Inverted-T / T-Anchor Top Surgery
aka. Inferior Pedicle, Wise Pattern
The Inverted-T Top Surgery procedure is ideal for medium to large chested men who wish to retain the most sensation possible in the nipple-areola complex (NAC.) Developed by Dr. Paul Steinwald, Inverted-T started as a breast reduction technique and has since evolved into a popular form of FTM Top Surgery.
The 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 the breast tissue is then 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 and sensation, thus Inverted-T offers better sensation than Double Incision Top Surgery.
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.
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.
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 Steinwald is a double-board certified surgeon practicing in Denver, Colorado. Since 2002, Dr. Steinwald has performed hundreds of FTM 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.
More U.S. Surgeons offering Inverted-T Top Surgery:
- Dr. Mosser - California
- Dr. Mangubat - Washington
- Dr. Sherie - North Carolina
- Dr. Medalie - Ohio
- Dr. Sajan - Washington
- Dr. Hansen - Oregon
- Dr. Olson - New Jersey
- Dr. Thakar - Oregon
Dr. Adams in South Africa also offers this technique, while Dr. Bartholomeusz, who does FTM top surgery in Australia has developed a similar technique called "The Flying Brevet."
Last updated: 07/10/17