AN OVERVIEW OF MASTECTOMY TECHNIQUES

There are many surgical techniques for breast removal but when one studies them closely, few are valuable. For successful surgery, one must take into account the size of the breast, the suppleness, thickness, elasticity and color of the skin, the fats, the size of the areola as well as that of the nipple itself. One must also consider your goals - whether you wish to follow with a phalloplasty later or have it performed at the same time as chest surgery. One may, for instance, use the skin removed at the areola to cover the arm if both operations (mastectomy and phalloplasty) are performed simultaneously. It is up to you whether you wish to reach the pinnacle immediately - a dangerous choice - or if you are willing to wait to improve the work with later touch-ups and incur less risk. One should give this serious thought, because the result of the surgery will make it possible for you to walk around bare-chested or not. One must also understand that, depending on individual morphology, it may always be possible to detect that something was done (such as extensive scarring, a hollow due to the ablation of the mammary gland or other such physical evidence).

It is difficult for the surgeon to know in advance how much the skin will retract after the removal of the mammary gland. Thus it is preferable not to remove too much, otherwise a catastrophe may ensue. - Figure 1 - A stretching of the scars in a widening direction, leaving behind a deformed areola, cracked and covered with stretch marks, as well as bigger, white scars. only a repigmentation of the skin may attenuate this result.
 
- Figure 1 -

Surgeons are often at fault in these kinds of incidents, striving for a perfect operation in spite of the dangers incurred by the patients. One must therefore carefully choose a surgeon. Trust is most important. We must always prefer the surgeon who will explain precisely what he will do and indicate all possible risks. It is our life, our freedom, to go shirtless when the weather is warm or when we want to tan. We have the right to choose our surgeon and must choose carefully.

In the Round Block technique, necrosis can occur during the removal of the mammary gland and the reduction of the areola and its reimplantation, causing a loss of sensitivity of the areola. If successful, however, the result is impeccable.

The nipple itself may be deformed, and/or white scars will show upon the darker color of the areola. (The dotted lines indicate where the incision is cut first, then the areola).

To avoid a much too visible hollow due to the removal of the mammary gland and the fats at the pectorals, it may be necessary to undergo liposuction to flatten out the fat. If the skin is thin, it has more suppleness and elasticity, and thus is more likely to retract later. It will retract less if it is thick, thereby diminishing the hollows.
 
- Figure 2 -

The technique which is the least risky, as the surgeon is cutting roughly outside the areola in a half circle. It may be performed along with liposuction, which is advisable for small and medium-sized breasts. A second operation after a minimum of one year may always be performed to remove unnecessary tissue.
 
- Figure 3 - shows outdated techniques,
 
- Figure 4 - called "marine anchor".

In order for chest surgery to be perfect, the surgeon, after removal of the mammary gland, must bring the areola to a new position, which implies that it must be completely cut out in a circle, the risks of which are exposed above.

While some surgeons choose to leave the mammary gland partially in place in order to avoid a hollow and to shape the area into a "pectoral" style, a collapse or displacement of the gland can occur and cause problems. A satisfying outcome may only be obtained through frequent muscle-building sessions. But be careful not to jump on your free weights immediately. I would also not advise weight-training prior to surgery, as the hollow may become more visible with muscular development of the torso.

There are many other techniques. For instance, there is the removal of the nipple, suctioning out the mammary gland and sewing back on of the nipple. In this method the rate of nipple rejection is high. Also, for very small breasts, the possibility of suction from beneath the armpits exists - but there may be problems with this too.

The duration of the hospitalization may vary according to the technique used. Four days is average. The operation time varies from 1 to 3 hours, depending on the chosen technique and the breast.

As far as bandages and showering, each surgeon has a different opinion. Some advise their patients to take hot baths to facilitate reabsorption of the hematomas while others ask that you not shower.

The bruises disappear in a few days, going from yellow to green. They should be no cause for concern; it is common and benign in cosmetic surgery.

The removal of stitches should not suffer delay, or they might leave traces of imprints. Some time must pass for the skin of the chest to be reabsorbed, taking into accound the size of the mammary gland and the quality of the epidermis. Surgeons often neglect to provide or recommend scar balms. It is up to you if you wish to use them or not.

This is only a quick overview of various chest surgery techniques. It is my hope that others will further elaborate on this topic.
 
 

One Technique of a Belgian Surgeon

 
 

This article was published in TNT (Transsexual News Telegraph) Issue # 7 - Summer 1997  
 

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