This is a unique FTM case.   The patient was a candidate for a keyhole procedure on the right but was a poor candidate for keyhole on the left.  If we did a double incision on the left the patient would have a large scar and his nipples would not look alike since the left nipple would be a graft.  For that reason we performed a keyhole on the right and a “circumvertical” technique on the left which preserved the nipple and removed excess skin through and oblique incision.  Three month photo, (scars still fading).