How the Procedure is Performed

First, the nipple areola complex is preserved on a “pedicle” which is composed of bidirectional blood supply from the inferior and superior chest wall. This pedicle is composed of a vertical rectangle of tissue located above and below the nipple. Then an elliptical horizontal skin excision pattern is created similar to the Double Incision but located higher up on the chest wall and centered around the nipple, which allows access to remove the breast tissue on either side and deep to the pedicle. Once the tissue is removed, the horizontal incisions are closed together and the nipple areola is brought out through the center of the scar through a small oval or circular incision. This also provides some hope at retaining erotic nipple sensation. Alternatively, the nipple areola can be treated as a free nipple graft if a completely flat chest is desired, in which case the nipple areola would be numb after surgery as in the Double Incision procedure and no hope of retaining erotic nipple sensation would be possible.

Indications for the Fishmouth Approach

Downsides to the Fishmouth Approach

In some ways this procedure is similar to the Buttonhole and Inverted-T in that there is some hope at preserving erotic nipple sensation. This approach is preferred by some nonbinary individuals who prefer a scar that is non-anatomic in nature. This non-anatomic scar may be considered a downside for some patients. For patients who desire a hope at retaining erotic nipple sensation and don’t mind a chest wall that is not completely flat, this is possible by maintaining the nipple areola on a bipedicled flap of tissue. For patients who desire a completely flat chest wall and don’t mind loss of erotic nipple sensation, the nipples can be treated as free nipple grafts.