There are many differences between the unmistakable look of a male versus a female’s chest. Females naturally carry more breast tissue, as well as have larger nipples and areolas that are more centrally-located on the breast. Males however have flatter and more muscular chests, with less breast tissue and smaller areolas and nipples placed laterally and lower on the breast, closer to the crease that runs underneath the breast. For these obvious reasons, patients transitioning from female to male seek top surgery, or a bilateral mastectomy, for removal of breast tissue to transform their female chest into a masculine one.
Any sex reassignment surgery (SRS), or gender reassignment surgery, requires the expertise of an incredibly experienced, board-certified cosmetic plastic surgeon. These are very serious, life-changing, as well as exciting procedures, helping transitioning patients to feel more satisfied with their bodies and more like the beautiful person they envision. Patients are advised to choose their surgeon wisely, as not all are alike or carry the same experience, skill set or sense of professionalism. Elements MediSpa’s Dr. Adibfar—supported by his compassionate and highly-trained and accomplished medical staff—is one of Toronto’s best board-certified cosmetic plastic surgeons with successful experience performing transgender surgeries. His thorough knowledge and application of skill to help transitioning patients on their journey is well recognized. Patients should always seek a surgeon that not only has the necessary credentials, but also extensive experience having performed the considered surgery successfully and with aesthetically pleasing, however realistic results. Let’s look at the surgery in more detail.
A bilateral mastectomy is a masculinizing surgery used to transform a female chest to one that appears more apparently masculine. Depending on the size of the patient’s breasts, the surgery may be done differently, however, there are two basic processes that take place in order to provide the desired results. Generally speaking, Dr. Adibfar first removes the excess breast tissue, then ends the surgery by contouring the chest area into a more masculine shape before inserting drains and closing the incisions.
Patients with a naturally smaller chest size may undergo keyhole surgery, or a peri-areolar procedure, which leaves the nipple and areola intact. With this procedure no extensive scarring is visible as a small incision is made solely at the base of the areola. As well it limits the chance of the patient experiencing any nerve damage to the area. There are limitations to this procedure however. Because the nipple and areola are not grafted, the placement and size or shape may not appear as masculine as would be if it were placed lower and more laterally close to the breast crease.
Patients with naturally larger breasts will undergo more extensive, however safe and effective, surgery. A bilateral mastectomy requires grafting and resizing of the nipple and areola. While this procedure does lend a more prominent incision line, the grafted nipple and areola are resized and placed lower on the breast for a chest that appears drastically more masculine. The incision line is made along the crease underneath the breast to remove excess breast tissue as well as subcutaneous fat via liposuction. Another incision may be made above the breast to remove tissue from underneath the chest wall. Liposuction is also applied along the sides to ensure less chance of the appearance of ‘dog ears’ closer to the patient’s armpits. Drains are then inserted into the patient’s underarms to control excess fluid build up before closing the incisions with dissolvable stitches and gently applying pressure bandages and dressings. Up to one year later, the patient may require more excess skin removal as the chest does take time to heal and acclimate to the body and it’s new shape.
The procedure is done under general anesthetic with local anesthetic usually used as well to control any chance of excessive bleeding during the procedure. Dressings and drains will be removed at the first follow up appointment and patients are advised to adhere closely to any guidelines concerning changing the dressings and bandages over the nipples and chest, as well as special instructions regarding pain medications, hygiene and/or tolerable levels of activity. After approximately 2 weeks, patients will be able to resume more normal activities, or return to work, while continuing to carefully tend to their dressings. Because grafted nipples and areolas have no nerve supply, patients may only experience nipple sensation every so often. It is also normal that patients’ nipples may experience scabbing or peeling of the skin as it heals.
As with most serious cosmetic plastic surgeries, healing takes time. It is normal for incision lines to appear more prominent before they begin to flatten and fade. This process can take up to one year, however patients undergoing a bilateral mastectomy are some of the most satisfied and overjoyed patients, reporting the results as life-changing as they begin to see their hard work and dedication pay off when faced with their reflection.
If you’re interested in learning more about SRS or gender reassignment surgeries, then Dr. Adibfar would be more than happy to answer any questions you may have confidentially and with the utmost understanding and concern for each patient’s safety.
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