Gender Reassignment Surgery

Transexual chest surgery is the first surgical procedure in Gender reassignment.

Patients who seek gender chest reassignment surgery are referred from a Specilaist Gender care clinic. It is mandatory to have a full psychological assessment which should be carried out by a Consultant Psychiatrist who specialises in Gender Identity and supports the request. Most patients would have seen a Transgender specialist Endocrinologist and will be on appropriate hormone therapy to assist further with the gender reassignment.

Some patients would choose to have their name changed legally either before the chest surgery or after. All patients should be under the NHS gender care clinic for ongoing support. Liverpool Breast Clinic offers a bespoke tailor made comphrensive surgical approaches to both Female to Male (FtM) and Male to Female Chest Surgery (MtF).


Female to Male Chest masculinisation Surgery

Transexual mastectomy is a subcutaneous mastectomy procedure which involves removal of all the glandular breast tissue at the same time retaining the subcutaneous fat. The Nipple-areola complex is usually reduced in size. The procedure is carried out with minimal scar to create an aesthetically pleasing male chest contour. The nature and position of the scar depends on the cup size of the breast that needs to be removed. Mr Chandrashekar surgeon at Liverpool Breast Clinic will discuss the nature of scar with you after making an assessment.

Mr Mysore Chandrashekar ,Consultant Oncoplastic Breast Surgeon says that Female to Male transexual Surgery is a complex and very specialised surgery and should be considered carefully and carried out by Specialist Surgeon who can provide the full range of options including free nipple grafting and areola and nipple reductions.

Before and after

FAQs

What is Female to Male transexual mastectomy?

Transexual mastectomy is a surgical procedure to achieve chest masculinisation for the Female to Male gender reassignment. It involves careful removal of all the glandular breast tissue, retaining the subcutaneous fat and reducing the size and repositioning the nipple areola complex to achieve an aesthetically pleasing male chest contour.

Who requests a FtM transexual mastectomy?

Patients who have gender incongruence and choose to reassign their sex from female to male seek this procedure.

What are the requirements to be to have this procedure?

Women who wish to have transexual mastectomy have to be seen and assessed in an Gender Identity Clinic either on the NHS or in a WPAGS and or EPAGS recognised Private clinic. They should meet the ICD 10/11 gender incongruence and the referring Consultant psychiatrist should confirm this in the referral letter. Some patients many need a second opinion from a clinical psychologist. A proportion of patients will have seen an endocrinologist and will be hormone therapy and would have had a legal name change, although this is not essential to have the surgical procedure.

What are the surgical options?

The surgical treatment to reassign a Female to Male chest is subcutaneous mastectomy with reduction and if necessary repositioning of the nipple areola.

What type of scar will i have?

For a small breast ( AA or A cup breast, the breast tissue is removed through a small incision along the lower half of the areola. A full circular incision around the nipple areola is preferred if the breasts are small B cup breast and for Full B to a C Cup a vertical scar ( Lolly-pop) scar is necessary. For Breasts around D and larger than D, an apron technique is employed as in addition to removing the breast tissue a significant amount of skin has to be removed and this results in a anchor shaped scar

What type of Anaesthesia will I need?

The operation is carried out a general anaesthetic.

How long does the procedure last?

This varies could vary from 2 and half hour to 4 hours but on average it is around 3 hours.

How many days will I be in the Hospital?

Generally this is a overnight stay procedure and you will be discharged when you up and about and pain free.

What is the recovery period?

You will be seen in clinic between day 8 to 10 after your operation and again in a weeks times for wound review. If you do have nipple grafting procedure then you will see in a further week. Generally most patients return to work in 3 to 4 weeks.

When can I return to gym and sports?

In 4 weeks time to allow the wounds and the nipple graft to have healed completely.

What are the potential complications?

Like with all surgery , Female to Male transexual mastectomy is associated with some complications. And following are some potential complications – Bleeding, haemotoma, seroma, loss of nipple graft, loss of nipple sensation, Deep vein thrombosis ( leg clot) Pulmonary embolism ( lung clot) and chest infection.

Will I require further surgery?

Rarely you may require some tweaking surgery such as removing of dog ears or Liposuction of lateral fat folds.

What after care will I need?

The surgical wounds will be covered with absorbent occlusive dressings which will be reviewed and changed on a weekly basis. You may be sent home with drainage tubes and drain bag to return in a few days to have them removed in the clinic.

Before and after photographs

Will send the photographs vis a separate email.


Male to Female transsexual chest surgery.

Male to female transexual chest surgery involves breast enhancement with implants. Although the procedure sounds like a cosmetic augmentation that is routinely carried out in women but transexual male to female breast enhancement requires careful consideration as a Male chest doesn’t have the same degree of skin and tissue elasticity as the female chest/breast. Therefore in some individuals particularly those seeking a large cup size breasts with tight chest skin the procedure is carried out in two stages, first stage would be insertion of a tissue expander (sophisticated balloon) in order to stretch the tissue and skin in the chest followed by replacing the tissue expander with a definitive silicone gel implant. However in majority of patients it would be possible to do the procedure in one stage with silicone implants.

Mr Mysore Chandrashekar, Consultant Oncoplastic Breast Surgeon says that Male to Female transsexual Surgery is a complex and specialised surgery and should be considered carefully and carried out by Specialist Surgeon who can provide the full range of implant based breast reconstructive options.

Before and After

FAQs

Who requests a FtM transexual mastectomy?

Patients who have gender incongruence and choose to reassign their sex from male to female seek this procedure.

What are the requirements to be to have this procedure?

Men who wish to have transexual breast enhancement have to be seen and assessed in an Gender Identity Clinic either on the NHS or in a WPAGS and or EPAGS recognised Private clinic. They should meet the ICD 10/11 gender incongruence and the referring Consultant psychiatrist should confirm this in the referral letter. Some patients many need a second opinion from a clinical psychologist. A proportion of patients will have seen an endocrinologist and will be hormone therapy and would have had a legal name change, although this is not essential to have the surgical procedure.

What are the surgical options?

The surgical treatment to reassign a Male to Female chest involves breast enlargement with silicone implants. If the areola (pigmented pigmented skin around the nipple) is small it can be augmented by micropigmentation techniques.

What type of scar will i have?

The commonest incision of choice will be placed along the lower border of the new enhanced breasts. Alternative will be to place the incision in the armpit.

What type of Anaesthesia will I need?

The operation is carried out under general anaesthetic.

How long does the procedure last?

This varies could vary from 1 to 1 and half hour but on average it is around 1 hour.

How many days will I be in the Hospital?

Generally this is a overnight stay procedure and you will be discharged when you up and about and pain free.

What is the recovery period?

You will be seen in clinic between day 8 to 10 after your operation and again in a weeks times for wound review. Generally most patients return to work in 2 to 3 weeks.

When can I return to gym and sports?

In 4 weeks time to allow the wounds to have healed completely.

What are the potential complications?

The complications associated with Male to Female breast enhancement is mainly related to the implants that are used and they are as follows:-
Bleeding, infection leading to loss of implant (1%risk), implant leak/bleed/rupture, capsular contracture 5% ( hardening of implant capsules), implant migration/rotation, implant palpability( Rippling), implant palpability(knuckling), Breast Implant illness (BII), Breast Implant associated-Anaplastic Large cell Lymphoma ( BIA-ALCL) risk is 1 in 24000 implants sold, Shelf-life of implants 10-15 years needing maintenance surgery, possible reduced sensitivity of mammograms – need for Eklund views, reduced sensitivity of nipples and/or breasts or excessive or painful sensation of nipples, bottoming out of implants, residual asymmetry of breasts, can’t guarantee a definite cup size, Deep vein thrombosis, pulmonary embolism,chest infection.

Will I require further surgery?

As an implant will be used , implants have a shelf life and therefore will need to be replaced in 10 to 15 years.

What after care will I need?

The surgical wounds will be covered with absorbent occlusive dressings which will be reviewed and changed on a weekly basis. Generally a drain is not inserted but on occasion the surgeon will choose to place one You may be sent home with drainage tube and drain bag to return in a few days to have them removed in the clinic.

Before and after photographs

Will send the photographs vis a separate email.


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