Understanding Peri Areolar Mastectomy
Peri-areolar top surgery is a gender-affirming chest masculinisation technique designed for individuals with smaller chest sizes and good skin elasticity. It involves a circular incision around the edge of the areola, allowing the surgeon to remove breast tissue while preserving the nipple-areola complex. In some cases, a second concentric incision is made to remove excess skin, and the outer circle is tightened around the areola. This method typically results in minimal scarring and maintains nipple sensation, making it a preferred option for those seeking a subtle, natural-looking outcome.
This technique is most suitable for transmasculine and non-binary individuals with A or small B cup chests, firm skin, and minimal ptosis (sagging). It’s often recommended for patients who want to avoid nipple grafting and prefer less invasive surgery. However, it may not be ideal for those with larger chests or significant skin laxity, as it offers limited access for tissue removal and contouring compared to double
Surgical Process – Peri-Areolar Technique
In peri-areolar top surgery, a circular incision is made around the edge of the areola. Through this incision, the surgeon removes breast tissue while preserving the nipple-areola complex. In some cases, a second concentric incision is made to remove excess skin, and the outer circle is tightened around the areola to create a flatter chest. The underlying pectoral muscle is not touched. This technique is ideal for individuals with small chest sizes and good skin elasticity, as it leverages the skin’s natural ability to contract.
Optional Enhancements and Refinements
- Liposuction may be used to refine the chest contour, particularly around the sides and underarms, and to smooth the transition between the chest and lateral tissue..
- Nerve-preserving techniques are often used to maintain nipple sensation.
- The nipple-areola complex is typically left intact, avoiding the need for grafting or repositioning.
- The areola can be reduced in size before grafting.
Preparing for Your Peri-Areolar Top Surgery Consultation with Mr Vahidi
If you’re considering the peri-areolar technique, your consultation is the perfect time to explore whether it’s the right fit for your body and goals. Mr Vahidi will guide you through the process and ensure you feel informed, supported, and confident.
Bring your questions. This is your journey—every concern matters. No question is too small, and we’ll revisit anything until you feel completely clear.
Key topics to discuss:
- Incision details: The peri-areolar method uses a circular incision around the areola. Ask about scar visibility and healing.
- Chest contouring: Will liposuction be used to refine the shape?
- Nipple-areola size and placement: Can it be adjusted to match your goals?
- Recovery expectations: What’s typical, and what’s unique to this method?
- Suitability: Is this technique ideal for your chest size and skin elasticity?
Procedure Timeline
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Time Off Work2-3 Weeks |
Hospital StayOvernight |
Bathing/Shower1 Week |
Walking1 Day |
Full Exercise4-6 Weeks progressive recovery and shoulder movement |
Compression Garments6 Weeks |
Prone Sleeping1-2 Weeks |
Sexual Activity4-6 Weeks |
Full Recovery4-6 Weeks |
Driving4-6 Days |
Air Travel4 weeks |
Risks
Eligibility Criteria
Are You Eligible for Top Surgery?
FTM top surgery (female-to-male chest masculinization) and non-binary top surgery are gender-affirming procedures designed to help individuals feel more aligned with their gender identity. These surgeries are suitable for people who experience gender dysphoria related to their chest and are seeking a permanent, physical change as part of their transition.
To be eligible for transgender top surgery, individuals typically need to meet the following criteria:
- Persistent gender dysphoria related to chest anatomy
- Have been living socially in their affirmed gender for at least 12 months
- A psychological referral from a GMC or HCPC registered psychologist or psychiatrist
These guidelines are based on the internationally recognized WPATH Standards of Care (SOC 8), which outline best practices for gender-affirming healthcare. You can learn more about these standards here:
Exploring Hormone-Free Options
Top Surgery Without Testosterone
Yes, you can get top surgery without being on testosterone. While some healthcare professionals may recommend starting hormone therapy before undergoing FTM top surgery or non-binary chest surgery, it’s not a requirement. There is no single path to transition—many individuals choose not to take testosterone and still proceed with gender-affirming top surgery.
In fact, non-binary top surgery is increasingly common among people who are not on hormones. These patients do not experience worse outcomes than those who are taking testosterone. Everyone’s journey is unique, and your eligibility for transmasculine surgery or chest masculinization is based on your needs, not your hormone status.
If you are currently taking injectable testosterone, please inform Mr Vahidi. In some cases, patients may be temporarily switched to Testogel due to a small increased risk of blood clotting associated with injections.
Understanding Surgical Permanence
The Irreversible Nature of Top Surgery
Top surgery is a definitive step in gender affirmation, providing a permanent change to the chest’s appearance. This procedure involves the removal or reshaping of breast tissue to create a masculine or gender-neutral contour. Due to its irreversible nature, it’s crucial for patients to fully understand the long-term implications and make informed decisions. This permanent transformation is a significant milestone for those seeking congruence between their body and gender identity.
Patients are encouraged to discuss their goals and concerns with their surgeon to ensure the results align with their expectations and lifestyle. This commitment to permanence underscores the importance of thorough consultation and preparation.
Navigating Surgical Risks
Potential Complications of Top Surgery
Common Complications After Top Surgery
While gender-affirming top surgery is generally safe and has high satisfaction rates, like any surgical procedure, it carries some risks. These can vary depending on the surgical technique used (e.g., double incision, keyhole, periareolar) and individual health factors.
General Surgical Risks
- Bleeding: Excessive bleeding may occur during or after surgery
- Infection: Though rare, infections can develop at incision sites
- Poor wound healing: Delayed healing or wound reopening (dehiscence) may require medical attention
- Hematoma: A collection of blood under the skin that can cause swelling and pain
- Seroma: Fluid buildup under the skin, often managed with surgical drains
Procedure-Specific Risks
- Loss or changes in nipple sensation: Especially common with nipple grafting
- Nipple necrosis: Rare but serious, involving tissue death due to poor blood supply
- Scarring: All top surgery results in scarring; the extent depends on technique and individual healing.
- Asymmetry or contour irregularities: Uneven chest shape or nipple placement may occur
- Chronic pain: Some individuals experience long-term discomfort or nerve-related pain (e.g., Post-Mastectomy Pain Syndrome)
Anesthesia risks: Includes allergic reactions, airway issues, or heart complications