The FTM/N Periareolar Surgery Technique

The FTM/N Periareolar Surgery Technique (also called the ‘donut’ or ‘circumareolar’ technique) is a chest masculinization surgery technique. This technique allows for an intermediate amount of skin removal by using incisions that run in a circular fashion around each areola.



The Periareolar procedure lies at a crossroads between Keyhole surgery and other surgeries that may require more skin removal. This procedure is a good fit for patients who have more skin than would be appropriate for the Keyhole surgery, but wish to have a procedure involving relatively minimal skin incision. It is a good fit for patients with minimal excess skin.  However, all things considered, this is one of the procedures that has a higher revision rate because of the challenges involved, so one has to keep that in mind when choosing this procedure.


Other names for the Periareolar procedure are Circumareolar and Donut Incision techniques. They all refer to the same thing, but Periareolar is most commonly used. Some people call the procedure a “peri” for short.



The procedure involves a donut shape of skin removal around the areola. This is performed by marking the areola down to a more masculine size (about 22 mm in diameter), and then marking an outer circle of skin to be excised. The outermost layer of the skin (the epidermis, plus a very superficial portion of the dermis) is removed. Then, through this layer of tissue, the surgeon makes an incision and then works beneath the layers of the skin to remove the breast tissue.


After the breast tissue has been removed, the surgeon performs a stitch called a “purse string” stitch to bring the outer circle down to the diameter of the inner circle. Sometimes, this has the downside of creating a pleating affect, oftentimes called a sunburst or a ripple pattern around the area left because of the mismatch between a large circle and a small circle. Most of the time, these ripples diminish or disappear completely in the weeks and months that follow surgery.


The result is a male appearing areola requiring only a single incision around the circle of the areola.



This procedure depends on a relatively narrow margin of error with regards to the health of the layer of fat on the tissue that is left beneath the skin. Achieving a perfectly uniform thickness across the entire chest can be a challenge even for the most capable of surgeons. Therefore, it is not uncommon for there to be some very subtle undulations in the surface contour of the chest with this procedure. Although these minor irregularities can happen with any procedure, they are less common with the Double Incision procedure.



While most patients have a considerable decrease in sensation immediately after surgery, the majority recover most or all sensation. This is one of the great advantages of this procedure



While periareolar surgery has many advantages, it can only be used if the patient requires minimal excess skin removal. To get a better idea of which body type you have and therefore which surgical procedure is the best fit for you click here. Using the Periareolar technique on a patient with excess skin can result in a loose fold of skin in the lower chest or a pronounced pleating or sunburst pattern of wrinkling around the areola that does not go away.


We can never be 100% sure of how skin is going to react to any procedure, but there are parameters which can help you and your surgeon determine which procedure is the right one for you.



For some patients, chest tightness is extremely important. If that is the case, the Double Incision technique will likely produce better results than the Periareolar. While the Double Incision procedure does create a considerable horizontal scar, it is the most powerful procedure for achieving a uniformly tight and smooth chest appearance.


Up at the top is an animated video that shows how the periareolar (a.k.a. donut) FTM/N surgery is done