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To Join or Not to Join – Chest Reconstruction Top Surgery Incisions

In this article, we discuss the reasons why a patient may choose to join or not join incisions for their chest reconstruction top surgery. The decision of whether to join or not to join the incisions for chest reconstruction top surgery can depend on your anatomy, or your preferences for your final aesthetic results or both. At the Gender Confirmation Center (GCC), we have found that there are pros and cons to both approaches. However, our surgeons tend to most commonly join the incisions. We explain why here.

Plastic surgeons try their best to hide the incisions they make during surgery in parts of the body that already exist. For example, they will often place top surgery scars right at the base of the pectoral muscle, which often has a shadow that can at least partially hide the scars as they heal. However, a joined incision, which goes all the way across the chest, is not hidden in any shadow. This means a single scar can be more visually apparent than two scars. Despite this, we want to explain our logic behind why we may join the incisions, leaving patients with one top surgery scar rather than two.

For most top surgeries, we remove some skin along with the chest tissue to flatten and tighten the chest. We do this under the arms to avoid  extra skin that remains after surgery, often referred to as “dog ears.” If the incisions do not meet in the middle of the chest, there can be extra skin there as well. To avoid the incisions meeting in the middle, some surgeons will curve the scars upward, which can resemble the shape of the chest before surgery. This is not an outcome that patients often desire. Instead, we join the incisions to create one straight scar across the chest.

Our surgeons can set expectations for you regarding whether or not you may need incisions that join in the middle, rather than two separate incisions. Some patients are borderline between the two options, in which case an additional conversation is warranted to weigh the pros and cons of either option. A secondary revision surgery is possible as well if you opt for two incisions, but end up with excess skin. 

Ultimately, we do not force our patients to join the incisions if they do not want to. But, we do try to be realistic and let patients know the potential outcomes if it does appear that they may need a joined incision.