Transgender Breast Surgery
Female to male (FTM) transgender surgery.
Introduction
When considering surgery, it is essential to have documented psychiatric assessment supporting the transgender diagnosis.
Patients should be on prescribed hormonal treatment for at 12 to 18 months prior to surgery as this supports the transformation, and patients have experienced the effects of hormonal change.
It is important to realise that surgery is not essential, and has inherent risk.
Essentially the surgery is not reversible and requires considerable thought and an informed decision making process. You must consider the potential risks and complications.
As hormonal treatment seems to have little influence on breast size (FTM), often the first surgery performed in the female-to-male (FTM) transsexual is the creation of a male chest by means of subcutaneous mastectomy (SCM). This procedure allows the patient to live in the male role, prior to genital surgery.
In female-to-male transsexuals, the operative procedures are usually performed in different stages: first the subcutaneous mastectomy which may be combined with hysterectomy and oophorectomy and then later genital surgery.
Subcutaneous Mastectomy
The aim of the SCM in a FTM is to achieve ‘a male chest’, which is cosmetically pleasing. This surgery may involve several stages as it involves:
- Removal of breast tissue and excess skin
- Reduction of the areola
- Positioning of nipple and areola, and reducing the size of the nipple if needed
- Minimising the infra-mammary fold
Much depends on the initial size of the breast and the skin quality of the breast. These factors determine the technique and the feasibility of achieving a good outcome.
Long term breast binding alters the shape of the breast and the skin quality and elasticity. This affects the skin properties in relation to re-shaping the breast and healing of surgical scars. Elasticity of the breast is desirable as it alters the healing process.
The technique used for SCM depends on the size of the breast. The incision may be:-
Small – semicircular around the areola
Medium / Large – Circular around areola, extended if needed.
- Placed along the lower border of the breast
- It is likely that skin will need to be excised to achieve flatness
- Nipple graft may be required if the nipple and areola need to be made smaller and repositioned
- Although the breast tissue will be removed during surgery, some subcutaneous fat is retained to achieve a reasonable thickness of skin and tissue, which forms a soft contour of the new flat breast.
Sometimes liposuction may be required to remove any excess fat from the upper outer areas of the chest wall or to achieve symmetry.
A small amount of tissue may also be left behind the nipple and areola to support this and avoid a depression or indentation
FTM breast surgery often requires more than one surgery for adjustments. The fee quoted is for the first surgery only. Please note that further surgery will be chargeable.
Post- operatively
Dressings will be applied to the wounds. Drains may be inserted.
An elasticated support jacket will be applied, which should be worn for 4 to 6 weeks (24/7) after surgery.
Wounds will be checked one to two weeks after surgery, in the outpatient clinic.
Further follow up appointments to see the surgeon will also be arranged until wounds have settled
Complications
Infection / abscess
Bleeding / Haematoma: – Small hematomas and seromas can be drained by aspiration (drawing off) with a syringe and needle, but for larger collections surgical evacuation is required. You may need to have a further operation to stop any bleeding.
Nipple change in sensation – numbness can be expected; this may recover partially or fully in the long term. Some patients experience sensitivity of the nipple.
Nipple loss: – If the blood supply is affected, part or all of the nipple may be lost. This is called nipple necrosis and forms a black scab and dies off. Skin breakdown around the nipple and areola can be left to heal by conservative means. Where partial or total nipple necrosis occurs, this may require a secondary nipple reconstruction. Even in the patients without complications, some patients require an additional procedure to improve the aesthetic results. Tattoo of the areola may be performed, if desired.
Fluid collection – this may require repeated drainage for several weeks after surgery
Asymmetry
Thickened scars, Bruising, swelling, Pain
DVT / PE – clots on the legs or lungs due to immobility. Elasticated stockings will be provided to avoid this.
It is important to note that there have been reports of breast cancer after bilateral SCM because in most patients the preserved nipple and areola and some incomplete glandular resection leaves behind some breast tissue at risk of malignant transformation.
You will have access to a the breast care nurse for any queries or advice
Please do not hesitate to ask your doctor or nurses for more information