Female to Male Chest Reconstruction / Non-binary surgery
Female to Male Chest Reconstruction aims to change the characteristics of a female chest to that of a specific gender identity such as a male or a non-binary individual.
The principles of Female to Male Chest Reconstruction are to remove the breast tissue, obliterate the breast fold, site the nipple in the correct anatomical position and to re-drape the skin.
Female to Male Chest Reconstruction is best performed on someone who is in the best physical shape. On this basis patients will be advised to have stopped smoking and, if necessary, loose weight. A high BMI increase risks of surgery, in general, but specifically the surgical outcomes are far better in those who have attained an ideal weight. Medical conditions such as diabetes may influence surgery.
All patients will undergo some form of pre-operative assessment, and we may need you to engage with your general practitioner to optimise any medications.
Your gender identity specialist will have considered your psychological requirements before asking us to consider performing your surgery.
The aftermath of your operation may affect your wellbeing; sometimes additional support is required for you to adjust to you new form. It is very important that you have a realistic attitude of what female to male chest reconstruction surgery can achieve and to be prepared to accept varying degrees of scarring, loss of sensation (especially in your nipples) and irregularity or asymmetry.
Our observations indicate the overwhelming majority of our patients gain enormously from their surgery and move forward in their lives, often better than they had hoped.
There are a number of techniques available to achieve female to male chest reconstruction depending on the size and shape of the breast, the position and size of the nipple and the quality of the skin.
It is also important to recognise that the patient will have their own preferences.
A large breast size requires a formal mastectomy and usually free nipple grafting. Patients sometimes refer to this as the “double incision” technique. It is the most common method used and results in a curved or linear scar across the lower chest. The free nipple graft is placed in an appropriate position.
Other techniques may include keeping the nipple alive on a thin flap of tissue. This will be discussed, if appropriate, at the time of consultation. The Peri-areolar mastectomy is reserved for those with a small breast volume and therefore may be appropriate.
Young patients who have a small cup size may benefit from removal of the breast tissue via double incision in the tissue below the nipple, avoiding a scar around it. This technique is dependent on the remaining skin contracting.
The Procedure
Each technique requires a general anaesthetic and at least one overnight stay.
Drains, soft tubes connected to a vacuum bottle, are inserted to reduce the risk of a collection of blood in the operative site.
The wounds are closed with soluble sutures reinforced with steri-strips, (paper sutures). Further dressings, of a very simple nature, are then applied.
The drains are generally removed the following morning.
The dressings remain intact for two weeks.
If free nipple grafts are used they are held in position with a foam dressing which is sutured in place.
A degree of swelling is to be expected along with bruising. This will gradually resolve over the next few weeks.
Complications of Female to Male Chest Reconstruction
Poor scarring Ideally scars settle down to be a thin white line however on occasions they can remain red and thickened. Rarely, keloid scars can form. These can prove troublesome to treat
Infection Any surgical wound can become infected; antibiotics are administered at the beginning of the procedure to reduce this risk.
Bleeding The breast is naturally a very vascular organ. Blood vessels are sealed during the operative procedure but, on occasions, one may open up soon after, (24 to 48 hours). The use of a drain helps reduce the risk of a haematoma, which is a collection of blood in an operative site that may require drainage.
Asymmetry The scars on the left and right will not be exactly symmetric (no one’s body is). Any difference should be minimal and become less obvious as the scars mature and fade.
Free nipple graft failure If the graft fails the resulting wound will be allowed to heal by secondary intention. Nipple tattooing is then possible.
Dog ears Dog ears, (puckering), at the end of the mastectomy scar is possible, especially if the original breast is very large. Any puckering that does not settle down after a number of months may be revised under local anaesthetic.
Seroma Occasionally fluid can collect at the site of your operation for some weeks after. The binder may help to prevent this but if you do notice more swelling you should make contact with Mr Fitton. Occasionally the fluid is drained off using a needle. The procedure is no worse than having a blood test. Sometimes this has to be repeated a week or so later.
On the day of Surgery
You will be asked to come to the ward on the day of surgery where you will be taken to your room. Mr Fitton, the nursing team and the anaesthetist will visit you.
Mr Fitton will mark your chest and finalise the arrangements for your operation.
At the appropriate time you will be taken to the anaesthetic room and then into the operating theatre for the procedure.
The procedure usually takes between 90 and 120 minutes.
After your operation you will be transferred to the recovery suite before being returned to the ward.
Mr Fitton will review you after surgery and then again, the following morning. If appropriate the drains will be removed at this stage and discharge can be organised for later on in the day. If the amount of drainage is too great for their removal, you will be asked to stay for the drains to be removed the following morning.
When you leave the hospital the Resident doctor and the nurse team will ensure you have all your instructions and tablets to take away with you.
Surgical binder
It is beneficial to wear a snug surgical binder for at least a fortnight following surgery. This helps reduce swelling and also supports the scars. You can either provide their own, new and not previously worn garment or supply us with chest measurements so that we can order one for you.
Follow-up
We will arrange to see you again in the out-patient department about 10 days after your surgery when your dressings will be removed and your wound checked. We therefore ask you to keep the dressing dry for the first 10 days but by all means wash yourself by either sitting in a shallow bath of water or using a flannel. Assuming all is well further follow-up will either be with the GP or, if you wish, with Mr Fitton again.
General recovery
Bilateral mastectomy is a significant undertaking for patients, both physically and psychologically. Some form of fatigue can be expected for up to 6 weeks.
It is imperative not to take to one’s bed or sit for prolonged periods. Deep vein thrombosis, subsequent pulmonary embolus and its implications are more common in those patients who do not mobilise. Drinking regular volumes of water is also beneficial.
Arm and shoulder physiotherapy is important and can be self-directed. Placing one’s hands on one’s head, reaching behind to the spine or over to the opposite shoulder with each arm helps maintain the suppleness of the shoulder joint. Standing next or wall and walking the hand up the wall is also beneficial.
Activities such as swimming or extreme gym attendance should be curtailed for six weeks.
"I just wanted to thank you (and your team) for the life-changing result of my top surgery. This will provide me with the freedoms that I’m excited to enjoy, including being able to go swimming and actually staying cool in summer! All jokes aside, you have helped to mark a new chapter in my life, for which I am incredibly grateful."
J
Patient
A big thank you
"I would just like to say a big thank you, to you, Mr Fitton and all the nurses that I encountered during my stay at Nuffield hospital and at my pre/ post op appointments. You've all been very lovely and provided an amazing service."
EM
Patient
A big thank you
"I would just like to say a big thank you, to you Leanne, Mr Fitton and all the nurses that I encountered during my stay in hospital and at my pre/post op appointments. You've all been very lovely and provided an amazing service.’"
Anon
Patient
What you need to know...
Consultation
Female to Male Chest Reconstruction aims to change the characteristics of a female chest to male or a non-binary.
Stay Required
Each transgender technique requires at least one overnight stay.
Time
The transgender procedure usually takes between 90 and 120 minutes.
Anaesthetic
Each technique requires a general anaesthetic. There are 3 techniques.
