Arch Plast Surg.  2019 Sep;46(5):433-440. 10.5999/aps.2018.01214.

Mastectomy in female-to-male transgender patients: A single-center 24-year retrospective analysis

Affiliations
  • 1Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital Frankfurt, Frankfurt am Main, Germany. sha.kuehn@gmail.com
  • 2Rhein-Main Working Group on Transsexualism and Transidentity, Frankfurt am Main, Germany.
  • 3Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt am Main, Germany.
  • 4Department of Plastic Surgery, Helios Clinic Wuppertal, Wuppertal, Germany.

Abstract

BACKGROUND
Mastectomy in male transgender patients is an important (and often the first) step toward physical manhood. At our department, mastectomies in transgender patients have been performed for several decades.
METHODS
Recorded data were collected and analyzed for all male transgender patients undergoing mastectomy over a period of 24 years at our department.
RESULTS
In total, 268 gender-reassigning mastectomies were performed. Several different mastectomy techniques (areolar incision, n=172; sub-mammary incision, n=96) were used according to patients' habitus and breast features. Corresponding to algorithms presented in the current literature, certain breast qualities were matched with a particular mastectomy technique. Overall, small breasts with marginal ptosis and good skin elasticity allowed small areolar incisions as a method of access for glandular removal. In contrast, large breasts and those with heavy ptosis or poor skin elasticity often required larger incisions for breast amputation. The secondary correction rate (38%) was high for gender reassignment mastectomy, as is also reflected by data in the current literature. Secondary correction frequently involved revision of chest wall recontouring, suggesting inadequate removal of the mammary tissue, as well as scar revision, which may reflect intense traction during wound healing (36%). Secondary corrections were performed more often after using small areolar incision techniques (48%) than after using large sub-mammary incisions (21%).
CONCLUSIONS
Choosing the suitable mastectomy technique for each patient requires careful individual evaluation of breast features such as size, degree of ptosis, and skin elasticity in order to maximize patient satisfaction and minimize secondary revisions.

Keyword

Transgender; Mastectomy; Gender reassigning surgery

MeSH Terms

Amputation
Breast
Cicatrix
Elasticity
Humans
Male
Mastectomy*
Methods
Patient Satisfaction
Retrospective Studies*
Skin
Thoracic Wall
Traction
Transgender Persons*
Wound Healing
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