Association Transgenre Wallonie
Page E26 - Mastectomy
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Physical appearance is not the essence of personality

 but it is important.

Mastectomy - torsoplasty

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Mastectomy or breast removal refers to a surgical operation aimed at removing a complete breast (mammary gland and asipous tissue). This surgical operation is often indicated in a woman suffering from breast cancer. But it is also a frequent operation in the context of a transgender man's transition.

It is one of the operations, sometimes even the only one, that a transgender man wishes to undergo in order to obtain a virile body.

Mastectomy is an operation that not only gives a manly appearance to the torso of the transgender man but it also allows him to improve his self-esteem by allowing him to be better in his body. This operation also allows a very significant reduction in gender dysphoria.

In the context of this operation, the skill of the surgeon and the quality of the intervention are of paramount importance. Indeed, if the surgery is well performed, the scars will be very little or not visible. This will allow the transgender man to be able to go shirtless in the right season without attracting the attention of the most observant.

The different surgical techniques

Currently, there are two two techniques that are most often used. But it must be remembered that it is the surgeon who will choose the technique best suited to the circumstances and the particularities of the anatomy of the patient to be operated on.

This surgery can be accompanied by a remodeling of the torso and more particularly of the nipple. Indeed, the nipples and areolas of the female body are generally of a diameter and a size greater than those of the cisgender man. They are also positioned lower on the female chest. It will therefore no doubt be necessary to resize them and reposition them in a manner similar to the characteristics of those of cisgender men. These actions are part of the torsoplasty surgery which is therefore very often performed after a mastectomy.

The first of these techniques is called "peri-areolar":

This procedure is generally reserved for very small and small breasts (in principle for cup sizes A and B).

In the case of very small breasts (A cup), a semi-circular incision is made under the nipple. It is through this opening that the mammary gland and fatty tissue are removed. The skin will tighten naturally and after a few months the scar will no longer be visible. In this operation, it is impossible to resize and reposition the nipples. It is therefore necessary that initially, the nipples are of a small diameter and placed sufficiently high on the torso.

This surgery has the following advantages: no asymmetry of the torso, no scar and a fairly quick convalescence.

For small breasts (B cup) whose skin has good elasticity, the procedure is identical to the previous one. As there is excess skin, this is removed by an incision around the areola and the skin is tightened and stitched around this areola. With this technique, it is possible to resize the nipple and reposition it on the torso so that it takes on a masculine appearance. There is therefore a disadvantage and an advantage with this surgery: the risk of asymmetry is possible and the scars disappear after a few months.

The second technique is called "double incision":

This surgery with nipple graft gives satisfactory aesthetic results. Its big disadvantage is that both scars are visible. This obviously depends on the ability of the surgeon to make sutures that are not too wide with very fine stitches. Over time, these scars will diminish and whiten, becoming less noticeable. If moreover, the hairiness becomes quite abundant, they disappear almost completely. The disadvantages of this technique are the risk of asymmetry of the torso as well as the possible necrosis of the nipple.

Possible complications

The most common complication is hemorrhage. For at least 24 hours after the operation, bleeding is heavy and excess blood is sucked out through subcutaneous drains. If the cauterization of the blood vessels is insufficient or poorly carried out, the drains cannot suck everything out and pockets of blood form in a hematoma under the skin. It will then be necessary to make incisions to empty these pockets of blood and again cauterize the blood vessels at the origin of this situation.

Another complication is constituted by hematomas which can form within 48 hours after the operation and are therefore detected and treated quickly. It is however possible that a hematoma is not spotted and that subsequently, it grows and blackens while hurting you. It is necessary to treat this situation very quickly by making a puncture of the agglomerated blood at the place of the hematoma. This hematoma usually leaves no visible trace.

A more serious complication is nipple necrosis caused by lack of blood supply. If this situation is not treated very early on its appearance, it will be necessary to operate again to remove all the affected tissues. This will leave a significant and visible scar although it is possible to reconstruct the damaged nipple.

Other complications such as skin fibrosis, scar degeneration and torso asymmetry are possible. All of these drawbacks have solutions. It is for this reason that it is necessary to carefully monitor the healing of the operation and not to hesitate to contact the surgeon again at the slightest problem in order to avoid really damaging situations.

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