"Transgender"
FTM Mastectomy (Top Surgery)

Transgender breast correction of FTM or non-binary  individuals can be a solution to achieve a more masculine chest. For this, the mammary gland and excess skin are completely removed. In non-binary patients, it is possible or preferable to only partially remove them. The ultimate goal of this procedure is to make patients feel better because their physical characteristics are more in line with their self-image and how they can present themselves to the outside world. This increases self-esteem and self-confidence. However, it is extremely important to have realistic expectations for this procedure. There are disadvantages such as, for example, scars and complications are also possible.
 
The choice of surgical technique and incisions (and consequently the location of the scars) largely depends on 2 factors: the size of the mammary gland and the elasticity of the skin. Here a short overview of the various techniques. During the consultation you will be explained what is the best and safest choice for you.

Semicircular incision

With this technique, only an incision is made on the lower edge of the areola. This technique is ideal for patients with a small breast volume and good skin elasticity. The gland can be removed through this keyhole operation, but no excess skin can be removed. The resulting scar is barely visible around the bottom edge of the areola.

Periareolar incision

This technique is indicated for patients with moderate breast gland volume and good skin elasticity. A circular incision is made around the full circumference of the areola and the gland is removed in this way. In addition, a second circular incision is placed with a slightly larger diameter to eliminate the excess skin. When the skin is closed, both skin edges are tightly stitched together, resulting in a scar around the full circumference of the areola.

Double incision with nipple transplantation

This approach is usually required in patients with large breast volume or when the breast has sagged below the breast fold. First, the nipple is completely detached from the body. Then 2 incisions are made. The first in the breast fold and a second horizontal incision across the chest. The gland and skin excess are completely removed and the wound edges sutured. Then the nipple is placed back as a graft. The areola is almost always made oval with a diameter of about 3 cm. A significant drawback of this surgery is the fact that the nipple will be insensitive after surgery. On the other hand, this is an intervention with a minimal number of complications.

Anchor incision (“ Inverted T ”)

Also this operation is possible in patients with higher breast volume and excess skin. With this technique the nipple and areola are not detached from the body so there is a greater chance that the sensitivity of the nipple is preserved, but unfortunately this cannot be guaranteed. The disadvantages of this technique are the additional vertical scar and also that this technique always leaves a small breast volume (so the breast does not become as flat as with the double incision) because some tissue must be preserved to ensure blood flow to the nipple .

Fish mouth incision

This technique leads to a scar around the nipple with horizontal extensions medially and literally for several centimeters besides the areola. This technique is very rarely used, except in some non-binary patients.
 

Breast correction in two steps

Most patients, of course, prefer the periareolar technique because of its limited scar. If the gland volume and skin surplus are not too pronounced, you can work in 2 steps. During the first procedure, the glandular package is removed using the periareolar technique, together with a small amount of skin. Then wait and see how the excess skin will contract (if there is good elasticity). The skin surplus is then removed in a second session, at least six months after the first operation. Of course, because of the two interventions, this increases the costs.