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Buttonhole Technique Top Surgery
Buttonhole Top Surgery is a gender-affirming chest reconstruction procedure that creates a more masculine chest shape while preserving nipple-areola sensation. Buttonhole is a good approach for optimizing nipple-areola size, position, sensation and pigmentation.
Popularized by Dr. Hope Sherie, the Buttonhole Technique enables the removal of larger amounts of breast tissue and skin than the Keyhole and Peri-areolar methods, making it a good choice for those who are larger-chested. Using this new technique, Dr. Sherie also re-sizes and re-positions the nipple-areolar complex (NAC) without the additional vertical incisions used with Inverted-T, while preserving appropriate nipple projection and pigmentation, and providing a level of sensation not possible with free nipple grafts.
How It Works: Similar to Double Incision Top Surgery, two horizontal incisions (curved, straight, or oblique) are made at the top and bottom of the pectoral muscle and breast tissue and excess skin are removed. Instead of using free nipple grafts (as in Double Incision) the NAC is re-sized and left attached to nerves and blood supply via a thin dermal pedicle, which preserves sensation.
To
re-position the NAC, a circular incision is
made in the chest wall at the appropriate
locations for male nipples, and the NAC is
brought from under the skin through this
opening—like a button through a buttonhole—and
stitched into place. This approach helps to
avoid the extra incisions required by the
Inverted-T method.
The result is a masculine looking chest with nipples that retain sensation and pigmentation, have appropriate projection, and have a more natural appearance than free nipple grafts.
Buttonhole
Top Surgery patients are left with two Penrose
drains — small tubing that exits through the
pectoral incisions and drains excess blood and
lymphatic fluid into a dry pad. These drains
are left in until the first follow-up
appointment. Patients report that they are
much more comfortable than the more commonly
used JP
drains.
For more information about Buttonhole Technique Top Surgery, please contact Dr. Sherie.
Dr.
Hope Sherie, MD, FACS is a
board-certified surgeon who has extensive
training in transgender surgery procedures.
Dr. Sherie offers trans men the highest
level of surgical care at her practice in
Charlotte, North Carolina, where she
specializes in FTM Top Surgery and Body
Sculpting with VASER hi-definition
liposuction. Dr. Sherie is a member of the
Charlotte Transgender Health Care Group and
the World Professional Association for
Transgender Health (WPATH). Website: cosmeticconciergemd.com
Contact Dr. Sherie View Before & After Gallery
More U.S. Surgeons offering Buttonhole Top Surgery:
- Dr. Mosser - San Francisco, California
- Dr. Sajan - Seattle, Washington
- Dr. Champaneria - San Diego, California
Back to Top Surgery Procedures »
Last updated: 01/23/25