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Inverted-T / T-Anchor Top Surgery

Inverted-T Top Surgeryaka. Inferior Pedicle, Wise Pattern

The Inverted-T Top Surgery procedure is ideal for medium to large chested individuals who wish to retain the most sensation possible in the nipple-areola complex (NAC.) Developed by Dr. Paul Steinwald, Inverted-T is based on a breast reduction technique and has evolved into a popular form of Top Surgery.

The Inverted-T procedure is similar to Double Incision Top Surgery: skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. (The muscle itself is not touched.) The skin is pulled back and breast tissue is removed. Additional liposuction may be performed to adjust contour.

The important distinction between Double Incision and Inverted-T has to do with nipple grafts vs. a resized/repositioned NAC. With Inverted-T, the NAC is reduced in size and repositioned via an extra vertical incision that runs from the bottom of the areola to the horizontal incision along the pectoral muscle. Because the nipple stalk and nerve are not severed, the NAC retains its blood supply as well as a degree of sensation that just isn't possible with the free nipple grafts used in Double Incision Top Surgery.

"Patients often report retention of at least 60-80% of preexisting nipple sensation," says Dr. Steinwald.

Inverted-T Top Surgery also has the potential for less complications compared to Double Incision because there are no nipple grafts (which have a risk of infection and loss.)

Inverted-T Top Surgery is typically an outpatient surgery that lasts 3-4 hours. General anesthesia is used, but patients are rarely catheterized.

View Photos of Inverted-T Surgery Results »

Top Surgery Recovery

After surgery, patients are usually left with two medical drains — small tubing that lines the length of the incisions, under the skin, that exit through a small incision under each arm, with a resevoir bulb attached at the ends to collect excess blood and lymphatic fluid. These drains are left in for several days to a week, and need to be emptied by the patient or an assistant a few times a day. Many surgeons also have patients wear a compression binder after surgery, for anywhere from 1-6 weeks. The binder helps prevent fluid build up, aids the skin in adhering back to the chest wall, and also helps with minimizing scars.

Inverted-T and Double Incision Top Surgery compared
Comparison of Inverted-T and Double Incision

Healing times vary, but many trans men return to desk jobs and light work after two weeks. There should be no heavy lifting, regular lifting of your arms over your head or weight training for 6-8 weeks.

What to discuss with your surgeon at your consultation:

  • Incision lines and placement (straight, curved)
  • Size and placement of the nipple-areola complex
  • Will a nipple reduction be included?

Dr. Paul SteinwaldDr. Paul Steinwald is a double-board certified surgeon practicing in Denver, Colorado. Dr. Steinwald has performed hundreds of Top Surgeries. He is known for pioneering the Inverted-T procedure, a method designed to preserve as much nipple/areola sensation as possible. Patients come from around the world to see Dr. Steinwald and to have this specific procedure done. Dr. Steinwald will operate on Informed Consent and will also operate on minors aged 16 and 17 with parental consent.

Contact Dr. Steinwald

Surgeons offering Inverted-T Top Surgery:

Dr. Bartholomeusz, who is now retired but used to perform Top Surgery in Australia, developed a similar technique called "The Flying Brevet".

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Last updated: 09/18/23

FTM Surgery