FTM top surgery info

From T-Vox
Jump to: navigation, search

This is a comparison of the details, risks, advantages and disadvantages of each of the three types of FTM chest reconstructive surgeries. It is a very brief overview really. You need to look at pictures (http://transbucket.com/ and http://groups.yahoo.com/group/ftmsurgeryinfo/ are the best places to look) of as many people as you can, keeping aware of what method they had done, who their surgeon was, and how much time has passed between surgery and the taking of the photograph. (Do not look at photos of people who are very newly post-op; what you want to see is the long-term healed results. Of course it's going to look like hell initially; the person just underwent major surgery.)


Please note that scars do fade and are really not the end of the world. Unless you're someone who scars really badly, your scars will fade to nothing as time passes, and a competent surgeon will place them so they're hidden by the pectoral muscle. (Brownstein in particular is known for doing this consistently and well.)


Disclaimer: Individual results vary as widely as individual health, individual surgeon skill and care, and individual luck. The most important thing is for each of us to decide which chest characteristics are important to us; locate the most skilled and reliable surgeons for that procedure (to reduce the listed risks for that surgery as much as possible); and then discuss our individual options with those surgeons.


Contents

Double Incision

What is it also called?

  • Bilateral mastectomy
  • Mastopexy


What is it?

Skin is opened in two incisions, along top of chest and along bottom of pecs, from center of chest out toward armpits. Almost all breast tissue is removed by scalpel. Nipples are removed, resized and repositioned in a graft higher up on the chest. Minor liposuction sometimes used to contour fat at borders of surgical area/under arms. Incision is closed together at bottom of pecs line. Some surgeons will maintain original nipple/areola on stalk ('dermal pedicle') instead of grafting, to preserve nerve sensation.


Who is it for?

  • Larger chests (B, C, D+, sometimes large A).
  • Looser skin, more droop or 'ptosis'; 'deflated' chest. If your breasts hang down more as opposed to sticking out, you have looser skin and will likely want double incision.


Risks: What do I want to watch out for/worry about?

None of these things are guaranteed to happen if you have double incision. They are simply things that could happen. Discuss any concerns with your surgeon.

  • Loss of nipple graft, including loss of all or part of areola, nipple.
  • Permanent numbness.
  • Large, dark hypertrophic ("spreading") scarring.
  • Poor placement/shape of scars by surgeon.
  • Poor placement/sizing of nipple.
  • Irregular appearance of reconstructed nipple; irregular areolar shape.
  • Adhesion scars at scar line if underlying muscle surface is nicked.
  • Puckering at scar.
  • Dog-ears under armpits.


What are the scars?

Larger, more prominent scars; usually in a "W" shape, or two "C"s, across lower pectoral area. Can take several years to fade. A competent surgeon will place them beneath the pectoral fold so they are hidden by developed pectoral muscles.


Will I need revisions (extra surgeries)?

Revisions may be necessary. Usually to remove small amounts of breast tissue left near the armpits, or to repair dog-ears or small puckers in scar line.


What sensation might I have?

Sensation returns gradually over time. Better nipple sensation possible if original nip/areolae retained with "pedicled" procedure, instead of reconstructed with graft.


Overall Pro/Con

  • Flatter chest initially/during healing process. Nipples are generally smaller, and in a higher position on chest. Very good possible outcome for larger-chested individuals. Healed, well-placed/well contoured scar hides well under developed pectoral muscle.
  • Scars are more prominent; will be very visible on individuals without developed chest muscles, at least initially. Scar may spread over time and/or take several years to lighten. Grafting brings with it greater possibility of nipple damage, loss or loss of sensation. Grafted/reconstructed nipples frequently recover only 'protective' or touch sensation but not erotic sensation.


Some doctors who perform this type of surgery

(See "Photos" section of Yahoo site FTMSurgeryInfo; also on TransBucket.com)

All common FTM doctors. Brownstein, Fischer, Garramone, Perry Johnson, McGinn, Medalie, and Raphael are among the best in the US at this method. Ching and MacLean sometimes perform a "pedicled" version, which can maintain original nipple and areola for preserved sensation.

Keyhole

What is it also called?

  • Subcutaneous mastectomy
  • Sometimes called "peri-areolar" interchangeably


What is it?

Skin is opened along bottom half of areola border. Most of breast tissue and surrounding tissue is removed via liposuction through this small hole. Nipples may or may not be resized, but cannot be repositioned. Areola is not reduced; surrounding chest skin is not reduced.


Who is it for?

Smallest chests (small/very small A has best result in this method). Tightest skin, most elastic skin, least body fat. No sagging of chest ('ptosis'). Works best with smallest amounts of least-dense, least-fibrous breast tissue: glandular tissue must pass through liposuction needle.


Risks: What do I want to watch out for/worry about?

None of these things are guaranteed to happen if you have keyhole. They are simply things that could happen. Discuss any concerns with your surgeon.

  • Significant risk to nipple(s), including loss of all or part of areola, nipple, from liposuction trauma to blood and nerve supply.
  • Risk of 'fat necrosis' (an under-skin infection) from liposuction trauma.
  • Permanent numbness or nerve pain.
  • 'Adhesion' scars under skin (lines where skin surface puckers as scar binds onto chest muscle), from damage to underlying muscle surface by liposuction needle.
  • Insufficient retraction of remaining skin.
  • Insufficient retraction/sagging of areolar skin.


What are the scars?

Nearly invisible scarring at incision line along bottom junction of areola and skin. Sometimes also adhesion scars / puckers under chest skin.


Will I need revisions (extra surgeries)?

Revisions may be necessary. Usually to remove chest skin and/or areolar tissue that has not shrunk close enough to the chest. Also to repair adhesion scars, or contour underskin fat around surgical area. Nipples may be resized.


What sensation might I have?

Sensation returns gradually over time. Sensation may not fully return, particularly erotic sensation.


Overall Pro/Con

  • Less prominent scarring, frequently invisible. Possibility of good nipple sensation. Good possible outcomes for very small-chested individuals.
  • More significant risk of loss of sensation/death of nipples, areolae, due to damage to blood supply, tissues and nerves from liposuction needle. Risk of infection, 'fat necrosis' from liposuction. More postoperative pain; more risk of ongoing nerve pain. For all but smallest 'small A' sized patients, significant risk of insufficient 'shrinkage' of chest skin, leaving lumpy, deflated-looking or puckered surface, as no extra skin around areola was removed. Risk adhesion scars under upper chest skin. Areolae remain original size and at original position on chest.


Some doctors who perform this type of surgery

(See "Photos" section of Yahoo site FTMSurgeryInfo; also on TransBucket.com)

  • Alter
  • Brownstein
  • Fogdestam


Peri-Areolar

What is it also called?

  • Subcutaneous mastectomy
  • Sometimes called "keyhole" interchangeably


What is it?

Skin is opened along entire circumference of areola. Skin is separated away from underlying breast tissue. Breast tissue is removed by scalpel. Nipple nerve and blood supply is maintained on a stalk ("dermal pedicle"). Excess skin is trimmed from around circumference of areola in "doughnut" shape. Minor liposuction sometimes used to contour fat at borders of surgical area. Areola is resized, then skin reattached to areola at its border. Nipples can be reduced in revision if desired. Areola may be repositioned to a limited extent, depending on original chest size (i.e., amount of chest skin available).


Who is it for?

A, B, possibly small C in rare cases. Works well with moderate body fat, moderate to very elastic skin. (May show slightly better result when done before starting T.) Some sagging/droop of original chest OK; better result with least stretching/thinning of chest skin. Fibrosity of breast tissue not an issue as tissue is not removed through liposuction needle.


Risks: What do I want to watch out for/worry about?

None of these things are guaranteed to happen if you have peri. They are simply things that could happen. Discuss any concerns with your surgeon.

  • Loss of nipple(s), including loss of all or part of areola, nipple.
  • Permanent numbness or nerve pain.
  • Broadening or "spreading" scars.
  • Off-round areolar shape.
  • Adhesion scars at scar line if underlying muscle surface is nicked.
  • Insufficient retraction of remaining skin.
  • Incomplete flatness of chest.
  • Puckering or pleating at scar.


What are the scars?

Nearly invisible scarring at incision line around the border of the areola and skin.


Will I need revisions (extra surgeries)?

Revisions may be necessary. Usually to additionally contour underskin fat around surgical area; or reduce broadened scars or small pleats in scars. Nipples may be resized.


What sensation might I have?

Sensation returns gradually over time. Good chance of returned sensation, normal erectile ability in nipples and chest.


Overall Pro/Con

  • Less prominent scarring, frequently invisible. Less risk of nipple loss. Possibility of normal sensation in nipples and skin. Less invasive surgery due to lack of significant liposuction damage to tissues; faster healing, less postoperative pain compared to keyhole. Good possible outcomes for A, B sized individuals.
  • Nipples may remain large and/or in a lower position on chest, compared to double-incision surgery, which places the nipples as appropriate for a male chest. Procedure done poorly, or on too-large a chest, can leave loose skin or pleating in skin at skin/areola closure. Procedure as done by some doctors may retain more breast tissue than in double incision initially and possibly permanently.

Some doctors who perform this type of surgery

(See "Photos" section of Yahoo site FTMSurgeryInfo; also on TransBucket.com)

  • Alter
  • DaVerio
  • Fischer
  • Mueller

See also

Personal tools
Namespaces

Variants
Actions
Navigation
The T-Vox Community
Toolbox