Surgical Therapy: Chest Wall Contouring for Female-to-Male Transsexuals

Abstract

The contouring of the chest wall is usually the first surgical step in female-to-male transsexuals. Its aim is to transform the female chest in one with a male appearance. It is usually the most sought after procedure in female-to-male transsexuals and the one that is performed almost on every patient with this gender disorder, as it provides the most visible result and has major implications in daily social interactions. The goals of the ideal chest wall contouring are the removal of breast tissue and excessive skin, the repositioning and remodelling of the nipple-areola complex (NAC) and the minimization of chest wall scars. These goals can be achieved with different techniques: in patients with large breasts, the technique that gives the best result is the mastectomy with free nipple-areola complex grafting. For medium-sized breasts, there are two options, based on breast volume and NAC position relative to the inframammary fold. In young patients with elastic skin and a NAC positioned cranially to the inframammary fold, the semicircular technique is the best choice. If the NAC is positioned caudally to the inframammary fold, the concentric circular or free NAC grafting technique is preferred.