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Peri-areolar chest surgery

January 7, 2011

Around Christmas, my dad and I had consultations with two surgeons –both recommended by other trans guys– about taking my tits off. I’ve thought about it ever since identifying as trans and finally decided that this surgery is right for me. And I came out to my parents over a year ago, so they’re pretty ready, too (although they are scared — more on that later).

Both surgeons are confident that I’m a good candidate for the peri-areolar procedure. I was astonished, being borderline A/B  cup, and having come to terms with the prospect of big scars from the double-incision method (both are described here). As the doctors explained the operation, I realized that they were describing the purse-string/draw-string/concentric circles procedure, which I had seen online; I had always assumed that it was rarely done, therefore not an available option.

I’d like to share the resources I’ve rounded up about this kind of surgery. I’ll include places where you can see “before” pictures because I didn’t believe I could get good results from peri until I saw how chests like mine turned out.

Resources on peri-areolar top surgery

The main obstacle to understanding this procedure, for me, stemmed from all the different terms used to describe it. Some call it simply peri-areolar; others specify “peri-areolar concentric circles” or “peri-areolar with purse-string (draw-string) sutures”; and still others use the terms peri and keyhole interchangeably.

What distinguishes peri from keyhole is that a ring of skin is removed around the areola, which makes this procedure available for medium breasts where there is excess skin. The edge of the remaining circle is larger than the areola so it has to be drawn taut like a drawstring bag. The result is a puckered border, although it smooths out over the following months. It can be done on A to B cups, depending on the surgeon and your skin elasticity (important to avoid puckering or wrinkles). In keyhole, there’s just a small incision below the areola through which breast tissue is sucked out. No skin is removed, so it’s limited to small A or AA cups.

More detailed descriptions

Dr Medalie explains peri and double-incision, and how he decides which to use on a patient. (Warning: graphic photos of the procedure being performed.)

“Mastectomy in Female-to-male Transsexuals”: journal article by Japanese surgeons. They describe –very thoroughly– their three techniques and what type of breast is recommended for each one. (Warning: black and white images of surgery being performed starting at page 3.)

Spanish/español: “Cirugía de reasignación sexual de mujer a hombre” describe tres tipos de mastectomías y también operaciones genitales. (Hay fotos de antes y después.)

Photos and personal accounts

Gender Outlaw described his experience with this kind of procedure and continues to post pictures where you can see how he’s healed in the long term (see posts tagged “chest surgery” and “transition photos”).

Jasper posted pictures from before and after surgery until 4 weeks post-op. He had a full B cup, but turned out fine. Warning: graphic images of healing nipples.

XXBoy also documented his surgery; see his “top surgery” tag or his post summarizing the whole experience, including how he lost a nipple (which is uncommon) and how that made him feel.

Transbucket has hundreds of user-submitted pictures of all kinds of trans/genderqueer/etc related surgeries. You have to register, but it’s well worth it. Some people post “before” images.

The McLean Clinic has two sets of before/after pictures of what looks like peri (it’s described as keyhole, but I think the “before” chests were too large not to need skin removal; it might be a difference in terms).

People on Youtube who talk about having peri: isaacgwood, nekoboi17, fateofmind05, blckpanthurr1, transposeme, drfchest,

Thanks to everyone who shares their transition experience — including, but not limited to, surgery!

3 Comments leave one →
  1. January 8, 2011 12:28 am

    Thanks for the clarifications. I didn’t know there were so many different types! Good on ya for getting so well informed. It must be a scary and anxious time for you, but exciting at the same time : ) I wish you well!

    As for me, if I get top surgery someday, it will likely be double incision as I have D cups : ( Oh well, I can get tattoos to camouflage the scars, or to blend it with them. McLean in Toronto is actually one of the surgeons I’m considering.

    • January 8, 2011 12:53 am

      Actually I found many more types in articles by non-North American surgeons! Such as the extended peri-areolar procedure which has short lines extending sideways from the areolas. It’s curious how surgery types vary geographically; for instance, the inverted T method is more common than DI where I live.

      I know I’m privileged to have a choice between peri and DI (well, inverted T), thanks to my chest size, but the DI scars don’t seem so terrible to me. Back when I was certain I’d need a procedure with large scars, I thought that it was *better* because they’d make me recognizable as trans, yet could still make up a story in stealth situations (I’d say I had lumps or cysts taken out). After seeing so many pictures of post-op trans chests, scarless cis chests look kinda incomplete!

      Your idea of chest tattoos sounds cool!

      I shook with anger when I read what the surgeon said to you. I still avoid a certain clothes shop because the salesperson was very rude to me until he realized I was going to buy several things, and then put on the HUGEST smile. And that was just a tiny incident. I can’t imagine what it’s like to be treated in that way by a doctor.

  2. January 8, 2011 10:38 pm

    Hmm, yeah, interesting about the geographical difference. I guess someone who can afford to travel has lots of choices. Yeah, I don’t really mind the scars so much. I tend to agree with you – they’re a trans marker. I’m sure that’s unappealing to many but I like anything that marks me as a trans and not cis guy. And, you’re right, a story can be made up. I guess any excuse for a new tattoo is something I’ll grab on to : )

    Yeah, I’m pretty pissed at the Dr. Although he’s a private practitionner and probably quite wealthy so not that surprised about the elitism… Not that ALL wealthy people are elitism, just that when I meet one who is, I’m not surprised. I’ve also met some who are not, fortunately. Although they are not the type to flaunt the wealth and more likely to be sharing it when they’re not elitists.

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