The periareolar approach is good for size A breast, and will inevitably produce some (hopefully transient) wrinkles as a larger circle is worked into a smaller circle. The smaller circle being the down sized areolar or pigmented shield that surrounds the nipple. A way of minimizing wrinkling is the leave the areolar halfway in size between an ideal male areolar and the original female areolar. This works well aesthetically only for very big FTM patients, but not so for smaller FTM patients who do not want any tell-tale vestiges of their feminity.
We are getting excellent results with a free nipple areolar complex graft. In other words, once removed, the graft is down sized and reapplied precisely in the correct anatomical position judged by when the patient is sat up during anesthesia and after the skin incisions are closed. Some compression is required for 7 days and this is done with both dressing and a compression garment vest which is essential for all patients to minimize bruising and swelling.
Harold M. Reed, M.D.