M+FNG Mastectomy + Free Nipple Graft
This is by far the most common technique as shown in both our research and in other large series. The nipple-areolar complex (NAC) is first reduced in size and harvested. Whilst it is being stored, the breast is removed as an ellipse and stitched with a horizontal scar.
The NAC is then grafted back in as symmetrical as possible producing a circular scar. This pair of incisions gives the technique its nick-name of the ‘2-scar technique’. It should be understood that this operation is not the same as a mastectomy for breast cancer so any lumps later in life should be investigated thoroughly and without delay.
(PA)Peri-Areolar
The Peri-areolar (PA) technique is much less common and can only be used in those with very little breast tissue and excellent skin elasticity. The incision is placed around the lower border of the areola (hence peri-areolar) so the surgeon has much less of an opening through which to operate.
The final position of the NAC is also difficult to control and it is a technically more difficult operation where the results are less predictable.
Surgery
The goals of surgery are the appropriate chest wall contour with good quality scars.
Whilst all individuals and their specific requirements will be taken into consideration and treated on an individual basis most have:
- General Anaesthetic
- Single overnight hospital stay
- Wound drains (usually removed the next day before discharge)
Non Surgical
Hormone substitution – some (not all) patients may choose to have testosterone therapy in order to become more masculine. When their voice has changed, this is considered an irreversible step. Changes to the breast, particularly if large, are often minimal and surgery is required to better enable a real life experience (RLE).
Binding
Is a process of flattening the breast tissue in order to create a more male appearing chest. This is usually employed in addition to hormonal therapy. Excessive binding can however lead to thinning of the skin.
Aftercare
- Wound review 1 week (usually at the hospital, but with the local GP by arrangement if you live far from the hospital)
- Outpatient review at 6 weeks and 6 months
The great majority undergo Mastectomy and Free Nipple Grafting (with the so-called 2-scar technique), but occasionally a Peri-areolar scar may be appropriate.