Dr. Gary Alter, M.D. Female to male transsexuals usually need chest contouring to create male appearance. The surgery required depends on breast size and the amount of excess skin. Small breasts can be removed through an incision around the junction of the skin and areola. At the same time, the nipple is reduced and the areola made smaller. A larger breast must be removed though a transverse incision with a free nipple graft.
Every attempt is made to minimize the scars.
The nipple areolar complex can also be maintained on a pedicle of breast tissue, but this can leave a large amount of breast tissue on the larger breast and result in a longer scar. Liposuction is often combined with these procedures to provide optimal contouring.