Commentary on: Female-to-Male Gender Affirming Top Surgery: A Single Surgeon’s 15-Year Retrospective Review and Treatment Algorithm

In "Female-to-Male Gender Affirming Top Surgery: A Single Surgeon's 15-Year Retrospective Review and Treatment Algorithm," the authors report on a retrospective study of 1358 subcutaneous mastectomies performed in 679 female-to-male (FTM) transgender patients.¹ The objective of this study was to determine the safety profile and aesthetic outcome of two different operative techniques that were utilized for male chest contouring. The first technique, the so-called "keyhole" technique, was performed in 104 patients (15.3%), whereas 575 patients (84.7%) underwent the second technique, the "double incision free nipple graft (DIFNG)" technique. The keyhole technique is the operative procedure that is routinely utilized for gynecomastia resection through a semicircular (semi-areolar) incision as described in 1946 by Webster.² The DIFNG technique also is a classical surgical procedure, first described by Thorek more than 50 years ago, involving an elliptical mastectomy excision with a free full-thickness skin graft to reconstruct the nipple-areola complex (NAC).³