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!