If your chest is on the smaller side — typically an A or B cup — periareolar top surgery can create a flat, masculine contour through a single incision hidden around the areola. The result is chest masculinization with minimal visible scarring, avoiding the longer incision lines associated with double incision techniques.
What Is Periareolar Top Surgery?
Periareolar top surgery removes breast tissue through a circular incision around the edge of the areola, resulting in a flat masculine chest with scarring confined to the areolar border. Because the approach relies on the skin retracting to lie flat over the chest wall, it works best for patients with smaller chest sizes (generally A to small B cup), good skin elasticity, and minimal skin excess. The areola can be reduced in diameter during the same procedure.
Unlike the double incision method, periareolar top surgery preserves the nipple on its native blood supply and nerve connections, which means nipple sensation is more likely to be retained. However, patients with larger chests, significant ptosis, or poor skin elasticity may not achieve satisfactory results with this technique alone, and your surgeon will advise honestly if a different approach would serve you better.
Common Concerns Periareolar Top Surgery Can Address
- Chest dysphoria despite having a smaller chest size
- Desire for chest masculinization with minimal scarring
- Discomfort from binding a smaller chest
- Wish to retain nipple sensation where possible
Are You a Good Candidate?
- You have a smaller chest, typically A to small B cup
- Your skin has good elasticity with minimal excess or sagging
- You have a referral letter from a qualified mental health professional
Techniques & Options
Periareolar top surgery centres on a concentric incision technique, but there are variations in how the surgeon manages tissue removal and skin tightening. Chest size, skin quality, and nipple-areolar dimensions are all evaluated during consultation to determine which variation delivers the flattest result with the best scar outcome. Two main approaches are used:
Standard Periareolar (Concentric Circular)
Two concentric circular incisions are made — one around the existing areolar border and a larger one around it. Breast tissue is removed through this doughnut-shaped opening, and the outer skin edge is gathered and sutured to the areolar margin using a purse-string closure. This tightens the skin envelope and reduces the areola in a single step.
- Scarring limited to the areolar border
- Areola can be reduced and reshaped simultaneously
- Nipple remains on its pedicle, preserving blood supply and sensation
Extended Periareolar (Keyhole Variant)
A variation that uses a slightly larger outer incision to accommodate additional tissue removal in patients at the upper limit of candidacy for periareolar surgery. A small wedge of skin may be excised laterally to improve contour. This approach balances the minimal scarring benefits of periareolar surgery with the need for modest additional skin removal.
- Addresses slightly larger chests that fall between periareolar and double incision criteria
- Still avoids long horizontal chest scars
- Allows more tissue removal than the standard periareolar approach
Recovery Timeline
Days 1–3
Mild to moderate soreness and swelling around the chest are well controlled with prescribed pain medication. You will wear a compression vest to support healing and reduce swelling. Light walking is encouraged, and your care coordinator will check in daily.
Week 1–2
Swelling and bruising gradually subside. The purse-string closure may create temporary puckering around the areola, which smooths out as healing progresses. You will attend a follow-up for wound inspection and to have any sutures assessed. Light daily activities are comfortable.
Weeks 3–4
Comfort and mobility continue to improve. Most patients can resume desk work and gentle exercise. The compression vest is worn for four to six weeks total. Avoid heavy lifting and chest-level exertion during this period.
Months 2–6
The areolar scar matures and blends with the surrounding skin. Any residual puckering or irregularity continues to settle. Full exercise and activity can restart after surgical clearance. Most patients see their settled chest contour by the three-to-six-month mark.
What to Expect
Safety & Risks
Periareolar top surgery is a well-established technique with a good safety profile when performed on appropriately selected patients. As with any surgical procedure, it is important to understand the potential risks.
- Residual breast tissue or inadequate flattening requiring revision
- Skin puckering or contour irregularity around the areola
- Areolar stretching or widening over time
- Temporary or permanent changes in nipple sensation
- Haematoma or seroma formation
- Infection or delayed wound healing (uncommon)
Patient selection is critical to achieving a satisfactory outcome with periareolar top surgery. Chest size, skin quality, and expectations are assessed thoroughly during consultation, and an alternative technique is recommended if periareolar surgery is unlikely to deliver the flat, smooth result you are looking for.
How Much Does Periareolar Top Surgery Cost in Thailand?
Our pricing is transparent and all-inclusive — your quote covers everything from surgeon fees to hospital stay.
Periareolar Top Surgery
All-inclusive surgical package- Board-certified surgeon fee
- Anaesthesia & operating theatre
- Hospital stay & nursing care
- Post-operative medications
- Follow-up appointments
- Dedicated care coordinator
Common Questions About Periareolar Top Surgery
Everything you need to know before your procedure
Dr. Kanokwan Pattanaporn
MEDICALLY REVIEWEDDr. Kanokwan Pattanaporn
MEDICALLY REVIEWEDGender Affirmation Surgeon · Bangkok
Last reviewed: February 25, 2026
Medical References
- WPATH Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (2022)
- Wolter A et al. Periareolar Approach for Subcutaneous Mastectomy in Female-to-Male Transgender Patients — Journal of Plastic, Reconstructive & Aesthetic Surgery (2015)
- Claes KEY et al. Chest Surgery for Transgender and Gender Diverse Individuals — Clinics in Plastic Surgery (2018)
Medical disclaimer: Content on this site is provided for informational purposes and should not be treated as medical advice. Outcomes, timelines, and eligibility differ from person to person. Speak with an experienced gender-affirming surgeon before proceeding with any procedure.
What's Included
- Board-certified surgeon fee
- Anaesthesia & operating theatre
- Hospital stay & nursing care
- Post-operative medications
- Follow-up appointments
- Dedicated care coordinator
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