Subcutaneous mastectomy for female-to-male transsexuals is usually the first surgical procedure 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. Female-to-Male (FtM) transsexualism is a gender identity disorder; these patients have a belief of having been […]
Subcutaneous mastectomy for female-to-male transsexuals is usually the first surgical procedure 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.
Female-to-Male (FtM) transsexualism is a gender identity disorder; these patients have a belief of having been created in the wrong body. These individuals suffer from persistent psychological discomfort related to their anatomical sex and have a desire to live and be accepted permanently in the social role of the male gender. The disturbance in transsexuals can be associated with physical conditions (e.g. intersex), sometimes a chromosome abnormality or any mental disorder, such as schizophrenia, and results in the impairment of social and occupational life activities. Due to their desire to change their anatomical sex characteristics to those of the opposite gender, sex reassignment surgery is supposed to be the main surgical treatment in these patients.
Bilateral subcutaneous mastectomy in FtM transsexuals is one of the most important steps in gender reassignment operations, because achieving a male chest configuration with this first operation, important to give them male appearance. In these patients, mastectomy procedure involves the surgical removal of all gland tissue and the required amount of skin and subcutaneous fat tissue. Also, reconstruction of the nipple-areolar complex (NAC) by proper positioning of the NAC and an adequate reduction of the nipple and/or areola can be obtained, resulting in an aesthetically pleasing male chest reconstruction. Although many studies have reported in the literature about mastectomy procedures regarding breast cancer and gynecomastia surgery, the techniques of subcutaneous mastectomy in FtM transsexuals have been mentioned in a small number of papers, and six of them have been studied in large patient series. Generally, two main surgical options have been used in FtM chest contouring: breast reduction techniques can be modified or surgical methods developed for the treatment of gynecomastia performed with or without modification. Since the structure of the male breast differs from that of the female breast, not only in volume and projection but also in the size and position of NAC, subcutaneous mastectomy cases must be evaluated for appropriate surgical technique, preoperatively. The key determinants for the choice of best technique are a grade of skin excess and ptosis, breast size, and skin quality. To date, various mastectomy procedures in FtM transsexuals have been reported, including transareolar, semicircular, concentric circular, extended concentric circular, and nipple- areolar graft techniques
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