Mastectomy is the opposite of a breast augmentation as it removes unwanted breast tissue. This is the first surgical step to becoming male. Mastectomy is also referred to as ‘Top Surgery’ in the transgender community. There are several different types of mastectomies.
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Bilateral Mastectomy W/ Nipple Grafts
This procedure allows for removal of all breast tissue and excess skin. An incision along the lower border of the pectoral muscle fold is made to allow for minimal, visible scarring. The nipple-areolar complex is downsized and placed as a graft in the desired location. This allows for proper placement and downsizing of the nipples. This procedure, however, does leave a scar on each side of the chest.
Mastectomy Combined W/ Liposuction
Mastectomy with liposuction removes as much fat as possible while avoiding damage to the skin or muscles. This procedure results in minimal scarring. Significantly reduced postoperative pain and a rapid recovery time are also benefits of this procedure.
Peri-areolar Subcutaneous Mastectomy / Keyhole Incision
The peri-areolar, or keyhole, incision consists of removal of breast tissue through a small incision around the nipple. The nipple stays intact with the breast. This results in significantly reduced scarring. A suitable candidate should be young and slim with a small amount of breast tissue. Since the nipple stays intact, a person must have nipples that do not require repositioning.
Mastectomy W/ Dermal Pedicle Flap
The dermal pedicle flap consists of the full thickness of the skin and is attached by tissue where it receives its blood supply. An incision is made on each side of the chest along the lower pectoral muscle fold. The nipple areolar complex is then downsized and placed in a new opening. The ideal candidate is a large-breasted, or ptotic, individual. This procedure does result in scarring.
Double Incision Mastectomy
This procedure is best for individuals with larger or overhanging breasts. A double incision mastectomy consists of two horizontal incisions that are made at the top and bottom of the pectoral muscle. The original nipples may be removed, trimmed, and grafted onto the chest. This procedure allows for greater precision in nipple size and position. The disadvantage is scarring. Double incision mastectomy may be performed with the pedicle technique. This will allow the nipple to stay intact via a stock of tissue. It is repositioned while staying connected. The technique is often chosen in an attempt to maintain sensation in the nipple.
Anchor Incision Mastectomy
An incision is made around the areola and continues down the midline of the breast. The incision continues across the inframammary crease. This procedure allows for reshaping and sculpting of the entire breast. The ideal candidate for this procedure is one with overly large or ptotic breast tissue as other procedures will result in excess skin around the breast.