A periareolar incision is a circular cut made around the edge of the areola, the pigmented skin surrounding the nipple. It is also called a circumareolar incision, and in top surgery it is often shortened to “peri”. Because the scar follows the natural border between darker and lighter skin, it is one of the least conspicuous ways to access the chest.
This page explains the incision itself: where it is placed, how it is closed, how the areola is resized and how the scar heals. If you are considering the full procedure, our guide to periareolar top surgery, written by Mr Giuseppe Di Taranto, covers candidacy, recovery, risks and costs in detail.
What is a periareolar incision?
“Periareolar” simply means around the areola. The terms periareolar and circumareolar describe the same approach, and you may also see it referred to as the “donut” technique because of the ring of skin that is removed.
The incision gives the surgeon access to the breast tissue underneath without making a horizontal cut across the chest. The nipple and areola stay attached to their own blood supply, rather than being removed and replaced as a graft.
The same incision pattern is used in other areas of breast surgery, but in gender-affirming care its main role is in chest masculinisation for patients with smaller chests and good skin elasticity.
Where exactly is the periareolar incision placed?
The surgeon marks two concentric circles. The inner circle sits on the areola and defines its new, smaller size. The outer circle is drawn further out on the surrounding chest skin.
The ring of skin between the two circles, the “donut”, is then removed. Breast tissue is taken out through this opening, and liposuction may be used to refine the contour of the chest.
The wider outer circle is then gathered in towards the smaller areola with a purse-string suture, sometimes called a round-block suture. This tightens the skin of the chest and leaves a single circular scar along the edge of the new areola.
Does a periareolar incision reduce areola size?
Yes. Reducing the areola is built into the technique. Because the nipple-areola complex is not removed, it will not shrink to a more masculine size on its own, so the surgeon resizes it directly while it stays attached.
The average male areola is oval rather than round, around 2.7 cm wide and 2.0 cm tall. There is no single target size: the final dimensions are planned at consultation according to your chest proportions. Our article on nipple and areola reduction in top surgery explains the options in more depth.
As the scar matures, tension along the incision can make the areola stretch slightly. For this reason it is usually designed a little smaller at the time of surgery.
The periareolar incision in top surgery: who it suits
A periareolar incision can only remove a limited amount of skin. It works best when there is little excess skin to tighten and the skin can retract well after the tissue is removed.
In Mr Di Taranto’s assessment, the periareolar approach is generally indicated for chests classified as Fischer grades 1, 2A and 2B, with a nipple-to-fold distance of under about 7 cm. Larger chests, grades 3 and 4, usually need a double incision to achieve a flat, well-contoured result.
Whether the incision is right for you depends on your anatomy, not only on your scar preference. The candidacy criteria, step-by-step technique and recovery are covered in the complete periareolar top surgery guide.
Periareolar vs keyhole vs double incision: where the scars sit
The three main top surgery techniques differ mainly in how much skin they can remove and, as a result, where the scars end up.
- Periareolar (circumareolar): one circular scar around the full edge of the areola. Skin is removed and the areola is resized.
- Keyhole: a short semi-circular scar along the lower edge of the areola only. No skin is removed, so it suits very small chests with good elasticity. See keyhole top surgery.
- Double incision: two horizontal scars along the lower chest, usually with circular scars from free nipple grafts. It suits medium to large chests. See FTM top surgery.
In short, a keyhole incision leaves the smallest scar but removes no skin, while a periareolar incision trades a full circular scar for the ability to tighten some skin. For a closer look at how each pattern heals, read our guide to top surgery scars: placement, shape and healing.
The periareolar scar: how it heals
Because the incision follows the border of the areola, the change in pigmentation helps to disguise it. A periareolar scar is usually less noticeable than a horizontal chest scar, but like any scar it changes over time:
- 0–6 months: the scar is pink or red, slightly raised and firm. This is the most active phase of healing.
- 6–12 months: it gradually flattens, softens and fades in colour.
- From 12 months: most scars settle into a thin, pale line, although some continue to soften for longer.
Good aftercare makes a real difference. Once the wounds have closed, Mr Di Taranto’s team usually recommends silicone gel or sheets from around 8 weeks, together with gentle massage, and SPF 50+ or covering the scars for at least 12 months, as sun exposure can permanently darken an immature scar.
Tension is the main reason a periareolar scar can widen. That is why you will be asked to avoid lifting your arms above shoulder height and heavy lifting in the first weeks, and to stop smoking and nicotine for at least three weeks before and after surgery. If a scar does widen or the areola stretches, it can be improved with a minor revision once the scar is fully mature. More practical advice is available in our pages on mastectomy scars and keyhole surgery scars.
Is a periareolar incision right for you?
The best incision is the one that suits your chest, not simply the one with the shortest scar. A careful examination of breast volume, skin quality, nipple position and the distance to the chest fold is what determines whether a periareolar approach can give you a flat, natural-looking result.
Mr Giuseppe Di Taranto, Consultant Plastic and Gender Surgeon, sees patients at the Chelsea and Westminster Hospital (Private Care) and The Cadogan Clinic in London. If you would like a personal assessment of whether a periareolar incision is suitable for you, book a consultation with our team.
Frequently asked questions
Is periareolar the same as circumareolar?
Yes. Periareolar and circumareolar describe the same incision: a circular cut around the edge of the areola. You may also hear it called “peri” or the “donut” technique.
Does a periareolar incision reduce areola size?
Yes. A ring of skin is removed around the areola and the surrounding skin is gathered in with a purse-string suture, so the areola is made smaller during the same operation. Its final size is planned at consultation.
Is a periareolar incision the same as keyhole?
No. A keyhole incision is a short semi-circular cut along the lower edge of the areola and removes no skin. A periareolar incision goes all the way around the areola and allows some excess skin to be removed.
How visible is a periareolar scar?
Because it sits on the natural border of the areola, the scar is usually well disguised once mature. In the first months it is pink and raised; with silicone, sun protection and time it typically fades to a pale line.
How long does a periareolar incision take to heal?
The wound itself closes within the first few weeks, but the scar keeps maturing. It is usually red for up to 6 months, softens between 6 and 12 months, and most scars have settled into a fine line from around 12 months.
