The Modern Aspects of the Chest-Wall Contouring Surgery in Female-to-Male Transsexuals
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PuRPOSe To create a simple algorithm of choice for bilateral mastectomy in female-to-male transsexuals. MethOdS On the basis of our clinical experience of more than 400 bilateral mastectomies performed since 1993, we distinguish 3 different approaches: Type 1, bilateral subcutaneous mastectomy performed through semicircular incision at the border nipple-areola complex; Type 2, bilateral subcutaneous mastectomy with circular deepithelization around the nipple-areola complex, which is performed to correct skin excess; and Type 3 bilateral mastectomy with autotransplantation of the nipple-areola complex. Every patient was registered in a clinical study, medical photographs were taken, and clinical follow up was performed before surgery and 2 weeks, 1 month, 3 months, 6 months, and 12 months after surgery. Every patient has completed a clinical questionnaire , which includes a quality of life survey. Complications encountered were divided into early or late ones. Early complications, which occurred in the first 2 weeks, included hema-toma, 7 (11.4%); seroma formation, 12 (19.6%); partial necrosis of the nipple-areola complex, 3 (4.9%); and ligature inflammation, 2 (3.2%). Late complications (after 2 weeks) included hypertro-phic scar formation, 4 (6.5%); folliculitis in area of postoperative scar after deepithelization, 3 (4.9%); and hypersensitivity of the nipples, 1 (1.6%). Patient satisfaction rate is 90%. In 6 cases (10%), secondary surgical corrections were performed. In most cases, correction included scar revision with simultaneous lipofilling of anterior chest-wall deformities. COnCluSiOnS In many cases, the selection of the right type of bilateral mastectomy for the right patient is difficult. In our practice, we use our own algorithm of choice, which is based on the breast size, breast ptosis, skin elasticity, and the risk factors: In patients with small breast size (A) without ptosis and with good skin elasticity without risk factors, we perform Type 1 surgery. In patients with moderate breast size (B) with good skin elasticity, we perform Type 2 bilateral mastectomy. In cases of large breasts (C, D, and E), we perform Type 3 procedure. For patients with moderate breast size (B) with moderate ptosis, Type 2 surgery is performed if there are no additional risk factors to the blood supply of the nipple-areola complex. Type 3 surgery is chosen for this kind of breast size (B) in case of long-term smoking, breast-bandaging history, tuberous breasts, anterior chest-wall scaring, and severe ptosis. Despite the long residual scars, patients often prefer Type 3 This is an open-access article distributed under the terms of the Creative …