Masculinising chest surgery is indicated for patients with a persistent and well documented gender dysphoria who are assessed to benefit from mastectomy as part of a masculinising chest process. This process is likely to include male hormone supplementation and surgical breast removal with resitting of the nipples in a masculine position.
The chest and reconstructed nipple do not have the same sensitivity as the preoperative chest and natural nipple and nipples will not react in the same way to touch or temperature but are designed to give a more natural male appearance to the chest. The new nipple may be designed flat or have more projection and your preferences should be discussed with Mr Rubin.
This technique which leaves a scar around the nipple rather than across the chest is most suited to patients with small or minimal breasts. Nipple-areolar complex is not removed as a graft but kept attached. The main downsides with this technique are that the scar around the nipple is prone to be irregular as excess skin is gathered up around the nipple.
There is also a higher incidence of bleeding after surgery. One reason for this is the visualised operative field during surgery is reduced making it harder to see small bleeding vessels.
This has some of the advantages of a circumareolar technique but with a more predictable outcome. A proportion of the excess skin is taken out with the medial and lateral extensions which also has the advantage of allowing improved visibility of the operative field. There is a higher incidence of bleeding after surgery than with the double incision technique but lower than with the circumareolar technique alone.
This is commonly performed during the double incision technique and the aim is to create the new nipples in a position that is considered masculine and as symmetrical as possible to the nipple on the opposite breast. Variables include nipple size and the degree of projection and if you have specific preferences please discuss these with Mr Rubin before surgery.
It should be remembered that no matter how straight forward and routine a surgical procedure may be they all have their risks of complications and limitations
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