Understanding Double Incison Mastectomy
The Double Incision Mastectomy is the most commonly performed technique for FTM top surgery and non-binary chest masculinisation, especially for individuals with medium to large chest sizes or less elastic skin. It is a 3-hour procedure that requires an overnight hospital stay.
Pre-Surgery Preparation
1. Emotional Readiness & Expectations
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- Reflect on your goals: Are you seeking relief from dysphoria, a more masculine chest contour, or improved comfort in clothing and social settings?
- Understand the limitations: Scarring, changes in nipple sensation, and variations in healing are common. Nipple grafts may lose pigmentation or projection.
- Mental health support: Consider therapy or peer support to help process emotions before and after surgery.
2. Physical Preparation
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- Stop smoking at least 4–6 weeks before surgery to reduce the risks of complications and promote healing.
- Avoid medications and supplements that increase bleeding risk (e.g., aspirin, ibuprofen, vitamin E, omega oils) at least 2 weeks prior to surgery.
- Plan your recovery space: Set up essentials within easy reach, prepare meals, and arrange for help with daily tasks.
Surgical Process
- Two horizontal incisions are made—one above and one below the pectoral muscle.
- The breast tissue and excess skin are removed, but the underlying muscle is left untouched.
- The nipple-areola complex is typically resized and repositioned using free nipple grafts (FNG).
- Incisions may be customised (straight, curved, hockey stick) to suit body shape and aesthetic goals.
Optional Enhancements
- Nerve-preserving techniques may be used to retain erotic nipple sensation.
- Nipple-sparing methods or complete nipple removal are also options, depending on preference and anatomy.
Liposuction is often used during the procedure to:
- Refine the masculine chest contour, especially around the sides and underarms.
- Remove residual fat that might cause unevenness or bulging.
- Strategic liposuction is used to smooth transitions between chest and side tissue.
- Help prevent dog ears—puckered skin or fat at the ends of incisions near the armpits.
Preparing for Your Top Surgery Consultation with Mr Vahidi
Your consultation is a safe space to ask questions, express concerns, and explore your options. Mr Vahidi is here to help you feel relaxed, informed, and confident in your decisions.
Bring a list of questions. This is your body, your life—you’re in control. No question is too small or silly. If you’re feeling overwhelmed, we’ll go over everything as many times as needed until you feel clear and reassured.
Here are some key topics to discuss:
- Incision style: Would you prefer straight or curved incisions? These typically follow the natural line of the pectoral muscle.
- Nipple-areola: What size and placement do you envision?
- Recovery: What should you expect during healing?
- Preparation: How can you best prepare physically and emotionally?
- Personal considerations: Are there any individual health or body factors to be aware of?
Procedure Timeline
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Time Off Work2-3 Weeks |
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Hospital StayOvernight |
Bathing/Shower1 Week |
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Walking1 Day |
Full Exercise4-6 Weeks progressive recovery and shoulder movement |
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Compression Garments6 Weeks |
Prone Sleeping1-2 Weeks |
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Sexual Activity4-6 Weeks |
Full Recovery4-6 Weeks |
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Driving4-6 Days |
Air Travel4 weeks |
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Risks
Links & Downloads
Royal College of Anaesthetists Risk Information
Patient Information on Post Operative Complications.
The American Society of Plastic Surgeons: Global Open Journal Double Incision Mastectomy with Free Nipple Graft for Masculinizing Chest Wall Surgery
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