Abbed Turkia, Shifrin David A
Division of Plastic Surgery, University of Illinois at Chicago, Chicago, Ill.; and Shifrin Plastic Surgery, Chicago, Ill.
Plast Reconstr Surg Glob Open. 2017 Aug 10;5(8):e1445. doi: 10.1097/GOX.0000000000001445. eCollection 2017 Aug.
Gender reassignment surgery has gained in popularity with increased media exposure and society's recognition of gender dysphoria. Female-to-male gender reassignment often begins with the "top" or chest surgery. Mastectomy with free nipple grafting is the most frequently described technique in the literature. This technique is reliable yet lacks the ability to provide a true male chest shape. We discuss our technique for female-to-male "top" surgery combining traditional mastectomy techniques with a lower pole pedicle vascularized areola and a pectoral implant. A 32-year-old African American female with bilateral C cup breast with grade 2/3 ptosis presented for "top" surgery. Intraoperatively, the nipple areola complex was maintained on a lower pole pedicle at a thickness of 1.5 cm to maintain neurovascularity. A superior mastectomy flap was raised at the level of the breast capsule and remaining breast tissue excised. A lateral subpectoral pocket was created for insertion of a silicone pectoral implant. The new nipple position matured in the infero-lateral quadrant of greatest projecting portion of the chest. Lower pole pedicle provided vascularity to the areola, which avoids the need for a free nipple graft and potential hypopigmentation. Pectoral silicone implant provided upper pole fullness to mimic the male chest muscular distribution. Modification of mastectomy-based female-to-male gender reassignment surgery with a lower pole pedicle-based areola and pectoral implant provides an aesthetic improvement over the classic mastectomy with free nipple graft technique.
随着媒体曝光度的增加以及社会对性别焦虑症的认可，性别重置手术越来越受欢迎。女性向男性的性别重置通常从“胸部上方”手术开始。带游离乳头移植的乳房切除术是文献中描述最频繁的技术。该技术可靠，但缺乏塑造真正男性胸部形状的能力。我们讨论了我们的女性向男性“胸部上方”手术技术，该技术将传统乳房切除术技术与下蒂带血管乳晕和胸肌植入物相结合。一名32岁的非裔美国女性，双侧乳房为C罩杯，乳房下垂程度为2/3级，前来接受“胸部上方”手术。术中，乳头乳晕复合体保留在下蒂上，厚度为1.5厘米，以维持神经血管供应。在乳房包膜水平掀起上乳房皮瓣，切除剩余乳腺组织。创建一个胸肌下外侧腔隙以植入硅胶胸肌植入物。新乳头位置在胸部最突出部分的下外侧象限成熟。下蒂为乳晕提供血供，避免了游离乳头移植的需要以及潜在的色素沉着不足。胸肌硅胶植入物提供上极丰满度，以模仿男性胸部肌肉分布。基于下蒂乳晕和胸肌植入物对基于乳房切除术的女性向男性性别重置手术进行改良，相较于经典的带游离乳头移植乳房切除术，在美学上有了改进。
