Chest Wall Masculinization in Female-to-Male Transsexuals

Abstract

Esthetic masculinization of the chest wall is one of the first surgical steps in female-to-male transsexual (FTMTS) reassignment. This surgical procedure is not a simple mastectomy: it is required for removal of breast tissue with glandular resection and skin excess revision, to reduce and replace the nipple-areola complex in the right location, minimizing chest wall scars. The creation of an esthetically pleasing male chest allows the patient to live at ease in the male gender role. In this article, we present our series of 68 FTMTSs who underwent bilateral mastectomies for surgical sexual reassignment (a total of 136 mastectomies) according to our algorithm, in the period between January 2010 and December 2017. We selected 4 different operative procedures, classified as subcutaneous (“pull-through” and “concentric circular” techniques) and skin extended (“ultrathin vertical bipedicle” and free nipple graft). We achieved a total complication rate of 6.6%, less than that reported in the literature; additional procedures for esthetic improvements were performed in 14.7% of cases. The mean patient satisfaction was approximately 4.57% of a maximal value of 5 (excellent). To help surgeons in choosing the most appropriate FTMTS surgical technique and to reduce unfavorable results, we propose the use of our treatment algorithm in preoperative evaluation of the chest wall according to the breast volume, degree of glandular ptosis, and skin elasticity.

Feasibility, Safety, and Satisfaction of Combined Hysterectomy with Bilateral Salpingo-Oophorectomy and Chest Surgery in Transgender and Gender Non-Conforming Individuals

“…In our cohort, all transgender men perceived surgical interventions of GAS (genital and/or chest surgery) as very important for their wellbeing, with positive subjective changes in different areas of their life with no differences between the two groups. Although many authors have underlined the importance of chest surgery for transmen, these data suggest that HBSO is also important and has an impact on the life of trans men [ 17 , 22 ]. Confirming this, 54 to 63% of the transmen in our groups reported both interventions to be equally important.…”

“…The mean hospital stay length for combined surgery was 4.4 days with 2.7 days for HBSO alone, in line with the hospital stay for this type of surgery [ 27 , 28 ]. Data obtained from similar studies have indicated mean hospitalization stay ranging from zero to eight days [ 8 , 9 , 17 , 20 ]. Cizek et al recently highlighted the possibility of discharge on the same day of surgery and therefore the feasibility of the combined surgery of HBSO and bilateral mastectomy as day surgery [ 8 ].…”

“… Vertical bipedicle technique: in case of moderate-sized breast with poor skin elasticity or large breast with good skin elasticity. Glandular resection with free nipple grafting: for ptotic and large breasts with poor elasticity and female appearance [ 17 ]. …”

“…Glandular resection with free nipple grafting: for ptotic and large breasts with poor elasticity and female appearance [ 17 ].…”

Overview of Medical Management of Transgender Men: Perspectives from Sri Lanka

“…Breast amputation with a free nipple areolar complex graft is recommended for ptotic breasts [23]. A careful preoperative examination will identify these factors and will help the surgeon decide on the most appropriate technique for an individual [24].…”