Double Incision Top Surgery in Istanbul
Double incision with free nipple grafts is the most widely used technique for FTM top surgery. It gives the surgeon direct control over chest contour, skin removal and nipple position, so it is usually the most reliable way to achieve a flat chest when the chest is medium to large or the skin has stretched. Dr. Hakki Izmirli performs this operation in Istanbul for international patients.
What Is Double Incision Top Surgery?
Two incisions are made along the lower border of the chest muscle. Through them, the breast tissue and the excess skin are removed, and the remaining skin is redraped to create a flat, masculine contour. Liposuction may be used to refine the sides of the chest.
The nipples and areolas are removed, resized to a more masculine proportion and placed back as free nipple grafts in a position that suits the new chest.
Who Is It Suitable For?
Double incision is usually recommended if you have:
- a medium or large chest
- noticeable skin excess or sagging
- nipples that sit low and need to be repositioned
- reduced skin elasticity, for example after long-term binding
The final choice is made at your consultation, after Dr. Izmirli assesses your chest volume, skin excess, skin elasticity and nipple position. If your chest is small and firm, a keyhole or periareolar approach may be more appropriate.
How the Operation Is Performed
- Marking: the incision lines and new nipple positions are planned with you standing, before surgery.
- Surgery: under general anaesthesia, breast tissue and excess skin are removed and the chest is contoured. The operation takes about 2.5 to 3 hours.
- Nipple grafts: the nipples are trimmed and grafted to their new position, and a tie-over dressing is placed on each graft.
- Drains: small drains are placed to remove fluid during the first days of healing. They are removed at a check-up in Istanbul.
- Hospital stay: you stay one night in hospital.
Scars
Double incision leaves two horizontal scars across the lower chest. They are placed along the lower edge of the chest muscle so that they follow its natural shadow. Scars are red and firm at first and fade gradually over 12 to 18 months. How a scar matures depends on your skin, genetics and aftercare; you receive scar-care instructions at your follow-up.
Nipple Grafts: What to Expect
- A tie-over dressing is placed on the grafts at the end of surgery and removed at a check-up in Istanbul on the fifth day after surgery.
- It is normal for grafts to look dark or patchy during the first weeks.
- Nipple sensation is often reduced or lost after grafting. Some patients regain partial sensation over time, but this cannot be guaranteed.
Dr. Izmirli’s research on free nipple grafting has been published in Aesthetic Plastic Surgery, Plastic and Reconstructive Surgery and JPRAS.
Recovery Timeline
| Day 0 | Surgery (2.5–3 hours), one night in hospital |
| Day 5 | Tie-over dressings removed from the nipple grafts |
| Days 1–7 | Stay in Istanbul for check-ups; drains removed before you fly home |
| About 1 week | Return to desk-based work |
| 1 month | Wear the compression binder |
| 2 months | Return to the gym and heavy lifting |
Recovery varies from person to person. Your aftercare continues remotely once you are home.
Risks
Like any surgery, double incision top surgery carries risks. These include bleeding or haematoma, fluid collection (seroma), infection, partial or complete loss of a nipple graft, wide or raised scars, contour irregularities such as “dog ears” at the ends of the scars, and changes in sensation. Some of these can be corrected with a minor revision. Dr. Izmirli discusses your individual risks at your consultation.
Double Incision or Another Technique?
| Technique | Best for | Scars | Nipple sensation |
|---|---|---|---|
| Double incision | Medium–large chests, skin excess | Two horizontal scars | Often reduced or lost |
| Keyhole | Small, firm chests | Small scar at areola edge | Better chance to keep |
| Periareolar | Small chests, mild skin excess | Around the areola | Better chance to keep |
| Inverted-T | Medium–large chests, sensation a priority | Horizontal + short vertical | Better chance, not guaranteed |
Read more about each technique on our FTM top surgery page.
Your Consultation
A letter from a psychiatrist or therapist is not required at our clinic; a signed informed consent form is sufficient. If you already have a letter, you are welcome to share it. Send your photos for a free online consultation, and Dr. Izmirli will tell you whether double incision is the right technique for your chest.
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About the surgeon
Dr. Hakki Izmirli
Plastic surgeon with 20 years of experience, based in Nişantaşı, Istanbul. Dr. Izmirli trained at Istanbul University Faculty of Medicine and completed his residency in Aesthetic, Plastic and Reconstructive Surgery at Kocaeli University. His research on free nipple grafting has been published in Aesthetic Plastic Surgery, Plastic and Reconstructive Surgery and JPRAS.
Professional memberships: WPATH (Full Member) · ISAPS · ASPS (International Member) · TPRECD
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Medical disclaimer: The information on this website is for general information only and does not replace a personal consultation with a doctor. Every patient is different; results vary from person to person and cannot be guaranteed.
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