Double incision mastectomy is a gender affirming top surgery designed for trans masculine and gender diverse patients seeking a flat, masculine chest contour. This technique is commonly used for patients with moderate to larger amounts of chest tissue and allows for precise removal of tissue and reshaping of the chest.
The procedure includes removal of excess breast tissue and skin, with careful repositioning of the nipples to create a natural, balanced chest appearance. Each surgical plan is customized based on anatomy, chest size, and desired outcome, with a focus on symmetry, contour, and long term comfort.
Double incision mastectomy at SimplyTrans is performed under the care of Dr. David Sayah. Patients seeking double incision mastectomy in Beverly Hills or Los Angeles choose SimplyTrans for physician led planning, meticulous technique, and refined results that support confidence and alignment with identity.
Double incision mastectomy is a widely performed gender-affirming chest masculinization (“top”) surgery and may also be used as a preventive or medically necessary mastectomy. This procedure removes breast tissue through two horizontal incisions placed along the lower chest, allowing for complete tissue removal and precise chest contouring. It is especially well-suited for individuals with medium-to-large chest sizes and often includes free nipple grafts to reposition the nipples, creating a flatter, more masculine chest appearance.
Key Aspects of the Procedure
Surgical Technique:
The procedure uses two horizontal incisions to remove breast tissue and excess skin. In many cases, liposuction is also performed to further refine the chest contour and reduce the chance of “dog ears,” or excess tissue near the underarms.
Free Nipple Grafts (FNG):
Free nipple grafts are commonly part of this technique. The nipples are removed, resized if needed, and grafted back into a more masculine position on the chest. While this can improve the final aesthetic result, it often leads to reduced or complete loss of nipple sensation.
Double incision mastectomy is a widely performed gender-affirming chest masculinization (“top”) surgery and may also be used as a preventive or medically necessary mastectomy. This procedure removes breast tissue through two horizontal incisions placed along the lower chest, allowing for complete tissue removal and precise chest contouring. It is especially well-suited for individuals with medium-to-large chest sizes and often includes free nipple grafts to reposition the nipples, creating a flatter, more masculine chest appearance.
Key Aspects of the Procedure
Surgical Technique:
The procedure uses two horizontal incisions to remove breast tissue and excess skin. In many cases, liposuction is also performed to further refine the chest contour and reduce the chance of “dog ears,” or excess tissue near the underarms.
Free Nipple Grafts (FNG):
Free nipple grafts are commonly part of this technique. The nipples are removed, resized if needed, and grafted back into a more masculine position on the chest. While this can improve the final aesthetic result, it often leads to reduced or complete loss of nipple sensation.
Best Candidates:
Double incision mastectomy is generally ideal for patients with:
- Larger chest size
- Moderate to significant breast ptosis (sagging)
- Excess skin or reduced skin elasticity
For these patients, this approach often provides the most effective contouring and overall chest shape.
Recovery & Results
- Procedure time: Typically 2–4 hours
- Anesthesia: Performed under general anesthesia
- Drains: Surgical drains are commonly placed for about 6–7 days to help remove excess fluid
- Compression garment: A compression binder is usually worn for 1–6 weeks
- Return to activity: Many patients can return to light activity or desk work within about 2 weeks
Scarring
This technique does result in horizontal scars across the chest, but these scars typically fade and soften over time with proper healing and scar management.
Risks & Considerations
As with any surgical procedure, potential risks include:
- Bleeding
- Infection
- Poor wound healing
- Scarring
- Contour irregularities
- “Dog ears” or excess tissue near the underarms
A key consideration is that free nipple grafting commonly causes a significant decrease or complete loss of nipple sensation.
Why Choose Dr. Sayah for Double Incision Mastectomy in Los Angeles
Selecting a board-certified plastic surgeon with extensive Double Incision Mastectomy experience and commitment to safety protocols ensures optimal Double Incision Mastectomy results. Dr. Sayah’s qualifications include:
- Board certification by the American Board of Plastic Surgery
- Fellowship of the American College of Surgeons (FACS)
- Over 26 years of plastic surgery experience
- Medical degree from UCLA David Geffen School of Medicine, graduated top of class
- General surgery training at NYU Medical Center
- Plastic surgery residency at UCLA Medical Center
- Advanced fellowship training in endoscopic plastic surgery
- Hospital privileges at Cedars-Sinai Medical Center, Saint John’s, and UCLA
- Published research in fat grafting, surgical techniques, and body contouring
- Extensive experience with complex body sculpting procedures
- Artistic background as oil painter and sculptor
- International reputation serving patients from around the world
- Multilingual capabilities (English, French, Spanish, Farsi, Italian)
- Clinical faculty positions at Cedars-Sinai Medical Center and USC
- Member of the American Society of Plastic Surgeons
Dr. Sayah’s comprehensive training in reconstructive and aesthetic surgery, combined with his artistic sensibility, enables him to create beautiful, natural-looking enhancements that complements your unique body proportions. His commitment to patient safety, adherence to established safety protocols, and meticulous surgical technique ensure you receive exceptional care and optimal outcomes.
Meet Dr. David Sayah
Dr David Sayah is a board certified plastic surgeon in Beverly Hills known for his natural approach to aesthetic surgery. With more than 26 years of experience, he combines surgical precision with artistic insight to deliver balanced and refined results. His philosophy centers on enhancing individual beauty rather than changing it.
A graduate of the UCLA School of Medicine and a Fellow of the American College of Surgeons, Dr Sayah trained at leading medical centers including NYU and UCLA. His work in wound healing and scar formation research helps patients heal beautifully with minimal scarring. Fluent in five languages, he welcomes patients from Beverly Hills, Los Angeles, and across the world who seek exceptional, natural results.
