Female to Male Breast Surgery Can Help Transgendered Patients Achieve Their Ideal Appearance

Consultation

The process of top surgery begins with a consultation and thorough discussion and evaluation.  During your consultation, Dr. Jones will carefully review your goals as well as your health history.  In addition, you will have an examination to carefully assess what would be the best approach for you given your goals and anatomy.  After this, Dr. Jones will discuss with you the specific options that would work best for you and together you will form a treatment plan.

Day of Surgery

On the day of the procedure, you will again come to our office, which is also a fully accredited surgical facility.  You will meet with the same staff as the day of your initial consultation as well as your board certified anesthesiologist.  Dr. Jones will also meet with you again and discuss the procedure and answer any additional questions.  You will then be brought back to the operating room and undergo the procedure, which typically takes a couple of hours.   You will typically spend another hour in recovery afterwards.  When you are ready, you will  be allowed to go home or to a local hotel with a responsible adult.  You will then be brought back the next day to be evaluated and to answer any questions.  This helps to prepare you for the recovery process.  Follow-ups are then usually spaced out more as necessary.   

The procedure

Dr. Jones employs a variety of techniques to perform ‘top surgery’ (aka subcutaneous mastectomy).  The goal is to limit the incisions and extent of the procedure as much as possible while meticulously removing the necessary amount of tissue and producing a nice aesthetic result.  Most procedures will require the placement of at least some stitches, which will be dissolvable.  Dr. Jones also will usually then cover the incisions with tape or glue and then gauze and you will wear a compression garment.  This minimizes any postoperative wound care.  Special quilting sutures will also be placed so drains are rarely necessary, which makes for  a much easier recovery.  Patients will then wear a simple compression garment for approximately one month.  Most patients are up and around immediately and only require a couple of days off of work.  Light exercise is commonly resumed a couple of weeks after the procedure with full exercise and activity usually resumed by one month.

Techniques

Liposuction

Subcutaneous mastectomy can occasionally be performed with liposuction alone.  This technique minimizes incisions the most, but requires a patient to have small breasts with tight skin and small nipples and areolas.  In addition, the breast tissue has to be fatty and soft enough for removal.  Most patients are not good candidates for this approach, but those that are do very well with a typically very easy recovery.

Periareolar  approach

Another technique for performing subcutaneous mastectomy that Dr. Jones performs is a periareolar (around the nipple) technique.   This incision can either be placed at one edge of the areola or completely around it (if it needs to be decreased).  Dr. Jones will use this incision to access the breast tissue and directly remove it.   This procedure allows for extensive breast tissue removal with very minimal incisions and scars that are usually difficult to see.  Dr. Jones usually does not need to place drains with this technique, as mentioned above. 

Inframammary approach with or without free nipple graft

For patients with more extensive breast tissue, an inframammary (bottom of the breast) incision is commonly necessary and this is commonly accompanied with nipple removal and resizing with replacement as a graft.  This produces a longer incision along the lower fold of the breast that is shaped in a masculine orientation where the normal shadow of the pectoralis muscle lies.  Again, quilting sutures are utilized to avoid drain placement and make for an easier recovery.  As with the other techniques, these patients commonly return to work in a couple of days and resume normal daily activity immediately.  This is the most common technique utilized.

At Jones Plastic Surgery in Oklahoma City, we enjoy being able to care for transgender patients and we employ many different techniques to achieve their goals.  If you are interested in top surgery or another procedure, please contact our office so we may answer any questions you have and to schedule a consultation.