Transsexual Mastectomy: Selection of Appropriate Technique According to Breast Characteristics

Background: Subcutaneous mastectomy for femaleto-maletranssexuals is usually the first surgical procedurein sexual reassignment. The main objective ofsubcutaneous mastectomy is to create an aestheticallypleasing male chest contour by removing all glandulartissue while minimizing chest wall scars.Aims: In this paper, we present our experience withsubcutaneous mastectomy performed in female-tomaletranssexual patients. The authors recommendtheir point of view to aid in selecting the most suitablesubcutaneous mastectomy technique depending onbreast characteristics.Study Design: Retrospective cross-sectional study.Methods: Between March 2011 and December 2014,52 patients underwent bilateral subcutaneous mastectomies(total of 104 mastectomies), performed usingthe following four techniques: Webster semicircular,concentric circular, vertical, and apron flap. The techniquedecision depended on the breast size, degree ofskin excess, skin elasticity, chest width, nipple areolarcomplex size and position.Results: Seventeen patients (32.7%) were operatedwith Webster semicircular, 7 patients (13.5%) with concentricperiareolar, 12 patients with vertical (23%); and16 patients (30.8%) with the apron flap technique. Theoverall postoperative complication rate was 13.4%. Allpatients were satisfied with the aesthetic results of theirsubcutaneous mastectomies within the follow-up period.Conclusion: To obtain higher patient satisfaction withaesthetic results and lower postoperative complicationrates, breast characteristics are evaluated in a detailedfashion, while choosing the ideal technique of Femaleto-Male(FtM) subcutaneous mastectomy. The presentedsurgical new algorithm facilitates the selection of themost reliable surgical technique.

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