Transsexual Mastectomy: Selection of Appropriate Technique According to Breast Characteristics

Year 2017, Volume: 34 Issue: 2, 147 - 155, 01.03.2017

Hüsamettin Top Serkan Balta

Abstract

Background: Subcutaneous mastectomy for female- to-male transsexuals is usually the first surgical pro- cedure in sexual reassignment. The main objective of subcutaneous mastectomy is to create an aesthetically pleasing male chest contour by removing all glandular tissue while minimizing chest wall scars. Aims: In this paper, we present our experience with subcutaneous mastectomy performed in female-to- male transsexual patients. The authors recommend their point of view to aid in selecting the most suitable subcutaneous mastectomy technique depending on breast characteristics. Study Design: Retrospective cross-sectional study. Methods: Between March 2011 and December 2014, 52 patients underwent bilateral subcutaneous mastec- tomies (total of 104 mastectomies), performed using the following four techniques: Webster semicircular, concentric circular, vertical, and apron flap. The tech- nique decision depended on the breast size, degree of skin excess, skin elasticity, chest width, nipple areolar complex size and position. Results: Seventeen patients (32.7%) were operated with Webster semicircular, 7 patients (13.5%) with con- centric periareolar, 12 patients with vertical (23%); and 16 patients (30.8%) with the apron flap technique. The overall postoperative complication rate was 13.4%. All patients were satisfied with the aesthetic results of their subcutaneous mastectomies within the follow-up period. Conclusion: To obtain higher patient satisfaction with aesthetic results and lower postoperative complication rates, breast characteristics are evaluated in a detailed fashion, while choosing the ideal technique of Female-to-Male (FtM) subcutaneous mastectomy. The presented surgical new algorithm facilitates the selection of the most reliable surgical technique.

Keywords

Female-to-male, transsexual, subcutaneous mastectomy

References

• 1. Lindsay WR. Creation of a male chest in female transsexuals. Ann Plast Surg 1979;3:39-46.
• 2. Colić MM, Colić MM. Circumareolar mastectomy in female- to-male transsexuals and large gynecomastias: a personal ap- proach. Aesthetic Plast Surg 2000;24:450-4.
• 3. Hage JJ, van Kesteren PJ. Chest-wall contouring in female-to- male transsexuals: basic considerations and review of the litera- ture. Plast Reconstr Surg 1995;96:386-91.
• 4. Hage JJ, Bloem JJ. Chest wall contouring for female-to- male transsexuals: Amsterdam experience. Ann Plast Surg 1995;34:59-66.
• 5. Takayanagi S, Nakagawa C. Chest wall contouring for female- to-male transsexuals. Aesthetic Plast Surg 2006;30:206-12; discussion 213-4.
• 6. Monstrey S, Selvaggi G, Ceulemans P, Van Landuyt K, Bowman C, Blondeel P, et al. Chest-wall contouring surgery in female- to-male transsexuals: a new algorithm. Plast Reconstr Surg 2008;121:849-59.
• 7. Namba Y, Watanabe T, Kimata Y. Mastectomy in female-to- male transsexuals. Acta Med Okayama 2009;63:243-7.
• 8. Antoszewski B, Bratoś R, Sitek A, Fijałkowska M. Long-term results of breast reduction in female-to-male transsexuals. Pol Przegl Chir 2012;84:144-51.
• 9. Berry MG, Curtis R, Davies D. Female-to-male transgender chest reconstruction: large consecutive, single-surgeon experi- ence. J Plast Reconstr Aesthet Surg 2012;65:711-9.
• 10. Wolter A, Diedrichson J, Scholz T, Arens-Landwehr A, Liebau J. Sexual reassignment surgery in female-to-male transsexuals: an algorithm for subcutaneous mastectomy. J Plast Reconstr Aesthet Surg 2015;68:184- 91.
• 11. Cregten-Escobar P, Bouman MB, Buncamper ME, Mullender MG. Subcutaneous mastectomy in female-to-male transsexu- als: a retrospective cohort-analysis of 202 patients J Sex Med 2012;9:3148-53.
• 12. Nahai F. Superior pedicle vertical scar mammaplasty: surgical technique. In: Hamdi M, Hammond DC, Nahai F, editors. Verti- cal scar mammaplasty. New York:Springer; 2005:25-36.
• 13. Webster JP. Mastectomy for gynecomastia through a semicircu- lar intraareolar incision. Ann Surg 1946;124:557-75.
• 14. Davidson BA. Concentric circle operation for massive gy- necomastia to excise the redundant skin. Plast Reconstr Surg 1979;63:350-4.
• 15. Lotsch F. Uber Hangebrustplastik. Zentralbl Chir 1923;50:1241-4.
• 16. Arie G.: Una nueva tecnica de mastoplastia. Rev Iber Latino Am Cir. Plast 1957;3:23-8.