Which Mastectomy Technique Is Right for You? Double Incision vs. Semiareolar vs. Donut

Choosing between double incision, semiareolar, and donut mastectomy comes down to three things: your chest size, the degree of breast ptosis (how much the breast tissue droops), and your own preference. All three are performed as part of top surgery and take around 90 minutes. Here is how they compare.

The three techniques at a glance

Double incision with free nipple graft

• Best suited for: larger chests, more significant breast ptosis

• Scarring: most visible of the three techniques, though placed and closed to heal as discreetly as possible

• Areola: nipples are resized and repositioned as a free graft

Semiareolar / periareolar

• Best suited for: smaller chests, minimal ptosis, good skin elasticity

• Scarring: least visible of the three techniques

• Areola: incision follows the natural edge of the areola

Donut (double-circular)

• Best suited for: a middle ground in chest size and ptosis, between the other two techniques

• Scarring: more visible than semiareolar, less than double incision

• Areola: smaller skin excision; areola can be repositioned 1-2 cm higher

How is my technique chosen?

Your surgeon recommends a technique based on your chest size, the degree of breast ptosis, and your personal preference. This is a conversation, not a one-size-fits-all decision — you will discuss the options and land on the right fit together at your consultation.

How do the scars compare?

Semiareolar leaves the least visible scarring, followed by donut, then double incision. That said, double incision scars are the necessary trade-off for patients with larger chests or more ptosis, where the other two techniques are not a safe or effective option.

How long does the surgery take?

All three techniques take approximately 90 minutes, regardless of which one is right for you.

Will I need surgical drains?

Drains are not used on a routine basis. They are used if your procedure is combined with liposuction of the chest or preaxillary area, or if your tissue is more prone to bleeding. When drains are needed, they are typically removed within the first week after surgery — and it is perfectly fine to travel home with them in place if you are visiting from abroad.

Ready to find out which technique is right for you?

Your surgeon will assess your anatomy and goals at consultation and recommend the technique that fits you best. Book a consultation to get started — available digitally for international patients.

Medically reviewed by Dr. Sayid Zommorodi, board-certified plastic surgeon with a PhD in surgical sciences from the Karolinska Institute. Last updated July 2026.