平胸手術
Masculine Chest Wall Contour Surgery (Top surgery) in Female –to-male Transgenders
To improve chest wall contour in some fmale-to-male transgenders, surgical intervention is necessary. Subcutaneous mastectomy is the surgery to remove female mammary glandular tissue that makes chest wall contour more masculine. According to the amount of breast glandular tissue, the position of nipple areolar and the elasticity of skin, we choose the two different surgery to achieve the optimal surgical results.
In the thin patient without big breasts, we preferred using key-hole incision for doing subcutaneous mastectomy to remove the glandular tissue. The key-hole incision was made along the upper edge of areola. It facilities unsightly scar as time goes by.
Fig.1: A 25 year-old female with BMI<20; pre-Op
Fig.2: 3 months after key-hole incision subcutaneous mastectomy
In patients with the ptotic breasts or huge amount of the glandular tissue, we recommend that the breast amputation and reposition of nipple-areola-complex will construct a more satisfied masculine chest wall contour.
Fig 3: A 30 year-old female with ptotic breast; the new nipple-areolar position was marked as “X”
Fig.4: six months after breast amputation and free nipple-areolar graft
Preoperative preparations:
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Check-up general data, chest X-film, ECG. Blood routine, liver function etc.
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Stop hormonal agents, if used.
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NPO, since the midnight before surgery
In surgery, it takes about four hours to complete the whole procedures. Blood loss is always minimal and no blood transfusion is needed. The suction drains will be placed for three to five days until the amount of fluid is less than 20c.c. The patients can go back to hotel in the afternoon with elastic bandages on the chest wall. The stitches will be off in ten days.
The chest style elastic garment should be wear day and night for the first postoperative month. And, then it should be wear in the daytime for at least six months.
原生女性在進入青春期後，胸部開始發育。男性與女性胸部的外觀，出現明顯的差異，不論是乳房大小，乳暈、乳頭的大小、位置，都非常地不同。胸部的發育，我們常說是女性的第二特徵。在女跨男變性手術中，胸部是一項非常重要卻常被忽視的議題。病人的期望，是能裸著上半身到海邊，或游泳池戲水，像個真正的男人。因此，胸部手術後的外觀就越顯得重要。
對於胸部不是很大，僅是Ｂ罩杯以下者，我通常會使用乳暈周圍的切口（上半圍）。經由這種切口，配合內視鏡的使用，將乳房組織切除。術後乳房皮膚可能會有些許的皺摺，須配戴彈性胸衣。三個月後，皮膚會自己回縮，恢復平整。
對於乳房尺寸較大的病人（通常是Ｃ罩杯以上），合併有皮膚鬆弛的病人，我會使用”甜甜圈”的切口，在乳暈周圍，切除掉一些的皮膚，其功能有二：
緊緻乳房切除後皮膚，避免皮膚的鬆垮，造成乳房下半部無法改善的折皺。
藉以改善乳頭乳暈的位置及大小。
若是乳房尺寸過大（大於Ｅ罩杯）或是有嚴重下垂的病人，則會考膚使用乳房截除加上乳頭、乳暈全層移植方式來改善胸部的外觀與乳頭乳暈的位置。這種乳房如果是使用“甜甜圈”的切法，會導致乳暈周圍有太多的放射狀折皺，病人不容易有自然的外觀。
不過，這種乳房截除的手術，會在下乳線處留下疤痕，可能需要再次手術來修疤，真可謂有一好就無兩好，魚與熊掌不可得兼，取其外觀上有利的術式吧！
以上各式手術皆需在全身麻醉下進行，約須4小時，出血量少於10 C.C. 故不須輸血。手術當日可以回家不須住院。有時視情形在乳房下方，留置引流管帶回家，回診待引流量小於20cc取出。術後會使用彈性繃帶壓迫胸部，若有太緊不適的情形，可以自行鬆開重綁。術後10天拆線，胸型要等待3至6個月，才會恢復自然漂亮的外型。
