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Buttonhole Technique Top Surgery

Buttonhole Technique Top Surgery
Buttonhole Technique Top Surgery

The Buttonhole Technique is an ideal FTM Top Surgery procedure for trans men who prioritize nipple-areola size, positioning, 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 medium- and large-chest trans men. 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.

Buttonhole Technique Top SurgeryTo 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. The Buttonhole Technique also has the potential for fewer complications as it avoids the risks of free nipple graft infection and/or loss.
View Before & After photos »

The cost of Buttonhole Technique Top Surgery is the same as Dr. Sherie's Double Incision surgery: $7500 (Accurate as of February 2016.)

Buttonhole Technique Top SurgeryAfter Buttonhole Technique 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 for just 2-3 days, and 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 SherieDr. 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:

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