Every top surgery leaves scars. What varies and what can be planned is where they sit, what shape they take, and how well they fade. Those three things are decided partly by the surgical technique, partly by your anatomy, and partly by how the scars are looked after in the months after surgery. This guide covers all three, including a question patients rarely know they can ask: what shape do I want my scars to be?
Top Surgery Scar Patterns at a Glance
The table is a general guide only. A consultation and physical assessment are needed to determine which options are appropriate for an individual chest.
Where Scars Sit With Each Technique
The technique that suits you is determined mainly by chest size, skin elasticity and your priorities around nipple sensation and each one produces a different scar pattern. An overview of the procedure itself is here: what is top surgery
Double incision
The double incision technique (https://gdtgendersurgery.com/double-mastectomy-surgery) is the standard choice for medium to large chests: two horizontal scars across the chest, that in some cases meet at the centre of the chest, usually with a circular scar around each areola if free nipple grafts are used. In larger chests or where skin elasticity is reduced, the scars extend further laterally to keep the chest flat. The scar pattern is covered in detail here: mastectomy scars after double incision (https://gdtgendersurgery.com/mastectomy-scars).
Periareolar
In the periareolar technique (https://gdtgendersurgery.com/periareolar-top-surgery), the incision runs along the border of the areola, where darker skin meets the surrounding chest. Because the scar sits on an existing anatomical boundary, it is disguised by the change in pigmentation and is usually far less noticeable than a horizontal chest scar. Some widening of the areola can occur as the scar matures; this is anticipated and managed surgically with a round-block suture.
Keyhole
For very small chests with good skin elasticity, keyhole surgery (https://gdtgendersurgery.com/keyhole-top-surgery) leaves a short semi-circular scar along the lower edge of the areola generally the least visible scar of any technique. More on this here: keyhole surgery scars (https://gdtgendersurgery.com/keyhole-surgery-scars).
Buttonhole and inverted-T
These hybrid approaches combine horizontal chest incisions with an incision around the areola, and are usually offered for intermediate chest sizes where keeping the nipple on its own blood and nerve supply is a priority. The full range of techniques is compared on our masculinising surgery page (https://gdtgendersurgery.com/services-for-those-seeking-a-masculine-aesthetic).
Scar Shape and Position: The Conversation Worth Having
With double incision surgery in particular, the horizontal scars do not have to follow a single standard line. Within the limits set by your anatomy, there is genuine choice about where the scars sit and what shape they trace and this is one of the most useful conversations to have at consultation, because it directly shapes how your chest will look. These options apply specifically to double incision mastectomy.
Scars that follow the pectoral border
Placing the incision along the lower border of the pectoral muscle tucks the scar into the natural shadow of the chest. The line is straight centrally and curves upwards towards the armpit, following the anatomy of the muscle itself. This tends to read as the most “anatomical” scar but it is only achievable when there is little excess skin on the outer chest, because the upward curve leaves no room to remove lateral tissue without creating a fold of redundant skin (a “dog ear”) beyond the end of the scar.
Straighter scars
A straight horizontal line suits patients without significant excess tissue at the centre or sides of the chest. The incision is placed slightly above the original breast fold (at the level of the pectoralis major muscle’s “shadow”) and runs only as far as the excess skin requires. Where some lateral excess exists but a straighter look is still preferred, the line can be tapered — kept low in the fold where tissue needs removing and rising only gently at each end.
Curved scars
A more curved scar, echoing the line of the old breast fold, is sometimes preferred including by some non-binary patients who want a softer, less squared-off chest. Counterintuitively, a curved scar is harder to achieve than a straight one: the tension that develops across the chest after surgery pulls scars flat, so the curve has to be deliberately exaggerated at the time of surgery to survive healing.
Connected scars
When the two breast folds sit very close together in the midline, joining the two scars into one continuous line can give a smoother result than leaving a narrow bridge of skin between them, which risks a central fold or divot. Where the folds are naturally further apart, separate scars work well.
Extended scars
When the two breast folds sit very close together in the midline, joining the two scars into one continuous line can give a smoother result than leaving a narrow bridge of skin between them, which risks a central fold or divot. Where the folds are naturally further apart, separate scars work well.
Fishmouth (batwing) Scars
Instead of sitting at the lower chest, the scar can be placed at the level of the areola. Skin is removed around the areola together with a triangle of skin on either side, leaving a horizontal line that runs across the mid-chest through the nipple a pattern known as fishmouth or batwing. Because the nipple stays on its own stalk of tissue, some sensation is often preserved. It suits medium-sized chests with a degree of excess skin, and appeals to patients who prefer a scar that does not follow the anatomical lines of the chest. The technique is described in more detail on our masculinising surgery page (https://gdtgendersurgery.com/services-for-those-seeking-a-masculine-aesthetic).
Previous breast reduction scars
Some patients who have previously undergone breast reduction may later consider a complete mastectomy to achieve a chest that better reflects their gender identity. In these cases, a double-incision mastectomy is usually possible, although the existing scars typically the anchor-shaped “Wise pattern” constrain where the new incisions can be placed.
The new lower incision is generally positioned just below the previous horizontal scar, allowing the old scar to be removed and avoiding two parallel lines across the chest. A nipple graft is usually performed, which also allows the pigmented skin of the original areola to be removed.
Two principles run through all of this. First, anatomy sets the boundaries: skin folds, tissue excess and previous scars influence what is possible, and a shape that suits one chest may produce a less satisfactory contour on another. Second, within those boundaries, the choice is yours. There is no inherently masculine or non-binary scar shape—only the shape that best suits your anatomy and how you want your chest to look. Bringing photographs of results you like to your consultation can help make this conversation more specific and concrete.
How Scars Mature
Scar maturation takes longer than most people expect, and scars normally look worse before they look better:
What Affects How Your Scars Heal
- Skin tone: scars usually settle lighter than the surrounding skin; in more pigmented skin they can stay more visible, and the risk of raised scarring is higher.
- Genetics: a personal or family history of keloids (scars that grow beyond the incision) or hypertrophic scars (raised scars that stay within it) matters raise it at consultation, because it changes both planning and aftercare.
- Wound healing: infection or prolonged inflammation around an incision increases the risk of a poor scar, which is why early wound care is not a formality.
- Tension: stretching across a healing incision widens scars the reason arm movement above shoulder height is restricted in the first weeks.
- Hormonal and circulatory factors: younger age, pregnancy and poorly controlled high blood pressure are all associated with a greater tendency to raised scarring.
Before Surgery: What You Can Do
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Scar quality is partly decided before the operation. Alongside standard pre-operative preparation (https://gdtgendersurgery.com/ftm-pre-op):
- Stop all nicotine cigarettes, vapes, patches for at least three weeks before and after surgery. Nicotine constricts the blood supply to healing skin and is the single biggest avoidable cause of poor wound healing.
- Eat properly: adequate protein, zinc and vitamin C give tissue what it needs to repair.
- Flag anything that slows healing: immunosuppressant medication and conditions affecting circulation should be discussed with your surgeon and GP in advance.
- Weeks 0–3: clean, uncomplicated wound healing is the only goal. Compression controls swelling, dressings protect the incisions, and arms stay below shoulder height.
- From weeks 3–8, once wounds are closed: daily medical tape or sheets keep the maturing scar soft and protect the scars from rubbing and trauma.
- From weeks 8-16, once wounds are closed: daily silicone gel or sheets keep the maturing scar soft; gentle massage helps flatten it. Your surgical team confirms when to start.
- First 12 months: UV exposure permanently darkens immature scars keep them covered or under SPF 50+.
- Throughout: hydration, no smoking, stable weight.
When a Scar Needs More Help
- Most scars settle well with the basics above. For scars that stay red, raised or wider than expected, the options usually in escalating order are:
- Steroid injections to reduce inflammation and break down excess collagen in thickened scars; first-line for hypertrophic and keloid scarring.
- Microneedling to remodel scar texture over a course of sessions.
- Laser and light-based treatment for persistent redness, pigmentation or thickness.
- Medical tattooing to camouflage a mature scar or blend nipple-areola scarring, often alongside areola reconstruction (https://gdtgendersurgery.com/areola-reconstruction/) from around 12 months post-op, the same waiting period as decorative tattoos over scars.
Surgical revision is reserved for mature scars, usually from 12 months onwards, and is most often done under local anaesthetic. Because a revision closes the wound under far less tension than the original operation, the new scar generally heals finer — which is why revising early, before the scar has matured, is counterproductive.
Scars and Identity
Not everyone wants invisible scars. For many patients they are affirming a visible record of a decision that improved daily life and some choose scar shapes or tattoos that make them a deliberate feature. Others want them as discreet as anatomy allows. Both are legitimate starting points for planning surgery, and neither needs justifying.
Common Questions
Do the scars ever disappear completely?
No. Scars are permanent, but most fade to thin, pale lines by 12–18 months, and the treatments above can improve scars that heal poorly.
Can I choose the shape of my scars?
Within the limits set by your anatomy, yes straighter, curved, following the pectoral border, connected or separate. Skin folds, tissue excess and any previous scars determine what is achievable; your preference decides the rest. This is planned together at consultation, ideally with reference photographs.
Which technique leaves the smallest scars?
Keyhole and periareolar, because the incision hides at the border of the areola. Both require a small chest and good skin elasticity; for larger chests, double incision gives the better contour at the cost of longer scars.
Why do my scars look red and raised months after surgery?
Because that is what maturing scars do they are typically at their most red and raised between three and six months. A scar that keeps thickening, itches persistently or grows beyond the incision line should be reviewed, as early treatment of hypertrophic and keloid scarring gives the best results.
What is the difference between a hypertrophic scar and a keloid?
Both are raised, thickened scars. A hypertrophic scar stays within the original incision and usually improves with time and treatment; a keloid grows beyond it and is more likely with a personal or family history. Both respond best to early treatment steroid injections, silicone and laser.
Can I tattoo over my scars?
Yes, once the scar is fully mature generally around 12 months. That applies to decorative tattoos and to medical camouflage tattooing alike.
Talking It Through
Scar placement, shape and aftercare are all discussed at consultation with Mr Di Taranto, including healed results from previous patients so you can see honestly what different choices look like over time. To arrange an appointment, use our contact page (https://gdtgendersurgery.com/contact-us/).
This page is general information, not personal medical advice. Discuss your individual case with a surgeon experienced in transgender healthcare (https://gdtgendersurgery.com/transgender-health-care/).
Medical Disclaimer
This article has been written for general informational purposes and does not replace personalised medical advice. All surgical decisions should be made in direct consultation with a qualified surgeon following individual assessment.
GDT Gender Surgery · Mr Giuseppe Di Taranto, GMC No. 7614248 · www.gdtgendersurgery.com
GDT Gender Surgery | info@mrditaranto.com | www.gdtgendersurgery.com