This is a procedure that does not involve cutting and removing skin under the line of our pectoral muscles. Instead, this procedure involves cutting the area around (peri-) the nipple (areolar) and removing breast tissue and fat from this smaller incision. Variations of this procedure have been called keyhole, circumareolar, and minimal scar. Peri procedures leave a scar around the nipple, but are only recommended for smaller chest sizes, otherwise we can get skin puckering and chests that are not as flat as we wanted. Because this procedure is less invasive than the double incision, it has the best chance of preserving nipple sensation. Not everyone is eligible for this procedure, and it is appropriate for those of us who are small-chested (usually A or B cup) and have less loose skin in the area. This is often determined by the surgeon by taking measurements and looking at our chest composition. Some surgeons are more comfortable than others operating on “borderline” candidates, those of us who are on the edge of being eligible for periareolar procedures in that surgeon’s practice. If you are “borderline” but really want a periareolar surgery, you might need a second revision surgery in order to be happy with your final result. Emerging research on this surgery shows that this version of top surgery is associated with higher risks of bleeding-related complications, as the surgeon has a smaller “window” to work through.