Breast surgery for transgender people from female to male.
Also known as a mastectomy, breast removal surgery is a procedure for individuals who wish to live authentically according to their true gender. Furthermore, chest surgery for female-to-male transgender individuals may be performed as part of the treatment process for depression due to the difference between gender expression and assigned sex (as seen in cases of gender dysphoria).
This procedure is performed by the plastic surgeon with highly specialized knowledge and experience.
How many methods are there for doing this surgery? .
On average, a mastectomy may take from 1 to 5 hours depending on the size of the mammary gland, areola, and nipple. Breast surgery methods usually applied on the transgender consist of keyhole surgery, periareolar contouring and double incision under the breast.
To better understand, we can see the illustration below:
Keyhole surgery.
This procedure is only recommended for people who have small breasts (cup A), firm breast skin and can last from 1,5 to 3 hours. The surgeon makes an incision along the lower half of the areola and removes all the mammary glands through this line.
Advantages.
- The scar line is extremely small, so the aesthetic effect is quite high.
- Preserving nipple sensation is better than other methods.
- Quick surgery and recovery time.
Disadvantages.
- Patients with moderate to large mammary glands and lax skin cannot perform this technique.
- Does not solve the problem of large areola.
Areola contour surgery.
This surgery is typically performed on patients with medium-sized breasts (cup A or B) and good skin elasticity. A circular incision is made along the edge of the areola to remove the mammary gland.
After that, making a larger circular incision is performed to remove the excess skin. The skin is stretched towards the center as a drawstring bag. An additional vertical incision extending below the areola is made to remove excess skin when there is sagging. This surgery can take between 3 to 5 hours to complete.
Advantages.
- In most cases, nipple sensation is preserved.
- Addresses excess skin around the areola.
- It seems that the scar is only around the edge of the areola, so the cosmetic effect is relatively good.
Disadvantages.
- It can not perform on patients who have large and saggy breasts.
Double incision below the breast.
This surgery is often combined with nipple-areola complex grafting and is applied to patients with large mammary glands(C cup or higher), nipple-areola position lower than the inframammary fold and severe sagging. The surgeon usually performs the removal of skin, fat and mammary glands in about 3 to 4 hours.
The patient's nipple-areola complex will be cut and shaped like a male nipple-areola and reimplanted in a new position.
Advantages.
- The skin and mammary glands are removed more thoroughly than the above methods, so they should be applied to patients with large breasts and sagging skin.
- Combined with nipple shaping should bring quite good physical effect.
Disadvantages.
- Leave a long scar and a bad scar.
- Reduced sensation of the areola.
What complication can occur?.
Like the other surgery, mastectomy carries the risk of bleeding, infection, and adverse reaction to anesthesia. Other possible complications include.
- Bad scar
- Hematoma
- Seroma
- Wounds do not heal
- Dissatisfied with the result
- The two sides are not balanced (breast asymmetry)
- Necrosis, especially nipple necrosis
What do the patients need to prepare before the surgery? .
- Transgender mastectomy is performed for people over the age of 18.
- Hormone therapy is not recommended prior to this surgery.
- In some cases, waiting for the pectoral growth after treatment with additional testosterone will provide the best result of surgery. If you are on testosterone therapy, patients will have a blood test to make sure your testosterone levels are within normal limits.
- Prior to the surgery, the surgeon will provide for patients some options and achieve results. Doctors also provide you some information about the anesthetics, the area of the surgery and post-operative care after the procedure may be needed.
- Patients need to follow the surgeon's instructions before the surgery consists of recommendations for eating, stop smoking and adjusting medications are being used.
What should patients know before surgery?.
- Discussions about the patient's aim and expectation with the surgeon.
- Exchange with the surgeon about some techniques to reduce the scars.
- Be prepared to share your family history of breast cancer with your doctor.
- All the patients need to check their breasts by themselves after and before the procedure.
- Make sure to get screened for breast cancer before surgery.
Postoperative recovery process.
Recovery time after a mastectomy varies for each individual. Most people are able to return to work or school approximately two weeks after the procedure.
To prevent fluid buildup after surgery, the doctor will insert a small tube into each side of the chest to drain excess fluid. These tubes are typically removed once the doctor determines that the condition is stable.
Days 1 and 2 of recovery are often the most uncomfortable. This discomfort can be the result of the anesthesia wearing off as well as the compression garment or surgical bra holding the bandage over the incisions or skin grafts.
To ensure there is no additional pressure on the surgical site, the patient will need to lie on his or her back for at least the first week after surgery.
Approximately 10 days after surgery, the patient will have an appointment to remove post-operative stitches.
Usually the swelling will go down within 2 or 3 weeks, but for some people this may take up to 3-4 months.
The skin of the nipple may appear dark in the early stages after surgery, but this typically fades as new skin develops. However, if redness, swelling, ulcers, or pus occur, the patient should see their doctor immediately for prompt treatment.
Patients should be careful not to lift their arms above their head for at least 2 to 3 weeks after surgery. Movements such as reaching and lifting can increase scarring. After 6 to 8 weeks, patients can usually do exercise, lifting, and running.
Post-operative care.
- Do not shower, the patients are not allowed to take a shower until prompt treatment, or the compression garment will be taken off. Using soft washcloths and taking sponge baths are typically the best and easiest ways to stay clean during recovery.
- Use an ice pack during the first two days after surgery. Most people experience some swelling and bruising, but the amount of swelling and bruising varies greatly. Ice can help reduce inflammation and ease pain.
- Do not lift or do exercise strenuously. Do not recommend lifting anything more than 5kg in the first two weeks of the recovery. Patients will continue with slightly exercise as walking as soon as they feel well. Only notice that don't do anything, just be careful not to do anything that increases the heart rate.
- Look after yourself. The best things you can do to speed up the healing process, it's important to rest, eat nutritious meals, and limit smoking and alcohol consumption.
- Use scar treatments. Mastectomy scars may initially appear red, which is a normal part of the healing process.
- Over-the-counter scar treatments can help accelerate healing and reduce both scarring and redness. Patients can use silicone sheets to apply continuous pressure to the wound, preventing keloid scars, typically for about 3 months. If keloid scarring has already developed, patients can return to their doctor for injections to treat the scarring.
* The result also depends on the natural disposition of each person.
