Mastectomy

Female-to-male mastectomy (FTM), also known as "top surgery" is a gender reassignment surgery in which breast tissue is removed to create a more masculine breast. Here are some details about FTM mastectomy, including information about techniques:

Surgical Techniques:

a. Double incision mastectomy: This is the most commonly used technique for mastectomy for FTM. A horizontal incision is made across the breast, usually just below the pectoral muscles, and the breast tissue is removed. The nipple-areolar complex is usually reduced in size and repositioned to create a more masculine appearance.

b. Periareolar or keyhole mastectomy: This technique is appropriate for individuals with smaller breasts or minimal excess skin. It involves making a smaller incision around the areola to remove breast tissue. This technique is less invasive, but may not be suitable for candidates with larger breasts or severe skin sagging.

c. Inverted-T or Anchor Mastectomy: This technique is used for those with larger breasts or more excess skin. It involves making an incision around the areola that runs vertically across the breast and making an additional horizontal incision in the inframammary fold. This allows more breast tissue and excess skin to be removed.

Surgical considerations:

a. Anesthesia: FTM mastectomy is usually performed under general anesthesia to ensure the patient's comfort throughout the procedure.

b. Incision placement: the surgeon carefully plans the placement of the incisions to achieve the desired esthetic result while minimizing visible scarring. Incisions are usually placed so that they can be hidden under clothing or in the natural folds of the breast.

c. Repositioning of the nipple and areola: The surgeon may alter the size and position of the nipple-areolar complex to achieve a more masculine appearance. This involves relocating the nipples to a more appropriate position on the breast.

Recovery and Healing:

a. Dressings and compression garments: After surgery, the breast is usually wrapped with bandages or compression garments to support it and minimize swelling. These may be replaced or adjusted during the recovery period.

b. Swelling and bruising: Swelling and bruising in the chest area is normal after surgery and will subside with time. Applying cold compresses and elevating the chest can help reduce swelling.

c. Pain management: pain medications may be prescribed to treat postoperative discomfort. It is important that you take the prescribed medications and inform the treatment team of any pain or concerns.

d. Activity Restrictions: During the initial recovery period, candidates must avoid strenuous activity and heavy lifting. The surgeon will provide guidelines on when it is safe to resume regular activities and exercise.

e. Follow-up visits: Regular follow-up visits with the surgical team are necessary to monitor healing progress, remove any sutures or drains, assess surgical outcomes, and address any concerns or complications.

Results:

Final results of FTM mastectomy include a flatter, more masculine breast contour. Scarring fades over time, but may still be visible, although it is often inconspicuous and can be hidden by clothing.

Candidates considering an FTM mastectomy should consult a qualified plastic surgeon who specializes in gender reassignment surgery. The surgeon will assess breast anatomy, discuss goals and expectations, and recommend the most appropriate technique based on individual circumstances. It is important to have realistic expectations and be aware that results may vary from individual to individual.

The preoperative and postoperative care of candidates undergoing FTM mastectomy plays a critical role in a successful procedure and smooth recovery. Below is some information about pre- and post-operative care for individuals considering FTM mastectomy:

Pre-operative care:

Consultation and Evaluation: Candidates should schedule a consultation with a qualified plastic surgeon who has experience with gender reassignment procedures. During the consultation, the surgeon will assess the candidate's overall health, discuss her goals and expectations, and determine the most appropriate surgical technique.

Medical Exam: A comprehensive medical examination will be performed to assess the candidate's general health and suitability for surgery. This may include blood tests, imaging studies, and consultations with other specialists as needed.

Hormonal therapy: if the candidate is undergoing hormone replacement therapy (HRT) as part of gender reassignment, the surgeon and endocrinologist may work together to optimize hormone levels prior to surgery. Adjustment of hormone dosage or schedule may be recommended to minimize the risk of complications and ensure optimal surgical outcomes.

Smoking and alcohol cessation: Candidates are advised to stop smoking and abstain from alcohol for a period of time before and after surgery, as this may interfere with the healing process and increase the risk of complications.

Postoperative care:

Dressings and compression garments: After an FTM mastectomy, bandages or compression garments are applied to the breast area to support the breast, minimize swelling and promote healing. These may need to be worn for several weeks as directed by the surgeon.

Swelling and bruising: Swelling and bruising are normal after surgery and will subside with time. Applying cold compresses and elevating the chest can help reduce swelling. The surgeon may also recommend special techniques or medications to reduce swelling.

Pain management: pain medications are prescribed to relieve postoperative discomfort. It is important that you take the prescribed medications and inform the treatment team of any pain or concerns.

Activity Restrictions: During the initial recovery period, candidates should avoid strenuous activity, heavy lifting and certain arm movements. The surgeon will provide specific guidelines on when it is safe to resume regular activities and exercise.

Wound care and scar management: the surgeon will provide instructions on how to care for surgical incisions and minimize scarring. This may include keeping the incisions clean and dry, applying topical ointments or silicone sheets, and keeping the incisions out of the sun.

Emotional support: the FTM mastectomy is an important step in the gender transition journey. Emotional support from friends, family, support groups or mental health professionals can be very helpful during the recovery process.

Follow-up visits: Regular follow-up visits with the surgical team are necessary to monitor healing progress, remove sutures or drains, assess surgical outcomes, and address any concerns or complications. The frequency of follow-up visits may vary depending on individual circumstances.

Healing and Recovery: Complete healing and final results from FTM mastectomy may take several weeks to months. It is important to follow the surgeon's instructions regarding postoperative care, including proper wound care, wearing compression garments as directed, and attending follow-up appointments.

It is important to communicate openly with the surgical team and follow their instructions for preoperative and postoperative care. This helps to achieve optimal outcomes, minimize risks, and promote a smooth recovery process. Pre- and post-operative care can be tailored to individual needs and the specific techniques used during the procedure.