Department of Plastic and Aesthetic Surgery, Florence-Nightingale-Hospital - Kaiserswerther Diakonie, Kreuzbergstrasse 79, 40489 Duesseldorf, Germany.
Department of Plastic and Aesthetic Surgery, Florence-Nightingale-Hospital - Kaiserswerther Diakonie, Kreuzbergstrasse 79, 40489 Duesseldorf, Germany.
J Plast Reconstr Aesthet Surg. 2015 Feb;68(2):184-91. doi: 10.1016/j.bjps.2014.10.016. Epub 2014 Oct 18.
Subcutaneous mastectomy is one of the first steps in sexual reassignment in female-to-male transsexuals (FTMTS). The main goal is to masculinize the chest by removing the female contour. In this study, we introduce an algorithm to facilitate choosing the appropriate mastectomy technique depending on morphological aspects.
The records of 173 patients (346 mastectomies) from January 2008 to December 2013 were retrospectively reviewed. The authors conducted four different surgical techniques depending on breast volume, grade of ptosis and skin elasticity. The outcome parameters such as complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and surgical correction rate were obtained and related to the employed technique.
From January 2008 to December 2013, we performed 346 mastectomies, of which 48 breasts (13.9%) were treated by a semicircular incision in combination with water-jet-assisted liposuction, 66 breasts (19.1%) by an additional circumferential mastopexy, 170 breasts (49.1%) by an inferior pedicled mammaplasty and 62 breasts (17.9%) by mastectomy with free nipple grafting. The mean operation time lasted 103.6 min. The overall complication rate was 11.8%. Secondary revisions were necessary in 9%. Of the patients, 88% rated the aesthetic results as "very good" or "good." Nipple sensitivity was rated as "very good" or "good" in 80.3% of the breasts.
FTMTS are a well-informed patient population and therefore increasingly more demanding for aesthetic outcomes. If possible, the most scar-saving procedure should be preferred. With ascending degrees of ptosis, a larger skin envelope and lesser elastic skin, an extended-incision technique is required. The presented surgical algorithm facilitates the selection of the appropriate mastectomy technique and shows a high patient satisfaction with the aesthetic result, a preservation of nipple sensitivity and a low rate of complications and secondary aesthetic corrections.
皮下乳房切除术是女性变男性跨性别者（FTMTS）性别重置的第一步。主要目标是通过去除女性轮廓使胸部具有男性特征。在这项研究中，我们介绍了一种算法，根据形态学方面来帮助选择合适的乳房切除术技术。
回顾性分析了 2008 年 1 月至 2013 年 12 月期间的 173 例患者（346 例乳房切除术）的记录。作者根据乳房体积、下垂程度和皮肤弹性进行了四种不同的手术技术。获得了并发症发生率、患者对美学效果的满意度、乳头敏感性和手术矫正率等结果参数，并与所采用的技术相关联。
2008 年 1 月至 2013 年 12 月，我们共进行了 346 例乳房切除术，其中 48 例乳房（13.9%）采用半圆形切口联合水刀辅助吸脂术治疗，66 例乳房（19.1%）采用附加环形乳房提升术治疗，170 例乳房（49.1%）采用下蒂乳房成形术治疗，62 例乳房（17.9%）采用游离乳头移植乳房切除术治疗。平均手术时间为 103.6 分钟。总的并发症发生率为 11.8%。需要进行二次修正的占 9%。患者中，88%的人对美学效果评价为“非常好”或“好”。80.3%的乳房乳头敏感性评价为“非常好”或“好”。
FTMTS 是一个知情的患者群体，因此对美学结果的要求越来越高。如果可能的话，应优先选择最能减少疤痕的手术。随着下垂程度的增加、更大的皮肤覆盖和更小的弹性皮肤，需要采用扩大切口技术。所提出的手术算法有助于选择合适的乳房切除术技术，并显示出患者对美学效果非常满意、保留乳头敏感性、并发症和二次美学矫正率低的特点。
