The Inverted T (Achchor) Incision

In an Inverted T procedure, the tissue that is attached to the nipple and areola keeps its blood supply and a very thin sheet of that tissue is maintained intact. This tissue, referred to as a pedicle, goes all the way down to the lowest part of the breast area and keeps blood supplied to the nipple and areola. While we hope nerves are also traveling within this pedicle, we won’t know until after the procedure is complete how much nipple sensation is conserved.

After the creation of the pedicle, the rest of the skin is folded around the pedicle and the excess is removed. What’s left over is the incision around the areola which comes from the areola down to the lower breast, and then a curved incision across the lower breast area. The Buttonhole procedure is similar in every way except that not as much skin is removed and therefore the small vertical incision can be omitted from the Buttonhole procedure.



Using the Inverted T method means that the nipple and areola do not need to be placed as a free nipple graft as with Double Incision techniques. Because of this, the Inverted T may result in a better chance of maintaining pre-surgery levels of sensation in the nipples, though this outcome is not certain.

Scarring is a downside because of the extra incision in the central breast area in the vertical region between the areola and the inferior incision. Another possible disadvantage is that the pedicle is left behind to keep the nipple and areola alive. This will contribute volume to the chest resulting in fullness or a mound.

In addition, the lower curvature of the incision is not as customizable by the surgeon because it has to be located in the lower breast fold. The surgeon cannot customize the horizontal location of the areola as much as they can with the double incision approach.



If maintaining a high level of nipple sensitivity is your priority, you may want to consider the Inverted T or the Buttonhole approach. However, it’s important to remember that retention of sensation is not guaranteed.

If you want to maintain a chest that is as flat as possible, or it is important for you to have a completely customized placement of the nipple or the incision, then the traditional Double Incision technique is probably the procedure to choose.