipple areola. It’s one of the few options that can retain some nipple sensation, which can make a significant difference in how the chest feels after healing.
Unlike older methods, this gender-affirming approach uses a circular incision around the nipple, allowing it to be lifted on a pedicle and repositioned through a ‘buttonhole’ in the skin flap, maintaining better nipple projection and placement while preserving some blood and nerve connections. The surgeon also removes breast tissue through one or two horizontal incisions along the chest, which allows for a smooth, contoured result without vertical scarring.
This method is often used for patients with moderate chest tissue, enough that the keyhole or peri-areolar approaches wouldn’t offer complete results, but not so much that the more invasive double incision technique is required.
The buttonhole technique also gives surgeons more control over the final shape of the chest, which can help achieve a more natural appearance. Some patients choose this option for the potential to avoid the more prominent top surgery scars associated with techniques like the inverted T or free nipple grafts that fully sever nerve sensation.
Different Buttonhole Top Surgery Techniques
There are several ways surgeons perform buttonhole top surgery, depending on your body and goals. The technique varies based on factors like how much breast tissue you have, how your skin heals, and the desired look and feel of your nipples. Many choose the buttonhole method because it helps preserve nipple sensation. Compared to double incision or inverted T techniques, it offers better control over chest contouring and nipple placement, while potentially minimizing larger scars. For the best results, trust your top surgery to an experienced surgeon like Dr. CV.
Double Incision Technique
The double incision method is one of the most common forms of top surgery, especially for those with a larger amount of breast tissue. Two horizontal incisions are made across the chest, just under the pectoral muscle line. This allows the surgeon to remove more breast mass, including excess skin, and shape the chest for a flatter look.
Because this technique requires removing the nipple areola, free nipple grafts are often used. The original nipple is taken off, resized, and grafted back as a flat piece of skin without its original supply of blood or nerve connection. This usually means a loss of sensation around the nipple, but for many people, the overall contour and chest shape make it worth it.
Buttonhole Technique
The buttonhole technique is often chosen by those who want a flatter chest without losing all sensation on and around the nipple. Instead of cutting off the nipple, the surgeon uses a circular incision to lift and preserve the nipple areola on a thin dermal pedicle. This keeps part of the blood supply and may allow for some return of feeling over time.
Through a lower horizontal incision, the surgeon removes the necessary breast mass and reshapes the chest. This approach offers more control over nipple projection, placement, and the final contour. It’s especially useful for patients who have moderate tissue but still want a more natural result with fewer visible scars.
Inverted T Technique
The inverted T technique is typically used when there’s a lot of excess skin to remove or when better control over shaping is needed. It combines a horizontal incision across the chest with a vertical one running down from the nipple, which is why it is called the “T” shape.
This method often preserves the nipple-areola complex on a pedicle to maintain blood supply and some sensation, though free grafts may be used in certain cases. Sensation can vary, with potential for partial preservation or loss. As with the double incision technique, sensation is often lost. While it can result in more scarring, it gives the surgeon more room to work, especially for larger-chested patients.
Keyhole Technique
The keyhole technique is designed for small-chested patients with good skin elasticity and minimal breast mass. A small incision is made around the edge of the areola, allowing the tissue underneath to be pulled out and removed. Because there’s no free nipple graft, the nipple is left attached, preserving full blood supply and potentially better sensation.
This option doesn’t involve removing much skin, so it only works if the chest has little sagging and no need for skin excision. While it offers the least scarring, it’s not recommended for those with more tissue or extra skin.
Nipple Grafts vs Free Nipple Grafts?
In top surgery, the term nipple grafts usually refer to free nipple grafts, but there’s an important difference between the two approaches.
With free nipple grafts, the entire nipple-areola complex is removed from the chest during surgery. Once the breast tissue is removed, the nipple is trimmed, sometimes resized, and then grafted back onto the new chest contour, much like a skin patch. Because the blood supply and nerve sensation are completely disconnected, the nipple usually loses feeling. It may also fade in color or change texture over time.
By contrast, other types of nipple grafts, such as those used in the buttonhole technique, attempt to preserve some blood supply through a thin dermal pedicle, which may help maintain nipple projection and a more natural appearance. This method may help keep some feeling in the nipple, but the results are different for everyone.
Free nipple grafts are sometimes the only option, especially with double incision or inverted T surgeries. But they’re not always required. Some patients choose the buttonhole technique because it provides an alternative method for reshaping the chest, with fewer compromises and a more natural appearance.
What to Expect at Your Consultation at a Gender Confirmation Center
Your consultation is where everything starts. The surgeon will look at your chest, talk through your goals, and figure out which top surgery method makes the most sense for you. If you have a moderate amount of breast mass, the buttonhole technique might come up as an option.
They’ll review your medical history, examine your skin, and explain how your nipple may be handled, either preserved or removed using free nipple grafts. Aspects such as nipple sensation, shape, and position will also be discussed.
Some people bring a letter from a mental health provider, depending on the clinic. You’ll also have the opportunity to ask anything on your mind, including questions about healing, scars, or what the final result might feel like. The goal is to determine what works for you, not to push one procedure over another.
FAQs: Buttonhole Top Surgery
Is Buttonhole Top Surgery Good for Non-Binary People?
Yes. The buttonhole technique can be a good fit for non-binary patients who want a chest that’s flat while keeping some nipple sensation or a more natural look.
What is the Peri-Areolar Area?
It’s the area around the outer edge of the areola. Some top surgery methods use this spot to make small incisions for tissue removal.
How Long is the Recovery Process from Buttonhole Top Surgery?
Most people need about 1–2 weeks before returning to work or daily tasks. Full healing, including scar fading and sensation changes, can take several months.
Ready for Your Buttonhole Top Surgery Consultation?
Thinking about buttonhole top surgery? Dr. CV Chegireddy at Atlanta Plastic Surgery offers expert, personalized care. Book a consultation today to explore your options and get clear answers from a trusted plastic surgeon.
References
- https://www.cosmeticconciergemd.com/buttonhole-chest-technique
- https://www.folxhealth.com/library/top-surgery-101-procedures-cost-and-safety
- https://www.genderconfirmation.com/buttonhole-top-surgery
- https://www.topsurgery.net/procedures/buttonhole-technique-top-surgery.htm
