Double incision top surgery

Two horizontal incisions below the pectoral border remove breast tissue and excess skin, with the nipples resized and replaced as free grafts. It is the most predictable route to a flat, tight chest when there is more tissue or skin to remove.

Who it suits

Larger chests, or any chest where the skin has lost elasticity. If a keyhole approach would leave loose skin behind, this is the honest answer.

Advantages

Significant tissue removal, precise reshaping of the chest wall, and a uniformly flat, masculine contour. Nipple size and position are fully under the surgeon's control.

Trade-offs

Two permanent horizontal scars under the pectoral fold, and reduced or absent nipple sensation because the grafts are detached and replaced. Recovery is a little longer than the smaller techniques.