Mastectomy (Top Surgery)
in Bangkok, Thailand
The plastic surgeon performs top surgery or Mastectomy, should achieve more than just a flat chest. Ideally, the result should be fully sensate and has minimal scarring. The procedure consists of the removal of most of the breast tissue and removal of excess skin. The sparing of the nipple and areola is sufficient if the nipple-areolar complex is appropriately sized and shaped. Still, often the reduction and repositioning of the nipple-areolar complex are required to approximate male nipples.
Top Surgery/ Mastectomy Techniques
Kamol Cosmetic Hospital offers three techniques, but the choice of procedures must be appropriately selected for the patient’s breast size and skin quality as follows;
a) A periareolar (or U-shape scar) technique, the incision is periareolar or U-shape scar. This technique is available for a small breast with good skin elasticity; it may be removed breast mass with a minimal incision scar as the picture 1
Picture 1. Shows U- shape scar for small breasts.
b) A concentric incision or O-shape scar technique, this technique is available for moderately sized breasts (B cup) with good skin elasticity. Breast mass is removed pass through a concentric incision which gathers skin and leaves a scar entirely around the areola (or O-shape scar).
Picture 2. Shows a concentric incision or O- shaped scar.
c) Double incision top surgery with nipple graft technique or Mastectomy by free nipple graft, this procedure is available for large or pendulous breasts to 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.
Picture 3. Shows double incision top surgery with nipple graft
Inelastic skin (often due to years of breast binding) can adversely affect the outcome and will influence (and limits) the surgeon's choice of technique.
A Good Candidate for Mastectomy (Top surgery)
- Trans men
- Realistic expectation
- Age is over 18 years old.
Preparation for Mastectomy (Top surgery)
- Consult with the surgeon to choose the most suitable option and ensure you are the right candidate and how can to achieve the goal.
- Undergo physical examination to ensure no health condition may affect the surgery
- Stop smoking at least two weeks before surgery
- Stop some medicines that interfere with blood clotting, such as aspirin, Ibuprofen, some kinds of vitamin and herbs at least two weeks before surgery.
Top surgery procedure
- Step 1 The procedure preform under anesthesia
- Step 2 Open the incision at the marked site that requirement and remove the breast mass to flatten.
- Step 3 Resect the excess skin and adjust the size and position of nipple-areolar like the original male chest.
- Step 4 Skin suture
Postoperative care for top surgery
- Postoperative care in the hospital 2-5 nights depending on the techniques
- Keep clean and dry every day
- Take medicine for pain, infection
- Follow up seven days, fourteen days after surgery, and every appointment.
- Take stitches off seven days after surgery
- Use compression garment to prevent swelling and adjust the chest shape 3-6 months
Risk and complications for FTM Mastectomy
After surgery risk and complexity are possible as follows;
- Bleeding is a risk of any operation, but the need for transfusion is very rare. However, specialized surgeons are well concerned and will always keep control to stop bleeding during surgery.
- Infections are infrequent complications.
- Nipple necrosis. The blood supply of the nipple might damage the more limited operation and the nipple necrosis. If the nipples use as grafts, the nipple graft does not take well. These complications are exceedingly rare.
- Loss of nipple sensation, numbness
- Loss nipple and areolar
- Poor healing
- Swelling after surgery
- Painful will occur but can take a pain killer
- 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. There may be residual tissue left, which appears as a contour deformity. This scar needs to remove at a second stage.
- Risk from anesthesia
Recovery for Top surgery
Recovery time depends on the person and the surgical technique. You can return to work after surgery for 2 weeks. After surgery a few days, you will feel uncomfortable. The swelling will be better within 2-3 weeks. It will heal completely 4-6 months, be concerned the physical activity such as sport, lifting, and running.