Double Incision Chest
The double incision technique is often used for transmen with
larger amounts of breast tissue or inelastic chest skin.
The usual candidate
Transmen with a C cup size of above are usually candidates for this type of chest reconstruction FTM surgery. Horizontal or U-shaped incisions are placed under the line of the pectoral muscles to reduce visibility.
This surgery usually involves the removal and repositioning of the nipple which results in a loss of nipple sensation.
Letting your surgeon know your priorities for the outcome of your surgery, including retention of touch sensation, natural appearance, and so on, prior to chest reconstruction ensures that they tailor your procedure to best achieve your desired result.
Surgery usually takes around three to four hours and is done using general anaesthetic.
You should arrange your transport home for the afternoon of the surgery as this is usually when you will be discharged. Some patients will be kept overnight to monitor their initial recovery.
The Incisions and Tissue Removal
Large incisions are made in a horizontal or U-shaped curve following the line of your pectoral muscle.
The skin is then peeled back to expose the mammary glands and fatty tissue which is removed using a scalpel or liposuction in harder areas such as near the armpits.
The muscles of the chest are not impacted by the procedure.
A degree of skin is also removed to keep the chest taut and the incisions are sutures to leave two seams just below the pectoral muscles.
Surgical drains will be inserted following the line of the incisions.
The double incision technique usually requires the nipple to be removed, cut to size, and grafted onto the newly sculpted chest in the approximate position of the male nipple.
Surgeons often use different approaches to nipple repositioning and it is important to establish which procedure your chest reconstruction surgeon will be using.
It may be possible for your surgeon to leave a pedicle (stalk of tissue) attaching the nipple to the body before moving it into a higher position more commensurate with a male chest.
Some areola trimming is usual, however, to maintain proportionality of the nipple to the chest.
The use of the pedicle technique can retain nipple sensation in some cases but is not always possible.
On rare occasions it may not be possible for a surgeon to preserve or graft the nipples into their new position.
This is an uncommon occurrence but may occur due to tissue death.
If this happens then a further procedure to tattoo nipples onto the chest is an option after your newly reconstructed chest has healed from the first operation.
This may be covered in the cost of your initial procedure and should be checked with your surgeon along with the methods he/she is intending to use for nipple repositioning.
Prior to the suturing of your incisions, you will have two surgical drains inserted along the length of the incision site.
These are long, thin tubing which exit the body via small incisions under each armpit and are attached to a small plastic bulb which collects fluid.
The drains can prevent the problematic build-up of fluid/blood under the skin and may need to be in place for a number of days or longer depending on the continuation of fluid drainage.
You will need to empty these drains periodically which may require the help of a friend, relative, or caregiver.
Advantages of the Double Incision Technique
If you are of a larger build with a bigger chest then the double incision technique usually offers better results for a more contoured male chest.
The scars from the procedure are somewhat disguised by the natural line of the pectoral muscle and some transmen find that they become even less visible as their muscles build from working out.
If you are having testosterone therapy then chest hair-growth may also help to cover the scarring.
The proper repositioning and resizing of the nipples during this procedure can give you a more natural looking appearance.
The double incision method also allows your surgeon easier access to remove a substantial amount of mammary tissue in comparison to the keyhole technique.