Top Surgery Journal Articles

2024

Patient-Reported Outcomes on Subjective Nipple Sensation After Double-Incision and Periareolar Mastectomy for Chest Masculinization: Subjective Nipple Sensation After Chest Masculinization.
Chen A, Garvey SR, Nanda AD, Friedman R, Jia E, Morgenstern M, Barron S, Tobias A, Cauley RP. Ann Plast Surg., 2024 Apr 1;92(4):383-388.
We found that nipple sensation may be associated with postoperative nipple satisfaction. Operative techniques to optimize nipple sensation preservation may improve this population's postoperative satisfaction.

2021

Low Risk of Persistent Pain, Sensory Disturbances, and Complications Following Mastectomy After Gender-Affirming Surgery. [FULL TEXT]
Lang CL, Day DL, Klit A, Mejdahl MK, Holmgaard R. Transgend Health. 2021 Jul 30;6(4):188-193.
There is currently no literature on postsurgical pain in trans men after mastectomy. We aimed at investigating the prevalence and severity of postsurgical persistent pain, sensory disturbances, and complications in trans men after mastectomy. Although a quarter of the patients in the study experienced persistent pain the pain is mild, not constant, and can be treated with weak analgesics. Trans men undergoing mastectomy should be thoroughly informed about this complication before surgery.

Chest Masculinization Technique and Outcomes in 72 Double-incision Chest-contouring Procedures with Free Nipple Grafting. [FULL TEXT]
Alexandra I. Naides, BFA, Jerette J. Schultz, MD, Nikita O. Shulzhenko, MD, and Jonathan D. Keith, MD, FACS. Plast Reconstr Surg Glob Open. 2021 Mar; 9(3): e3459.
The authors present the outcomes of 72 consecutive chest masculinization cases using the double-incision technique with free nipple grafting.

Classification of Transgender Man's Breast for Optimizing Chest Masculinizing Gender-affirming Surgery [FULL TEXT]
Wolf, Yoram MD, Kwartin, Samuel MD. Plastic and Reconstructive Surgery. Jan 2021, Vol 9, Issue 1.
A number of algorithms have been proposed for selecting the surgical technique; these have generally been based on the degree of breast ptosis and the quality and elasticity of the skin. We present a series of subcutaneous mastectomies operated on by 1 surgeon during the last 2 decades. Based on our experience, we suggest a classification system for selecting surgical technique.

Recognizing the Importance of Chest Surgery for Transmasculine Youth
Laura E. Kuper, G. Nic Rider and Colt M. St. Amand. Pediatrics, February 2021.
Transmasculine youth and adults often report that masculinizing chest surgery (MCS) is an important step toward gender affirmation. However, most research in this area has been focused on adults. In this issue of Pediatrics, Mehringer et al elicit transmasculine youth's descriptions of their experiences with chest dysphoria and MCS. Youth described improvements in mental health and quality of life after MCS. Although barriers to gender-affirming care remain widespread for transgender adults, barriers are particularly pronounced for youth. As youth in this study describe, lack of access to MCS prolongs unnecessary distress and difficulties in functioning.

2020

Surgical and patient-reported outcomes following double incision and free nipple grafting for female to male gender affirmation: does obesity make a difference?
Michael J. Stein, Emma Grigor, Jacob Hardy, Mario Jarmuske. Journal of Plastic, Reconstructive & Aesthetic Surgery, December 10, 2020.
Chest wall contouring using the Double Incision technique continues to be safe and effective for the management of gender dysphoria in transmale and nonbinary patients. Considering that obese patients have comparable surgical and patient-reported outcomes as non-obese patients, it is our practice to routinely offer the DIFNG technique to healthy obese patients with BMI's between 30 and 40.

A Three-Step Technique for Optimal Nipple Position in Transgender Chest Masculinization
Haripriya S Ayyala, MD, Thayer J Mukherjee, MD, Thuy-My Le, MSE, Wess A Cohen, MD, Margaret Luthringer, MD, Jonathan D Keith, MD, FACS. Aesthetic Surgery Journal, Volume 40, Issue 11, November 2020, Pages NP619–NP625.
The ideal position of the nipple-areola complex (NAC) in the transgender population can be a challenge to determine. The triple confirmation technique is an easy, reproducible method to guide the surgeon in relocation of the NAC.

Double Incision Mastectomy with Free Nipple Graft for Masculinizing Chest Wall Surgery [FULL TEXT]
Shervin A. Etemad, MD, William M. Furuyama, BS, and Julian S. Winocour, MD. Plast Reconstr Surg Glob Open. 2020 Nov; 8(11): e3184.
Although the literature about top surgery continues to document advances in technique and aesthetic outcomes, there is still significant room for improvement in the development of patient-centered outcomes. Given the increasing number of gender-affirming operations in the United States and the increasing evidence indicative of significant positive change, continued improvement and understanding of top surgery and other gender-affirming surgeries are essential.

Crowdsourcing the Ideal Nipple-Areolar Complex Position for Chest Masculinization Surgery. [FULL TEXT]
Cohen, W. A., Maisner, R. S., Hazim, N., Ayyala, H. S., & Keith, J. D. (2020). Plastic and reconstructive surgery. Global open, 8(8), e3070.
Chest masculinization surgery is increasing in prevalence. However, the ideal location of the nipple-areolar complex (NAC) is unknown. Our purpose was to determine the most aesthetically favorable male NAC position for use in chest masculinization through crowdsourcing. Ultimately, NAC localization during chest masculinization will be the result of shared decision-making between the patient and the surgeon to fulfill each patient’s aesthetic goals.

Free Nipple Grafts: What to Expect During the Healing Process
Alvina Won MD, E. Antonio Mangubat, MD. The American Journal of Cosmetic Surgery, Vol. 37, Issue 4, April 26 2020.
There is little documentation available that clearly describes the healing process of free nipple grafts for patients and their caregivers. The nipple-areolar complex is harvested as a full-thickness skin graft. It is resized and repositioned to conform to a more masculine aesthetic. A bolster of nonadherent dressing is tied over the graft and left in position for 7 days as adherence, imbibition, and inosculation occur. The superficial layer of epidermis of the graft initially exfoliates as it is replaced by upwardly migrating cells of follicular epithelium. This is observed as a sloughing which can be disturbing to the patient although it is an expected progression of the healing process. Viable pink dermis will be seen underneath. Pigmentation of the nipple graft can take 3-9 months.

A Comparison of Gender-Affirming Chest Surgery in Nonbinary Versus Transmasculine Patients.
McTernan M, Yokoo K, Tong W. Ann Plast Surg. 2020 Feb 6.
Increasingly more nonbinary patients are obtaining better access for gender-affirming chest surgery (top surgery), representing an important subset of patients who undergo such surgery. There were 111 nonbinary patients and 665 transmasculine patients included in the final analyses.

Analysis of Chest Masculinization Surgery Results in Female-to-Male Transgender Patients: Demonstrating High Satisfaction beyond Aesthetic Outcomes Using Advanced Linguistic Analyzer Technology and Social Media [FULL TEXT]
Black, Cara K.; Fan, Kenneth L.; Economides, James M.; Camden, Rachel C.; Del Corral, Gabriel A. Plastic and Reconstructive Surgery, Jan 2020 - Volume 8 - Issue 1 - p e2356.
Despite wide variety in surgical appearance, there is a high level of satisfaction and community support. This is in contrast to the low-quality ratings by plastic surgeons. The results demonstrate the strong psychological and functional underpinnings chest masculinization has for patients. However, surgical results can be improved through a variety of techniques such that patients have both excellent surgical results and high satisfaction.

Are Prophylactic Postoperative Antibiotics Necessary after Masculinizing Mastectomy with Free Nipple Graft? A Single-institution Retrospective Review
Oren Ganor, Nicholas G Cuccolo, Divya Jolly, Elizabeth R Boskey. Plast Reconstr Surg Glob Open, 2020 Jan 27;8(1):e2615.
Antibiotic overuse, particularly in the postoperative period, has contributed substantially to increased rates of antibiotic resistance. The aim of this case series was to report postoperative outcomes following chest masculinization with free nipple grafts performed according to a strict antibiotic protocol, which restricted prophylaxis to a single preoperative dose, in the absence of specific risk factors indicating a need for postoperative antibiotics. In this case series featuring 62 consecutive patients undergoing chest reconstruction with 124 free nipple grafts, there were no nipple losses or nipple graft infection events.

2019

Continued Barriers to Top Surgery among Transgender Men.
Nolan I, Poudrier G, Motosko C, Cook T, Saia W, Gothard M, Hazen A. Plast Reconstr Surg. 2019 Dec 2.
This survey examined barriers to transition-related care via a survey of insured transgender men and nonbinary individuals who underwent masculinizing top surgery.

Female-to-Male Transgender Chest Contouring - A Systematic Review of Outcomes and Knowledge Gaps
Cohen, Wess A. MD; Shah, Nikhil R. BA; Iwanicki, Margaret MD; Therattil, Paul J. MD; Keith, Jonathan D. MD, FACS. Annals of Plastic Surgery: November 2019 - Volume 83 - Issue 5 - p 589-593.
As the surgical treatment of gender dysphoria continues to grow, it is imperative for plastic surgeons to understand the surgical options and associated outcomes for transmasculine top surgery. Future research is needed to improve patient selection, surgical decision making, and patient-reported outcomes for different chest contouring techniques. In addition, there is a significant knowledge gap for the ideal nipple-areolar complex shape, size, and location.

Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes.
Cuccolo N, Kang C, Boskey E, Ibrahim A, Blankensteijn L, Taghinia A, Lee B, Lin S, Ganor O. Plast Reconstr Surg,2019 Jun 12;7(6):e2316.
The aim of this study was to provide a nationwide assessment of epidemiology and postoperative outcomes following masculinizing mastectomy and compare them with outcomes following mastectomy for cancer prophylaxis and gynecomastia correction in cisgender patients. Mastectomy is a safe and efficacious procedure for treating gender dysphoria in the transgender male, with an acceptable and reassuring complication profile similar to that seen in cisgender patients who approximate either the natal sex characteristics or the new hormonal environment.

What is "Nonbinary" and What Do I Need to Know? A Primer for Surgeons Providing Chest Surgery for Transgender Patients.
Esmonde N, Heston A, Jedrzejewski B, Ramly E, Annen A, Guerriero J, Hansen J, Berli J. Aesthet Surg J. 2019 Apr 8;39(5):NP106-NP112.
This was an observational study of nonbinary patients who underwent "chest-affirming surgery" from 2012 to 2017. A total of 458 patients with gender dysphoria underwent chest surgery; 58 (13%) patients were nonbinary. The most commonly performed procedure was the double incision technique with nipple grafts (72%). Chest surgery for nonbinary patients comprises a considerable proportion of transgender surgery practice, and surgeons who provide affirming care should be familiar with the unique characteristics and treatment options for this population.

Nipple areolar complex reconstruction is an integral component of chest reconstruction in the treatment of transgender and gender diverse people.
International Journal of Transgenderism, 20:1, 1-3, 2019.
There has been a growing trend for insurance companies in the United States to deny coverage of nipple areolar reconstruction for transgender patients undergoing chest masculinization. We, the undersigned, representing the national leaders in gender affirming surgical treatment are writing to state our joint and expert opinion that nipple and areolar reconstruction in trans masculine chest surgery is an inherent and irrefutable part of treatment for transgender and gender diverse individuals undergoing mastectomy for gender dysphoria. We cite our concerns regarding insurance denials for this medically necessary procedure.

Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study.
Poudrier G, Nolan I, Cook T, Saia W, Motosko C, Stranix J, Thomson J, Gothard M, Hazen A. Plast Reconstr Surg. 2019 Jan;143(1):272-279.
Following top surgery, measures of quality of life and sexual confidence improved significantly. In addition, 86 percent reported improvement in gender dysphoria-related mental health conditions. All but one respondent reported that top surgery had an overall positive impact on their life. Top surgery had major positive effects on all mental health and quality-of-life metrics. The authors' findings contribute to a much-needed body of evidence that top surgery markedly improves the daily lives and functioning of transgender and nonbinary individuals who choose to undergo it.

Female-to-Male Gender-Affirming Chest Reconstruction Surgery.
Ammari T, Sluiter E, Gast K, Kuzon WM Jr. Aesthet Surg J. 2019 Jan 17;39(2):150-163.
An appraisal of the available literature on top surgery to allow plastic surgeons to understand current practices and determine the best surgical technique using a decision algorithm and the patient's preoperative anatomy and characteristics.

2018

A Single Surgeon's Experience With Transgender Female-to-Male Chest Surgery.
Whitehead D, Weiss PR, Podolsky D. Ann Plast Surg. 2018 Sep;81(3):353-359.
Any of the reviewed techniques are safe in practice; however, there is a learning curve associated with their use, and longer follow-up will allow for the identification of late complications. The double incision with nipple transposition on a pedicle technique can be considered for patients for whom depigmentation of the nipple-areola complex is a significant concern, especially if they are willing to tolerate a potentially suboptimal chest contour.

Modified Nipple Flap with Free Areolar Graft for Component Nipple-Areola Complex Construction: Outcomes with a Novel Technique for Chest Wall Reconstruction in Transgender Men.
Frey J, Yu J, Poudrier G, Motosko C, Saia W, Wilson S, Hazen A. Plast Reconstr Surg. 2018 Aug;142(2):331-336.
The senior author's (A.H.) technique for component nipple-areola complex creation in chest wall reconstruction for trans men with a modified skate flap and free areolar graft, in conjunction with double-incision mastectomy, is described. The use of a modified nipple flap and free areola graft in transgender chest wall reconstruction for trans men allows for flexible, component construction of the male nipple-areola complex in a safe and effective manner.

Chest Surgery for Transgender and Gender Nonconforming Individuals.
Claes K, D'Arpa S, Monstrey SJ. Clin Plast Surg. 2018 Jul;45(3):369-380.
Chest surgery can greatly facilitate the experience of living in a gender role. Transmasculine chest surgery includes mastectomy and creation of a male chest. Preoperative parameters to be evaluated include breast volume, degree of excess skin, nipple-areola complex size and position, and skin elasticity.

Masculinizing Top Surgery: A Systematic Review of Techniques and Outcomes.
Wilson SC, Morrison SD, Anzai L, Massie JP, Poudrier G, Motosko CC, Hazen A. Ann Plast Surg. 2018 Feb 2.
Limited data exist comparing commonly used techniques in masculinizing top surgery, and most are single institution studies. A systematic review was performed on primary literature dedicated specifically to the technical aspects and outcomes of mastectomy for masculinizing top surgery. For each study, patient demographics and surgical outcomes were compared. This analysis notes several significant differences with regard to percentage requiring acute reoperation and percentage requiring secondary revision based on technique. Candidates for masculinizing top surgery should be educated on these differences.

Female-to-Male Gender Affirming Top Surgery: A Single Surgeon's 15-Year Retrospective Review and Treatment Algorithm
Giancarlo McEvenue, Fang Zhou Xu, Runting Cai, Hugh McLean. Aesthetic Surgery Journal, Volume 38, Issue 1, January 2018, Pages 49–57.
Of the 679 patients, 15.3% underwent Keyhole and the remaining 84.7% underwent DIFNG procedure. The total complication rate was 18.1% and the total reoperation rate was 11.2% and these rates were shown to decrease over time. The two techniques differed significantly (P < 0.001) in operating time (136 vs 102 min), breast weight excised (215 vs 638 g), and complication rate (33 vs 16%). The aesthetic rating of results was 4.6/5 for Keyhole and 3.7/5 for DIFNG. Safe and aesthetically pleasing results were achieved using this simplified algorithm. Experience with FTM techniques can decrease complication and reoperation rates over time.

2017

Creation of an Aesthetic Male Nipple Areolar Complex in Female-to-Male Transgender Chest Reconstruction.
Agarwal C, Wall V, Mehta S, Donato D, Walzer N. Aesthetic Plast Surg. 2017 Dec;41(6):1305-1310.
Llittle detail is written on methods for creating a male appearing nipple areolar complex (NAC) from a female NAC utilizing free nipple graft techniques. Incorrect positioning of the NAC on the chest wall and suboptimal shaping and sizing of the NAC are common pitfalls in male NAC creation. Our anatomic study supports placement of the male NAC relative to lateral and inferior borders of the pectoralis muscle. Nipple grafting techniques presented allow for a simple and reproducible method of creating an aesthetic male NAC shape in female-to-male transgender chest reconstruction.

Female-to-Male Chest Reconstruction: A Review of Technique and Outcomes.
Donato DP, Walzer NK, Rivera A, Wright L, Agarwal CA. Ann Plast Surg. 2017 Sep;79(3):259-263.
Critical evaluation of techniques, complications, and outcomes is important particularly as the surgery becomes more commonly performed. A retrospective review was performed of all patients undergoing female-to-male chest wall reconstruction from 2008 to 2015. Charts were reviewed to evaluate patient demographics, intraoperative details, and postoperative outcomes. Complications were stratified into major and minor complications based on the need to return to the operating room. Inframammary fold techniques and periareolar techniques cohorts were compared for major complications, minor complications, and need for revision surgeries. Our patient cohort demonstrates that female-to-male patients who undergo chest wall contouring through a transverse inframammary fold incision with either composite or standard free nipple grafting have decreased rates of revision surgery and trend toward having lower complication rates as compared with periareolar and limited scar techniques. To best manage expectations, patients undergoing a periareolar or other limited incision technique are counseled regarding an increased risk of hematoma and an increased likelihood of revisions.

Surgical Indications and Outcomes of Mastectomy in Transmen: A Prospective Study of Technical and Self-Reported Measures. [FULL TEXT]
van de Grift TC, Elfering L, Bouman MB, Buncamper ME, Mullender MG. Plast Reconstr Surg. 2017 Sep;140(3):415e-424e.
The objectives of the present study were to prospectively follow a cohort of transmen undergoing mastectomy to assess technical and self-reported outcomes and to evaluate surgical decision-making. Fifty-four transmen were recruited during a 10-month period at the Department of Plastic Surgery of the Centre of Expertise on Gender Dysphoria. Preoperative assessment included standardized chest examination. Six months postoperatively, participants rated their satisfaction with surgery, and 12-month postoperative surgical outcomes were reviewed independently. Compared with inframammary skin resections, concentric circular mastectomy-despite being performed in favorable breast types-appears to produce poorer technical and self-reported outcomes.

Aesthetic Female-to-Male Chest Transformation: Power of Combining Modified Mastectomy with a Pectoral Implant [FULL TEXT]
Abbed, Turkia; Shifrin, David A. Plastic and Reconstructive Surgery, August 2017 - Volume 5 - Issue 8 - p e1445.
The technique for female-to-male "top" surgery combining traditional mastectomy techniques with a complete lower pole pedicle vascularized nipple-areola complex (NAC) and a pectoral implant to shape the ideal male aesthetic chest.

A Review of 101 Consecutive Subcutaneous Mastectomies and Male Chest Contouring Using the Concentric Circular and Free Nipple Graft Techniques in Female-to-Male Transgender Patients.
Knox ADC, Ho AL, Leung L, Hynes S, Tashakkor AY, Park YS, Macadam SA, Bowman CC. (Vancouver, British Columbia, Canada; and Chicago, Ill.) Plast Reconstr Surg. 2017 Jun;139(6):1260e-1272e.
One hundred one consecutive female-to-male transgender patients undergoing subcutaneous mastectomy using the concentric circular or free nipple graft technique were retrospectively reviewed. In patients who meet selection criteria, the concentric circular technique is preferred because of fewer scars, improved aesthetic contour, and potential for retained nipple sensation. These patients must be counseled regarding the higher rate of complications and revisions. It was determined that smokers and those with a nipple-to-inframammary fold distance greater than 7 cm or nipple-to-inframammary fold distance less than 7 cm and a body mass index greater than 27 kg/m should undergo the free nipple graft technique because of the increased risk of complications with the concentric circular technique.

Masculine Chest-Wall Contouring in FtM Transgender: a Personal Approach.
Lo Russo G, Tanini S, Innocenti M. (Department Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Florence, Italy) Aesthetic Plast Surg. 2017 Apr;41(2):369-374.
Between July 2013 and June 2016, 25 FtM transgender patients underwent surgical procedures to create a masculine chest-wall contour. In our study, we just considered 16 patients who have undergone chest surgery with the double incision method. The patients' survey revealed a high satisfaction rate with the aesthetic result. In our group, no complications occurred, and two patients have undergone supplementary surgery for axillary dog-ear revision and nipple reconstruction. The authors propose a new technical approach and indications for FtM transgender patients' surgery. A longer scar that emphasizes the pectoralis muscle, a smaller nipple and a resized and refaced areola are the key points of our technique to give a masculine appearance to the chest. The scars are permanent, but most of them will fade and the patients are enthusiastic with their new "male" chest appearance. The high level of satisfaction, the great aesthetic result and the low rate of complications suggest to us the use of this technique in medium- and large-size breasts.

Transsexual Mastectomy: Selection of Appropriate Technique According to Breast Characteristics
Hüsamettin Top and Serkan Balta. Balkan Med J. 2017 Mar; 34(2): 147–155.
The main objective of subcutaneous mastectomy is to create an aesthetically pleasing male chest contour by removing all glandular tissue while minimizing chest wall scars. The authors recommend their point of view to aid in selecting the most suitable subcutaneous mastectomy technique depending on breast characteristics.

Chest-wall contouring surgery in female-to-male transgender patients: A one-center retrospective analysis of applied surgical techniques and results. [FULL TEXT]
Kääriäinen M, Salonen K, Helminen M, Karhunen-Enckell U. Scand J Surg. 2017 Mar;106(1):74-79.
Female-to-male transgender patients undergoing chest-wall contouring surgery at Tampere University Hospital between January 2003 and April 2015 were enrolled in the study. Breast appearance was evaluated and either a concentric circular approach or a transverse incision technique was used for mastectomy. The larger the breast, poorer the skin quality, and greater the amount of excess skin, the longer the required incision and resulting scar is for mastectomy of female-to-male patients. Hematoma is the most common reason for acute reoperation and secondary corrections are often needed.

The Impact of Male Chest Reconstruction on Chest Dysphoria in Transmasculine Adolescents and Young Men; A Preliminary Study [FULL TEXT]
Johanna Olson-Kennedy, Jonathon Warus. Journal of Adolescent Health, Volume 60 , Issue 2 , S88, February 2017.
Of the minors who had undergone male chest reconstruction, 93% reported being satisfied with the surgery "all of the time." No youth reported regret about the procedure. Results reflect the positive impact of male chest reconstruction witnessed in a clinical setting.

Top Surgery in Transgender Men: How Far Can You Push the Envelope?
Bluebond-Langner, Rachel; Berli, Jens U.; Sabino, Jennifer; Chopra, Karan; Singh, Devinder; Fischer, Beverly. Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 873e–882e.
The authors present their grading scale and the outcomes of the largest cohort of top surgery published to date. Application of this grading system can help determine which patients will benefit from a subcutaneous mastectomy with free nipple graft versus a circumareolar technique, with the primary endpoint being need for aesthetic revisions.

2016

Body Image in Transmen: Multidimensional Measurement and the Effects of Mastectomy [FULL TEXT]
Tim C. van de Grift, Baudewijntje P.C. Kreukels, Lian Elfering, Müjde Özer, Mark-Bram Bouman, Marlon E. Buncamper, Jan Maerten Smit, Margriet G. Mullender. The Journal of Sexual Medicine
Volume 13, Issue 11, November 2016, Pages 1778-1786.
Top Surgery positively influences body image more broadly than satisfaction with the chest alone. Positive evaluation of the body and decreased dysphoria during social situations were associated with increased quality of life and self-esteem. Despite this positive effect, there appears to be some residual body image issues at this point of follow-up.

Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study.
Sarah Peitzmeier, Ivy Gardner, Jamie Weinand, Alexandra Corbet, Kimberlynn Acevedo. Culture, Health & Sexuality, May 2016.
Chest binding involves the compression of chest tissue for masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals. There are no peer-reviewed studies that directly assess the health impacts of chest binding, yet transgender community resources commonly discuss symptoms such as pain and scarring. A cross-sectional 32-item survey was administered online to an anonymous, non-random sample of adults who were assigned a female sex at birth and had had experience of binding (n = 1800). Multivariate regression models were used to identify practices associated with self-reported health outcomes. Of participants, 51.5% reported daily binding. Over 97% reported at least one of 28 negative outcomes attributed to binding. Frequency (days/week) was consistently associated with negative outcomes (22/28 outcomes). Compression methods associated with symptoms were commercial binders (20/28), elastic bandages (14/28) and duct tape or plastic wrap (13/28). Larger chest size was primarily associated with dermatological problems. Binding is a frequent activity for many transmasculine individuals, despite associated symptoms. Study findings offer evidence of how binding practices may enhance or reduce risk. Clinicians caring for transmasculine patients should assess binding practices and help patients manage risk.

2015 and Earlier

Sexual reassignment surgery in female-to-male transsexuals: an algorithm for subcutaneous mastectomy.
Wolter A, Diedrichson J, Scholz T, Arens-Landwehr A, Liebau J. J Plast Reconstr Aesthet Surg. 2015 Feb;68(2):184-91. doi: 10.1016/j.bjps.2014.10.016.
In this study, we introduce an algorithm to facilitate choosing the appropriate mastectomy technique depending on morphological aspects.

Improved results after implementation of the Ghent algorithm for subcutaneous mastectomy in female-to-male transsexuals.
Bjerrome Ahlin H, Kölby L, Elander A, Selvaggi G.
J Plast Surg Hand Surg. 2014 Dec;48(6):362-7. doi: 10.3109/2000656X.2014.893887. Epub 2014 Mar 11.
At the Sahlgrenska University Hospital, a two-step procedure was used for mastectomies through 2002-2011. With this procedure, all patients were operated on with a concentric circular incision in the first session of surgery, followed by a second session 7-12 months later. From July 2011, a new approach was adopted, which consists of treating patients according to the algorithm and methods described by Monstrey et al. The aim of this study is to evaluate these two different approaches and determine if similar results, possibly with fewer surgeries and overall lower complication rate, can be achieved by using multiple techniques and a decision-making algorithm as compared to the two-step approach where only a concentric circular technique was used.

Effects of Testosterone Treatment and Chest Reconstruction Surgery on Mental Health and Sexuality in Female-To-Male Transgender People
Samuel A. Davis & S. Colton Meier, Pages 113-128, Aug 2013.
Results indicate that testosterone treatment in FTMs is associated with a positive effect on mental health on measures of depression, anxiety, and anger, while Chest Reconstruction Surgery appears to be more important for the alleviation of body dissatisfaction. The findings have particular relevance for counselors and health care providers serving FTM and gender-variant people considering medical gender transition.

The case for bilateral mastectomy and male chest contouring for the female-to-male transsexual [FULL TEXT]
C Richards and J Barr. Ann R Coll Surg Engl. 2013 Mar; 95(2): 93–95.
The literature showed that Top Surgery is necessary for trans men to live safely and effectively in their reassigned gender role, and further that it acts as a prophylaxis against distress, ameliorates extant distress as well as providing improved quality of life and global functioning for this patient group.

Subcutaneous mastectomy in female-to-male transsexuals: a retrospective cohort-analysis of 202 patients.
Cregten-Escobar P, Bouman MB, Buncamper ME, Mullender MG. J Sex Med. 2012 Dec;9(12):3148-53.
This study shows a correlation between the surgical technique, complication rate, and length of hospital stay. The largest series of subcutaneous mastectomies in female-to-male transsexuals to date is presented. In general, the larger the breast, the larger the scars that remain after the operation. On the other hand, the smaller the scars resulting from the operation, the higher the risk of hematoma.

Operative management and techniques of mastectomy in female-to-male transsexuals.
Morath S, Papadopulos N, Schaff J. Handchir Mikrochir Plast Chir. 2011 Aug;43(4):232-9. doi: 10.1055/s-0031-1273735. Epub 2011 May 17.
All procedures were conducted in a very scar-saving manner, however, a higher rate of correction procedures was necessary to individually adjust skin shrinking and thereby optimising the prior aesthetic results.

Combined Hysterectomy/Salpingo-Oophorectomy and Mastectomy is a Safe and Valuable Procedure for Female-to-Male Transsexuals.
Ott, J., van Trotsenburg, M., Kaufmann, U., Schrögendorfer, K., Haslik, W., Huber, J. C. and Wenzl, R. (2010). Journal of Sexual Medicine, 7: 2130–2138. doi: 10.1111/j.1743-6109.2010.01719.x

Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm.
Monstrey S, Selvaggi G, Ceulemans P, Van Landuyt K, Bowman C, Blondeel P, Hamdi M, De Cuypere G. Department of Plastic Surgery, Gent University Hospital, Belgium. Plast Reconstr Surg. 2008 Mar;121(3):849-59.
Skin excess and skin elasticity are the key factors in choosing the appropriate technique for subcutaneous mastectomy. Although the complication rate is low and patient satisfaction is high, secondary aesthetic corrections are often indicated.

Mastectomy for Female to Male Transsexuals.
NAMBA YUZABURO (Okayama Univ., JPN) TSUTSUI TETSUYA (Okayama Univ., JPN) KIMATA YOSHIHIRO (Okayama Univ., JPN) KOSHIMA ISAO (Univ. Tokyo, Graduate School of Medicine, JPN). Japanese Journal of Plastic & Reconstructive Surgery, VOL.49;NO.9;PAGE.985-991(2006).
Clinical experiences and information about mastectomy for FTM transsexuals.

Breast cancer after bilateral subcutaneous mastectomy in a female-to-male transsexual.
Burcombe RJ, Makris A, Pittam M, Finer N. Breast. 2003 Aug;12(4):290-3.
Female-to-male transsexual, aged 33, who developed breast cancer 10 years after cosmetic bilateral subcutaneous mastectomy and nipple reimplantation. The complex hormonal pathways involved and the implications of undergoing prophylactic mastectomy because of a high risk of familial breast cancer are discussed.

Circumareolar mastectomy in female-to-male transsexuals and large gynecomastias: a personal approach.
Colic MM. Aesthetic Plast Surg. 2000 Nov-Dec;24(6):450-4.
This technique provides naturally flat masculine breasts, leaving sufficient dermal vascularization for the nipple-areola complex which is of the utmost importance. All the patients were very satisfied with the result because of the periareolar scar only.

Chest wall contouring for female-to-male transsexuals: Amsterdam experience.
Hage JJ, Bloem JJ. Ann Plast Surg. 1995 Jan;34(1):59-66.
At the Academic Hospital of the Free University (Amsterdam, The Netherlands), usually one of three techniques is applied for a subcutaneous mastectomy. We describe and discuss our experience with 70 patients operated on before April 1993.

Back to Top Surgery Resources »

 

Last updated: 09/12/24