FTM (female-to-male) top surgery involves the removal of breast tissue and the masculinization of the chest. The type of surgery chosen often depends on the individual’s chest size, skin elasticity, and desired outcomes. Here are the primary techniques used in FTM top surgery:

1. Double Incision with Free Nipple Graft (Bilateral Mastectomy):
   • Description: This is one of the most common methods used, especially for those with larger chests or excess skin. Two horizontal incisions are made across the chest, and the breast tissue is removed. The nipples are resized and repositioned using the free nipple graft technique.
   • Scarring: This method leaves two horizontal scars on the lower part of the chest, below the pectoral muscles.
   • Best For: Individuals with larger chests or those with less skin elasticity.
2. Peri-areolar (or “Keyhole” Surgery):
   • Description: A circular incision is made around the edge of the areola. Breast tissue is removed through this incision, sometimes with the help of liposuction.
   • Scarring: Scarring is typically limited to the edge of the areola, making it less noticeable.
   • Best For: Those with small chest sizes and good skin elasticity.
3. Inverted-T or T-Anchor:
   • Description: This technique combines aspects of the double incision and peri-areolar methods. After the breast tissue is removed through a peri-areolar incision, an additional vertical incision is made from the bottom of the areola to the chest’s inframammary fold, forming an inverted “T” shape.
   • Scarring: There is a scar around the areola and a vertical scar extending downward.
   • Best For: Individuals with medium-sized chests and moderate skin elasticity.
4. Buttonhole Technique:
   • Description: This technique removes breast tissue through a small incision while preserving the nipple stalk. The nipple and areola are then resized and repositioned through the same incision.
   • Scarring: Minimal scarring around the areola and potentially a small horizontal scar.
   • Best For: Those who want to maintain more nipple sensation while needing to remove a moderate amount of breast tissue.
5. Fishmouth Technique:
   • Description: A horizontal oval-like incision is made across the chest, and breast tissue is removed. The nipple is resized and repositioned without detaching it.
   • Scarring: A horizontal scar across the chest, but often smaller than the double incision method.
   • Best For: Those with a moderate chest size and moderate skin elasticity.

Each of these methods has its pros and cons, and the best technique for a person will depend on their individual anatomy, desired outcomes, and the surgeon’s expertise. It’s vital for individuals considering FTM top surgery to consult with experienced surgeons to discuss options, understand the risks and benefits, and set realistic expectations for the procedure and recovery.