Chest construction surgery involves the removal or reduction of breast tissue and skin to make a flatter chest. It may involve changing the size and/or position of the nipples.

The goal is to have a chest with sensation, nipples with sensation (varies by technique), a fairly symmetrical chest with aesthetically pleasing contouring and minimal scarring (varies by technique).

Chest reduction is another option for those who prefer to minimize their chest tissue. These surgeries are done by a plastic surgeon.

Types of Procedures

There are many different techniques that can be used for chest construction. The technique used depends on factors like cup size and skin elasticity, as well as the size and position of your nipples. The three most common techniques are described below. Your surgeon will recommend a technique suited to your body shape and goals.

Keyhole

This technique may be used for those with an A cup size and lots of chest skin elasticity.

• A small incision is made along the bottom of the areola.
  
• Chest tissue is removed via a liposuction needle through the incision.
  
• The incision is closed. The nipple is usually not resized or repositioned.
  

This technique results in a small scar on the lower part of the areola and nipples with sensation.

Periareolar

This technique may be used for those with a B cup size or a C cup size and moderate to lots of chest skin elasticity.

• An incision is made all around the outside of the areola.
  
• A second circular incision is made a few centimetres away from the first.
  
• The doughnut shaped skin between the two incisions is removed.
  
• Chest tissue is then removed with a scalpel, or with a combination of scalpel and liposuction.
  
• Some trimming of the nipple areola complex may be done but the blood and nerve supply remain intact.
  
• The skin is sutured together around the areola.
  
• Drains (long thin tubing) may be placed in the chest to help drain off excess blood and fluid so that it will not build up under the skin.
  

This technique results in scarring that goes around the nipple-areola complex and nipples with sensation. There may be some puckering around the incision.

Double Incision

This technique may be used for people with a C cup size and reduced skin elasticity, or a D cup size.

• Large incisions are made horizontally across the chest, usually beneath the nipple.
  
• The skin is peeled back. Chest tissue is removed with a scalpel.
  
• Excess chest skin is trimmed.
  
• Incisions are closed, leaving two scars below the pectoral muscle lines.
  
• The nipple-areola complex is removed completely, trimmed to a smaller size and grafted to the chest in a higher position.
  
• Two drains (long thin tubing) are placed along each incision to allow blood and fluid to escape.
  

This technique results in prominent scars. (You may be able to grow chest hair to cover the scars or building your pectoral muscles may make the scars less noticeable. 

Some people choose to get tattoos over their scars.) There may be possible changes to the pigment or the areola. The sensory changes include complete loss of sensation in the nipples.

All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and artery blockages. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise, and respond to them appropriately. They will also inform you about what you can do to minimize your risks.

Some complications are particularly associated with chest construction. Below are a list of some possible complications of this surgery. Please note – this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

Absess Formation

An abscess is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon

Contour irregularities

When the skin tissue isn’t the expected shape. Major contour irregularities can be corrected through liposuction. This is necessary in about 5 to 25% of cases, depending on the surgeon and the technique

Decreased sensation

This is possible with the keyhole and periareolar surgeries and an expected result of double incision surgery (in which the  nipple-areola complex is removed completely and re-grafted to the chest)

Hematoma

When blood collects in the surgical site, causing pain, swelling and redness. It is the most common complication. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery

Nipple asymmetry

When the shape or location of nipple on one side looks different from the nipple on the other side. Some asymmetry is common; very noticeable asymmetry can be corrected through a surgical revision

Nipple necrosis

When the nipple, or part of it, falls off. If this happens within hours after surgery, saving the nipple may be possible; otherwise, the nipple may need to be replaced or reconstructed. This complication is rare.

Scarring

Scarring is to be expected; the degree varies by technique. Severe scarring may require surgical revision. You can take steps to prevent severe scarring by following your surgeon’s advice about getting rest, avoiding the sun, doing massage exercises and using ointments

Seroma

when clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon. Big seromas may need to be removed through surgery