Female to Male Mastectomy
The Basics
One of the first transgender procedures of female to male mastectomy patients typically undergo is removal of breast tissue to create a male chest. This is commonly referred to in the transgender community as “top surgery”. Various procedures are available depending on the amount of skin and breast tissue present. The most common procedure is the bilateral simple mastectomy with free nipple grafts. This procedure is designed for patients who have both excess skin and breast tissue.
The procedure leaves a scar on each side of the chest. Every effort is made to place the scar along the lower border of the pectoral muscle fold, thereby helping to make the scar less apparent. The nipple-areolar complex is then downsized and placed as a graft in the appropriate male location. A special dressing stays on the nipple graft for one week. Discomfort is moderate to mild and will be lessened with the prescribed pain medication. Bruising may persist 2-3 weeks. There are chest drains that typically stay in for 7-10 days on an average. Arm use should be completely avoided during the first week. This includes no driving, lifting or reaching. At one week limited daily activities may be resumed; vigorous exercise and weight lifting may be resumed at 6 weeks post surgery. Scars are permanent and should fade over time, but this takes up to one year.
The Mastectomy Procedure
Patients who are heavy, and have a considerable amount of lateral chest fatty tissue, may benefit from combining the mastectomy with free nipple graft with liposuction of the lateral chest. In these patients, combining these procedures reduces the need for lateral chest revisions.
Another technique for breast tissue removal is the peri-areolar subcutaneous mastectomy, commonly referred to as the "keyhole mastectomy". This procedure has the advantage of much less scars. However, this procedure is suitable for patients who have a small amount of tissue and minimal excess skin. The ideal candidate for a female to male mastectomy procedure is a young patient who is thin and has a small amount of breast tissue.
