Female To Male (FTM) & Female To Nonbinary (FTN) Reconstruction Chest Surgery
FTM & FTN Fishmouth Incision Surgery
This approach involves a horizontal scar that is located higher on the chest wall compared to the Double Incision approach, close to the level of the nipple areola complex. With this approach, the nipple areola ends up positioned in line with the scar, away from natural anatomic chest wall boundaries. This non-anatomic incision location is preferred by some nonbinary individuals who prefer an incision that does not follow anatomic boundaries. In this approach, excess skin can be removed and the nipple areola may remain attached or may be treated as a free nipple graft, depending on the level of chest flatness desired.
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
- Desire for a scar that is non-anatomic in nature
- Desire for a chance at retaining erotic nipple sensation and ok with lack of complete flatness of the chest wall (in which case the nipples would remain on a bipedicled flap
OR:
- Ok with loss of erotic nipple sensation and desire for a completely flat chest wall (in which case the nipples would be treated as free nipple grafts)
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.
Why Choose Us?
All Styles & Techniques
Double Incision, Keyhole, Peri, Buttonhole, Subglandular and Submuscular Breast Augmentation, Body Masculinization, Feminization and More
All Identities
Patients of all gender identities and all pronouns are welcome here
Individualized Care
We provide individualized care based on your specific surgical needs and goals and will inform you about your options
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