Summary
Introduction
Subcutaneous mastectomy is one of the first steps in sexual reassignment in female-to-male
transsexuals (FTMTS). The main goal is to masculinize the chest by removing the female
contour. In this study, we introduce an algorithm to facilitate choosing the appropriate
mastectomy technique depending on morphological aspects.
Patients and methods
The records of 173 patients (346 mastectomies) from January 2008 to December 2013
were retrospectively reviewed. The authors conducted four different surgical techniques
depending on breast volume, grade of ptosis and skin elasticity. The outcome parameters
such as complication rate, patient satisfaction with the aesthetic result, nipple
sensitivity and surgical correction rate were obtained and related to the employed
technique.
Results
From January 2008 to December 2013, we performed 346 mastectomies, of which 48 breasts
(13.9%) were treated by a semicircular incision in combination with water-jet-assisted
liposuction, 66 breasts (19.1%) by an additional circumferential mastopexy, 170 breasts
(49.1%) by an inferior pedicled mammaplasty and 62 breasts (17.9%) by mastectomy with
free nipple grafting. The mean operation time lasted 103.6 min. The overall complication
rate was 11.8%. Secondary revisions were necessary in 9%. Of the patients, 88% rated
the aesthetic results as “very good” or “good.” Nipple sensitivity was rated as “very
good” or “good” in 80.3% of the breasts.
Conclusion
FTMTS are a well-informed patient population and therefore increasingly more demanding
for aesthetic outcomes. If possible, the most scar-saving procedure should be preferred.
With ascending degrees of ptosis, a larger skin envelope and lesser elastic skin,
an extended-incision technique is required. The presented surgical algorithm facilitates
the selection of the appropriate mastectomy technique and shows a high patient satisfaction
with the aesthetic result, a preservation of nipple sensitivity and a low rate of
complications and secondary aesthetic corrections.
Keywords
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Article info
Publication history
Published online: October 17, 2014
Accepted:
October 5,
2014
Received:
March 12,
2014
Footnotes
☆Dates and sites of presentation: (1) 12 September 2013, 44th Annual Meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRAEC), Muenster, Germany. (2) 10 May 2013, 13th Spring Academy of the Society of Aesthetic German Plastic Surgeons (VDAEPC), Kassel, Germany. (3) 2 May 2013, 130th Congress of the German Society of Surgery (DGCH), Munich, Germany. (4) 14 October 2011, 24th Congress of the German Society for Aesthetic Surgery (GAECD), Duesseldorf, Germany. (5) 4 June 2011, 10th Spring Academy of the Society of Aesthetic German Plastic Surgeons (VDAEPC), Aachen, Germany. (6) 15 September 2010, 41st Annual Meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRAEC), Dresden, Germany.
Identification
Copyright
© 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
