Thorax masculinization in a transsexual patient: Inferior pedicle mastectomy without an inverted T scar

Transsexual individuals with gender dysphoria or gender identity disorder are rare, with a prevalence reported to range from 0.002% to 0.014%. Studies have shown that mastectomy yields significant improvements in body image and self-esteem in female-to-male transsexual patients. In patients with grade III breast ptosis, mastectomy with a nipple-areolar complex (NAC) graft is the most commonly used technique, although it has several disadvantages. In the case described herein, a bilateral mastectomy preserving the NAC in an inferior pedicle was performed. Additionally, a thin superior thoracic dermal-fat flap was preserved and eventually sutured at the previous inframammary fold, preventing an inverted T scar. This case shows the advantage of this technique for preserving the blood supply and innervation of the NAC, with a low hypopigmentation risk. Furthermore, in this technique, the patch effect does not impair the results of the NAC graft, and there is no need to use an inverted T scar that may result in thoracic feminization.

Keywords

Transsexualism - Gender dysphoria - Gynecomastia - Mastectomy

Publication History

Received: 27 January 2018

Accepted: 17 May 2018

Article published online:
28 March 2022

• REFERENCES

• 1 Sanchez Lorenzo I, Mora Mesa JJ, Oviedo de Lucas O. Psychomedical care in gender identity dysphoria during adolescence. Rev Psiquiatr Salud Ment 2017; 10: 96-103
• 2 Beek TF, Cohen-Kettenis PT, Kreukels BP. Gender incongruence/gender dysphoria and its classification history. Int Rev Psychiatry 2016; 28: 5-12
• 3 Moreno-Perez O, Esteva De Antonio I. Grupo de Identidad y Diferenciacion Sexual de la SEEN (GIDSEEN). Clinical practice guidelines for assessment and treatment of transsexualism. SEEN Identity and Sexual Differentiation Group (GIDSEEN). Endocrinol Nutr; 2012. 59. 367-82
• 4 van de Grift TC, Kreukels BP, Elfering L. et al. Body image in transmen: multidimensional measurement and the effects of mastectomy. J Sex Med 2016; 13: 1778-86
• 5 van de Grift TC, Cohen-Kettenis PT, Steensma TD. et al. Body satisfaction and physical appearance in gender dysphoria. Arch Sex Behav 2016; 45: 575-85
• 6 Becker I, Nieder TO, Cerwenka S. et al. Body image in young gender dysphoric adults: a European multi-center study. Arch Sex Behav 2016; 45: 559-74
• 7 Takayanagi S, Nakagawa C. Chest wall contouring for female-to-male transsexuals. Aesthetic Plast Surg 2006; 30: 206-12
• 8 Monstrey S, Selvaggi G, Ceulemans P. et al. Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm. Plast Reconstr Surg 2008; 121: 849-59
• 9 Thienot S, Bertheuil N, Carloni R. et al. Postero-inferior pedicle surgical technique for the treatment of grade III gynecomastia. Aesthetic Plast Surg 2017; 41: 531-41
• 10 Bonte A. Gynecomastie: techniques chirurgicales et indications. EMC Tech Chir Chir Plast Reconstr Esthet 2013; 45 (668-D): 1-9
• 11 Wolter A, Diedrichson J, Scholz T. et al. Sexual reassignment surgery in female-to-male transsexuals: an algorithm for subcutaneous mastectomy. J Plast Reconstr Aesthet Surg 2015; 68: 184-91
• 12 Colic MM, Colic MM. Circumareolar mastectomy in female-to-male transsexuals and large gynecomastias: a personal approach. Aesthetic Plast Surg 2000; 24: 450-4
• 13 Cannistra C, Piedimonte A, Albonico F. Surgical treatment of gynecomastia with severe ptosis: periareolar incision and dermal double areolar pedicle technique. Aesthetic Plast Surg 2009; 33: 834-7
• 14 Cardenas-Camarena L, Dorado C, Guerrero MT. et al. Surgical masculinization of the breast: clinical classification and surgical procedures. Aesthetic Plast Surg 2017; 41: 507-16