Buttonhole Top Surgery in Denver & Golden, CO
Buttonhole top surgery is a gender-affirming chest masculinization procedure that removes breast tissue while preserving nipple sensation. Offered at the Center for Cosmetic Surgery, this technique provides a thoughtful alternative to traditional top surgery approaches, especially for those seeking a flatter chest and improved sensory outcomes.
What Is Buttonhole Top Surgery?
This technique is a type of masculinizing mastectomy that removes breast tissue and repositions the nipple-areola complex (NAC) while preserving its nerve and blood supply. The NAC remains attached to a thin stalk of tissue known as a dermal pedicle. This connection helps maintain sensation and allows the nipple to be repositioned without being fully detached from the body.
“Buttonhole” refers to the small circular incision through which the preserved NAC is brought to the surface and secured in its new location. This method avoids the complete detachment seen in free nipple grafting.
Who Is an Ideal Candidate for Buttonhole Top Surgery?
This technique is best suited for individuals with physical and health profiles that match its surgical requirements. Candidates typically:
- Are in overall good health and fit for a two to three-hour surgery
- Are non-smokers or willing to stop nicotine use temporarily
- Maintain a stable weight, generally under 200lbs
- Have moderate to large chest volume with some skin laxity
- Can accept a slightly contoured chest under the nipples to preserve sensation
- Have nipple-areola positioning that doesn’t require major relocation
Those over 40 should get medical clearance from a primary care provider. As part of standard protocol, the removed tissue is sent for pathology review.
Key Benefits of Buttonhole Chest Surgery
Buttonhole surgery is chosen by individuals who meet specific anatomical criteria and highly value sensory preservation. Benefits include:
- Greater likelihood of maintaining both tactile and erotic nipple sensation
- Natural-looking nipple placement using live tissue rather than grafts
- Improved contouring for patients with moderate to larger chest sizes
- Minimal scarring around the areola due to partial preservation of the NAC
- Outpatient procedure with a streamlined recovery process
The approach prioritizes function and aesthetics, especially for those seeking long-term sensory outcomes.
How the Buttonhole Technique Works
The surgery is performed under general anesthesia at our accredited outpatient center. Key steps include:
Pre-Surgical Marking
With the patient upright, markings are made to plan incision lines and final nipple positioning.
Incision and Tissue Removal
A horizontal incision is made along the lower chest, and a circular incision is placed around each areola. Excess skin and breast tissue are removed through the horizontal access point.
Preserving the NAC
The nipple-areola complex is left attached to a narrow dermal pedicle, which contains its nerve and vascular supply. This preserved tissue allows for better sensory outcomes.
Nipple Repositioning
The areola is resized to a typical male diameter. A new circular opening (the “buttonhole”) is made in the ideal position, and the NAC is brought through and sutured in place.
Chest Contouring and Closure
Final shaping is done to create a masculine contour. Incisions are closed with sutures, and drains may be temporarily placed.
Recovery Timeline and Expected Results
Recovery from Buttonhole top surgery follows a structured timeline. Nerve healing and contour stabilization continue over time.
First Two Weeks
- Drains are usually removed within the first seven days
- Compression garment worn consistently
- Limit arm movements and avoid lifting heavy objects
- Gentle walking is encouraged
Two to Six Weeks
- Most return to light work and daily activities
- Gradual reintroduction of mobility
- Upper-body exercise remains restricted
Six Weeks and Beyond
- Cleared for full activity including workouts
- Final chest shape becomes more defined as swelling subsides
- Full results often stabilize after several months
Nipple Sensation
Sensation may return gradually, sometimes taking up to a year. Outcomes vary, but this technique improves the chances of regaining both touch and erotic sensation.
Scar Management
Once the incisions are healed, typically after three to four weeks, silicone-based treatments and massage can be introduced to help soften and lighten scars.
Cost of Buttonhole Top Surgery in Colorado
The cost of Buttonhole top surgery varies depending on your anatomy, surgical needs, and additional services such as extended recovery support. A detailed, individualized estimate will be provided during your consultation.
For patients traveling from out of town, we offer assistance with nearby hotel arrangements and can coordinate overnight nursing services if needed.
Buttonhole Top Surgery Before & After Photos
Our before-and-after gallery highlights a wide range of outcomes—from different chest shapes to variations in scarring and nipple placement.
These photos give you a closer look at how Dr. Steinwald personalizes each procedure, working with your anatomy and goals to create results that feel right for you.
Why Choose Us for Buttonhole Top Surgery in Colorado
Dr. Paul Steinwald brings over 20 years of experience performing gender-affirming chest surgery. As one of the first surgeons to modify traditional breast reduction techniques for transmasculine patients, he continues to lead with innovation that centers on safety, sensation, and long-term results.
He holds dual board certifications in plastic and general surgery, providing him with the depth and versatility to address various anatomical needs. His technique prioritizes preservation of nerve pathways, offering patients a better chance of maintaining nipple sensation after surgery.
All procedures are performed at our accredited Apex Surgical Facility, which features board-certified anesthesiologists, ensuring a high standard of safety and comfort. From your first consultation through post-operative care, you’ll receive personalized support and honest, affirming guidance every step of the way.
Buttonhole Top Surgery FAQs
Schedule Your Buttonhole Top Surgery Consultation
Interested in a gender-affirming procedure that prioritizes both form and feeling?
Schedule your Buttonhole Top Surgery consultation in Denver today to take the next step in your chest masculinization journey.