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Double incision top surgery with free nipple grafts is the most widely used technique for medium and larger chests. It removes glandular tissue and excess skin and usually achieves the flattest chest contour.
What is double incision top surgery?
Double incision top surgery is a mastectomy in which the surgeon makes two incisions along the lower edge of the pecs, removes breast tissue and excess skin, and re-attaches resized nipples as free grafts in a more masculine position. It is the go-to technique for medium and larger chests and usually gives the flattest result.
Double incision mastectomy with free nipple grafts is the most frequently performed chest masculinization technique. The surgeon makes two horizontal or gently curved incisions along the lower border of the pectoral muscle, removes breast tissue and excess skin, and closes the skin to create a flatter, more masculine chest contour.
The nipple-areola complex is removed, resized and placed back as a free graft in a slightly higher and more lateral position that fits typical male chest proportions. Because skin, tissue and nipples can all be repositioned independently, this technique gives the surgeon the greatest control over the final shape.
Surgeons may also discuss variants: double incision without nipple grafts (for people who prefer no nipples or plan nipple tattooing later), or double incision with the nipple kept on a pedicle of tissue, described on our page about the buttonhole and inverted-T techniques.
Who is it suitable for?
| Criterion | Typical situation |
|---|---|
| Chest size | Medium to large (often B cup and above) |
| Skin elasticity | Low to moderate, with excess skin |
| Nipple position | Sagging (ptosis) present |
| Main goal | The flattest possible contour and control over nipple placement |
| Sensation priority | Acceptance that nipple sensation is usually reduced or lost |
The final choice is always made together with the surgeon, based on chest size, skin quality, nipple position and personal goals. Our guide on choosing a technique compares all options, and our overview of all top surgery procedures also covers keyhole, periareolar and pedicle techniques.
How double incision mastectomy works
- Consultation and markings: the surgeon marks the incision lines and new nipple positions while you are standing.
- General anaesthesia: the operation usually takes around 2–3 hours, depending on volume and any added procedures such as liposuction of the flanks.
- Tissue removal and contouring: breast tissue and excess skin are removed; the contour is refined, often with liposuction at the sides.
- Nipple grafting: the areolas are reduced and secured in their new place, protected by a bolster dressing.
- Drains and compression vest: drains are often used and typically stay in for about 1–7 days; a compression vest is worn for several weeks.
An overnight stay at the clinic is usual. See our guide on preparing for top surgery for practical tips.
Top surgery scars and free nipple grafts
With double incision top surgery, the scars are two lines along the lower edge of the pecs, their length depending on how much tissue is removed. They are red or raised at first and usually fade and flatten over 12–18 months. Genetics, skin type and aftercare all play a role; read more in our guide on top surgery scars.
Nipple grafts need careful care: in the first weeks they may look dark or form scabs, and partial loss of pigment can occur. Nipple sensation is usually reduced or lost, although some sensation in the chest skin may gradually return over time.
Recovery, risks, pros and cons
As a rough guide, many people return to desk work after 1–2 weeks; heavy lifting and raising the arms overhead should be avoided for several weeks, and strenuous exercise generally for 6–8 weeks. Details are in our top surgery recovery guide; for requirements, preparation and scar care, see our complete top surgery guide.
Like any surgery, double incision carries risks: hematoma, seroma, infection, partial or complete nipple graft loss, sensation changes, contour irregularities (for example small lateral "dog ears"), raised scars and the need for a revision. Stopping smoking before and after surgery significantly lowers the risk of healing problems.
| Pros | Cons |
|---|---|
| Suitable for larger chests and less elastic skin | Longer, more visible scars |
| Usually a very flat contour | Nipple sensation usually reduced or lost |
| Control over nipple size and position | Graft care and possible pigment loss |
| Generally low revision rate | Drains and compression vest in the first weeks |
Double incision top surgery cost and consultation
Cost depends on technique, surgeon, clinic and what the package includes. As an indicative range, top surgery packages in Turkey often fall between about 3,500 and 6,500 EUR; a written quote is always needed. Learn more in our guide on top surgery cost, or compare with the periareolar and keyhole techniques.
If you are still deciding where to have surgery, compare our top surgery destinations in Europe and worldwide, including detailed pages on top surgery in Turkey and top surgery in Italy.
Wondering whether double incision top surgery is right for you? Request a free, non-binding top surgery consultation: send us a few photos and we will connect you with an experienced plastic surgeon.
Sources and further reading
- Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 – WPATH – International Journal of Transgender Health (2022)
- Schedule Gender-Affirming Surgery (Mastectomy – requirements) – Cleveland Clinic
- Masculinizing surgery – Mayo Clinic
- Top Surgery (Chest Feminization or Chest Masculinization) – Johns Hopkins Medicine
- Postoperative care and common issues after masculinizing chest surgery – UCSF Transgender Care
- Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy – JAMA Surgery (Bruce et al., 2023)
Last checked: 10/2026
Frequently asked questions
The scars are two lines along the lower edge of the pecs. They usually fade and flatten over time but remain visible when shirtless. Their appearance depends on genetics, skin tension and aftercare.
With free nipple grafts, nipple sensation is usually reduced or lost. Some sensation in the chest skin may gradually return over the following months, but this cannot be predicted with certainty.
It depends on the surgeon and on how much fluid is produced: roughly 1 to 7 days. Some surgeons work without drains in selected cases.
Yes, that is a possible variant. Some people prefer no nipples or plan to have them tattooed later. Discuss it with your surgeon during the consultation.
It depends on the clinic, surgeon and included services. In Turkey, packages are indicatively around 3,500 to 6,500 EUR. More in our guide on top surgery cost.
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