I consulted last week with a local surgeon (one hour away) who does a sort of variation on double incision but keeps the nipple attached to a pedicle of tissue. He does not do nipple grafts. I have a big chest, so peri and keyhole are not options for me.

This surgeon makes one long incision along the bottom, creates a hole high on the chest, and pulls the nipple through the hole. I guess this is similar to the old "anchor" technique.

I saw one set of before and after shots of a guy who was similar to me in chest size and body type, and the result was quite good. I'm going to compare notes with another FTM who just consulted with this surgeon, and I should be hearing from one or two former clients very soon.

My question is stated in the subject line. Why have such surgeries mostly fallen out of favor? Why is DI with nipple graft so much more popular these days?

P.S. On a side note, I'm very serious about having this guy do my surgery. I would like to preserve sensation and would also like to get my surgery locally. I've heard good things about this guy from a few other FTMs (although a couple had small breasts and had a peri or keyhole procedure, so their experiences are of limited value to me). The surgeon answered all of my many questions (I had an extensive list), and he seemed pretty cool. The price for cash is $8000, and that includes everything but the pain meds. But I do wonder why so few surgeons practice similar techniques.

I think Reardon was one of the few to perform that and he's retired. I was going to go with him about 3 years ago before my illness. But then I also found out that breasts may have to be a certain size for it to work.

nipple grafts don't necessarily mean no sensation.  i've retained most of what i had pre op.

my understanding on the pedicle technique is that it is inferior to grafts in both the placement and resizing of your nipples.