Female To Male (FTM) & Female To Nonbinary (FTN) Reconstruction Chest Surgery
Inverted-T Approach
The buttonhole approach and inverted-T approach are similar in that their purpose is to provide some hope of retaining erotic nipple sensation after surgery. Both procedures avoid free nipple grafting by keeping the nipple areola attached to some underlying breast tissue, thus the result is a chest wall that is not as flat compared to the Double Incision technique. Patients who require more skin excision may benefit from the additional inferior vertical scar, resulting in an anchor-shaped scar pattern.
How the Procedure is Performed
First, the nipple is preserved on what is called the “pedicle” which is a small mound of breast tissue that lies beneath and inferior to the nipple areola. This pedicle is carefully preserved underneath the skin to provide some nerve supply and blood supply to the nipple areola. Then an anchor-shaped skin excision pattern is developed with the lower incision located at the inferior chest fold, and there is little customizability regarding scar shape. Breast tissue is removed through those incisions on either side and above the pedicle to the nipple areola. Blood supply to the nipple areola is continuously monitored throughout the case, and any concerns may result in less tissue being excised or the nipples being converted to free nipple grafts. The skin incisions are then closed together to result in an anchor-shaped chest wall scar and the nipple areola complex is brought out through a separate oval or circular incision within the chest wall skin.
Indications for the Inverted-T Approach
- Desire for a chance at retaining erotic nipple sensation
- Ok with the lack of complete flatness of the chest wall
- Large amount of skin excess
Downsides to the Inverted-T Approach
Similar to the Buttonhole approach, the major downside to this approach is the lack of complete chest wall flatness as compared to the Double Incision approach. This lack of flatness may also make it difficult to see visible muscle definition beneath the skin. Other down sides include lack of control over nipple areola position and lack of control over the shape of the inferior chest scar. In addition, this approach only provides a chance at retaining erotic nipple sensation, not a guarantee. Because nerves take a long time to recover after surgery, it may not be known for months whether nipple hypersensitivity has been preserved.
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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