Mastectomy (Top Surgery)
in Bangkok, Thailand
The mastectomy (top surgery) procedure performed by the plastic surgeon, should achieve more than just a flat chest. Ideally, the subcutaneous mastectomy results in a chest which has an aesthetically pleasing male contour, is fully sensate and has minimal scarring. The procedure consists of removal of most of the breast tissue and removal of excess skin. Sparing of the nipple and areola is sufficient if the nipple-areolar complex is appropriately sized and shaped, but often the reduction and repositioning of the nipple-areolar complex is required to approximate male nipples.
Mastectomy (Top Surgery) Techniques
The choice of technique must be appropriately selected for the patient’s breast size and skin quality:
a) Small breasts with good skin elasticity may be removed with a minimum of incisions andsubsequent scarring. A periareolar (or U-shape scar) approach is most often used in these instances.
Figure 1: Keyhole approach for smaller breast
b) Moderately sized breasts (B cup) with good skin elasticity can most often be removed with a concentric incision which gathers skin and leaves a scar completely around the areola (or O-shape scar).
Figure 2: Concentric incision approach
c) Large or pendulous breasts require a full mastectomy, which includes removal of the nipple, with free grafting of the nipple to the appropriate new location. This technique will impact nipple sensation significantly but may be the only option for large or inelastic breasts.
Figure 3: Mastectomy by free nipple graft
Skin which is inelastic (often due to years of breast binding) can adversely affect the outcome and will influence (and limits) the surgeon's choice of technique.
Risks and complications:
- Bleeding is a risk of any operation, but the need for transfusion is very unlikely. However, specialized surgeons are well concerned and will always keep control to stop bleeding during surgery.
- Infections are very rare complications.
- Nipple necrosis. The blood supply of the nipple might be damaged with the more limited surgery and the nipple could die. If the nipples are used as grafts, then it is possible that they might not survive. These complications are exceedingly rare.
- The scars of the areola usually heal very well. The scars below the breast will take longer to fade out and will widen as mentioned above. However, a raised or excessively wide scar is possible and might need further treatment. It is possible that there may be residual tissue left, which appears as a contour deformity. This would need to be removed at a second stage.