For women undergoing a sex change, the first transgender surgery patients often undergo is the removal of breast tissue. This creates a more masculine chest for the transgender individual. In the medical community, this is known as mastectomy; in the transgender community, it is commonly referred to as “top surgery”. There are a variety of different mastectomy procedures and techniques available to remove breast tissue. The selected procedure is often based on the amount of breast tissue present in the patient, and the preference of the surgeon preforming the procedure.
The most common procedure is known as a bilateral simple mastectomy. In a bilateral simple mastectomy, the breast tissue, nipple, areola and excess skin is removed from both breasts, but the lymph nodes stay intact. Typically, this procedure is coupled with a free nipple graft to make the appearance of the chest more natural.
This technique leaves a scar on each side of the chest. The surgeons at American Institute for Plastic Surgery make every effort to make the scar less apparent by placing the scar along the lower border of the pectoral muscle fold. The nipple-areolar complex is downsized and placed as a graft in the appropriate location. A special medical dressing stays on the nipple graft for one week.
For patients with a considerable amount of lateral chest fatty tissue, our plastic surgeons recommend a mastectomy combined with liposuction of the lateral chest. This technique can reduce the need for lateral chest revisions in patients with excessive lateral chest tissue. This procedure is also often coupled with a free nipple graft for a more natural appearance.
For patients with a small amount of breast tissue — ideally, a cup size A or smaller — the peri-areolar subcutaneous mastectomy / keyhole incision is considered the best procedure. This technique has the advantages of leaving minimal scarring, and retaining the sensation in the nipples.
In the keyhole method, a surgeon makes a small incision along the border of the areola. Next, the surgeon inserts a liposuction needle into the incision to remove the breast tissue. The nipple is left attached to maintain sensation. Following surgery, the incision is closed. Typically, no nipple reconstruction is necessary in this procedure.
In the peri-areolar method, a surgeon makes an incision along the entire circumference of the areola. Next, the breast tissue is removed using a scalpel. Surgeons may sometimes use the combination of both scalpel and liposuction to ensure that all breast tissue is removed. The nipple is left attached using a small stalk of tissue (pedicle) to maintain sensation. The skin of the chest is then pulled tight toward the center of the incision, and the nipple is fully reattached to cover the opening. The nipple may be resized and/or re-positioned during this procedure.
Typically, before incisions are closed, chest drains are inserted to collect excess blood, fluid and other buildup. These drains typically stay in for 7-10 days on average. Discomfort can be moderate to mild, but will be lessened with prescribed pain medication. Bruising may persist 2-3 weeks. Scars are permanent, but should fade over time (this can take up to one year).
Patients should avoid using their arms during the first week following a mastectomy surgery. The means no driving, lifting, or even reaching. At the end of week one, limited daily activities may be resumed. After six weeks, vigorous exercise and weight lifting may be resumed.
The following image gallery depicts pictures of our patients who have received mastectomy at the American Institute for Plastic Surgery. To see the pictures in better detail, please click on any individual image. If you are interested in undergoing a mastectomy procedure, please contact us today. Our facility is located in Plano, but we serve patients throughout Dallas, Texas.