FTM CHEST SURGERY
The procedure used is based on the following:
· Size and shape of breast 胸部的大小和形狀
· Elasticity of skin 皮膚的彈性
· Patient's needs and preferences 病人的需求和喜好
In general, patients who have smaller breasts can have the entire surgery performed through an incision in the lower half of areola (the pigmented portion of the nipple) using liposuction in combination with surgical removal. It is also possible to remove larger breasts using this technique, if the skin of the breast is thicker, more elastic, and not damaged or stretched out. In these patients with good skin tone, the excess skin and the areola will shrink a remarkable amount. If the skin does not shrink enough, it may be necessary to have a small amount of skin removed (in a keyhole pattern or in an incision around the areola). If the patient is willing to return for an additional procedure if necessary, I think this is a very reasonable approach. In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, I usually recommend removing the excess skin and breast tissue in the crease of the pectoralis muscles and put the nipples back on as grafts. However, this surgery leaves larger scars on the chest.
Some small breasted patients have a strong preference for liposuction alone in order to preserve sensation or to stretch out the costs. You can have the liposuction done first, and if necessary, the residual breast tissue can be removed in a second operation. Having this done in two stages probably doesn't alter the final result, but does increase the number of operations required and time off work. In a majority of patients who have liposuction alone, I think I could improve the result with surgical excision of the remainder of the breast tissue. Nevertheless, this is my opinion, and some people are quite content with just liposuction.
Chest surgery is routinely done as an outpatient. The patient will need to stay in the area from three to six days following the surgery depending on the type of procedure done. If a patient chooses to stay in a hotel they should have a friend or family member stay with them to help with their care.
Risks and complications
Obviously, procedures such as this are not without risks or complications and I want to review these with you.
Bleeding is a risk of any operation, but the need for transfusion is very unlikely. However, when using minimal incisions to surgically excise most of the breast tissue the risk of blood loss is greater. Although a transfusion has not been required to date using this combined approach, it is recommended that you consider donating a unit of your own blood in advance of surgery to assure that if a transfusion is necessary, the blood would be your own.
Infections are rare complications. 不太可能發生感染併發症。
Nipple numbness 乳頭無感覺
The blood supply of the nipple might be damaged with the more limited surgery, and the nipple could die. If the nipples are used as grafts, then it is possible that they might not survive. These complications are exceedingly rare in my experience.
The scars of the areola usually heal very well. The scars below the pectoral muscles will take longer to fade out and will widen as mentioned above; however, a raised or excessively wide scar is possible and might need further treatment. It is possible that there may be residual tissue left,which appears as a contour deformity. This would need to be removed at a second stage.
Other risk 其他風險
Depression of the skin where the breast tissue was removed is a risk and possible complication. The possibility of this complication can be reduced or avoided by leaving some breast tissue on the skin. Since not all the breast tissue is removed, you are still at risk for developing breast cancer, and therefore, you should still be vigilant in routine self-exam and screening for breast cancer.
by Jamie Walker
(This information is gleaned from my reading and personal experience, conversation with my surgeon, and with others who have had surgery. I am not an expert on surgery. Your experience may differ, depending on the technique of your surgeon and on your individual case.)
Top Surgery for female-to-male transsexuals is called "male chest reconstruction." It differs from a mastectomy in that the incisions and reconstruction are done with the intended result of a contoured, male-looking chest. A mastectomy by itself would result in a concave chest front, no nipples, and more obtrusive scars. Make sure that your surgeon understands the technique not just of mastectomy itself, but of male chest reconstruction.
The operation is usually done under general anasthesia, because it takes so long - 3-1/2 to 4 hours. An incision is made under each breast, excess skin and the mammary glands are removed. Fat is removed also, leaving the right amounts in the right places to have a normal looking chest. The nipples and aereolas are removed and prepared as separate split skin grafts, reduced to male size, then sutured back on individually. The skin is contoured and sutured together.
Drains are put in, in a small incision under the main incision, one on either side of the chest, and left in for several days to a week. Sutures are removed in about a week. A binder is worn for a week or two to keep fluid from forming under the skin. It takes 3-4 weeks to recover from the anasthetic as well as the surgery itself -- expect to tire easily, and save your energy for healing!
The scars look their worst at about 6 weeks due to growth of blood vessels and scar tissue which enable healing. They may also be itchy, again due to healing.
From six weeks to six months the scars gradually flatten and pale. At six months the surgeon can do any further modifications needed. Sometimes there are "dog ears" (excess skin at end of incision), too small nipples, excess fat, etc., due to the inability to predict how an individual's body will respond to surgery.
It takes at least a year, and maybe more, to a minimal scar. This all depends on age, health, and individual variations. Smoking definitely impedes healing. Vitamins, herbs, and clean living may help healing.