From , we did 52 two-sided subcutaneous mastectomies in the Company from Vinyl, Reconstructive and Aesthetic Functions, Trakya School Healthcare, Edirne, Chicken ( Desk step 1 ). The common diligent many years are 28.2 (age groups, 18-47). The latest loads away from patients was in fact anywhere between 40 and you will 100 kg and you can average body mass index (BMI) is 23.cuatro (Bmi variety, 15.6-thirty-six.7). Thirty clients got a history of acquiring testosterone hormone procedures ahead of procedure. Hormone procedures are discontinued four weeks before medical intervention. And additionally, for each patient undergone an entire psychiatric, endocrinological, urologic and gynecological review, and this acceptance brand new diagnosis of “FtM transsexualism” are generated. An 
enthusiastic ultrasound test is performed to test the current presence of glandular structure and also to ban one pathologic size in all circumstances. ‘Diligent Told Agree Form’ is actually obtained from every anyone.
Desk step one
Preoperatively, the option of technique is actually predicated on breast proportions and degree off skin excessively, facial skin elasticity, NAC proportions and you will reputation. A four degree breast group try did centered on nipple size and surface too much:
Most of the clients have been informed regarding the appropriate technique out of slices and you may you’ll be able to postoperative markings. Of these people who maybe not accept postoperative markings beyond the subpectoral shadow, this disorder are detailed. Up coming, specific subcutaneous mastectomy try picked in accordance with the algorithm shown from inside the Figure step one . Appropriate antibiotics had been applied 60 minutes up until the procedure as well as for the 5 weeks after. Someone pleasure questionnaire try did 12 months adopting the surgery to check the overall visual consequence of subcutaneous mastectomy. Diligent fulfillment are rated as the “decent” (5), “good” (4), “satisfactory” (3), “reduced satisfactory” (2) and you can “unsatisfactory” (1).
Medical techniques
All of the subcutaneous mastectomies was basically did around general anesthesia. Toward diligent for the vulnerable reputation, particular facial skin incisions have been made based on preoperative markings. Inside the height out-of flaps, most cautious dissection try did to preserve all subcutaneous lbs above the fresh mammary gland. Thus, adequate thickness facial skin produces an aesthetically pleasing chest wall surface appearance versus purely followed and you will disheartened components amongst the surface and you will breasts wall surface.
About cases of breasts with reduced size and surface extreme, the fresh Webster technique was used ( Shape 2 ). The fresh incision starts out-of ‘three’ standing inside areola-body combination and you will ends during the ‘nine’ standing. It may be prolonged laterally and medially by at the very least step 1 cm, having most useful publicity of your own subcutaneous dissection town. Through the level regarding NAC cutting-edge, a small amount of mammary muscle is incorporated not as much as which flap to prevent despair deformity. Up coming, subcutaneous mastectomy is accomplished. At the conclusion of this process, to make an aesthetically pleasing male chest figure, the necessary quantity of subcutaneous pounds muscle is excised off above the amount of the fresh new submammary bend, if required. Whilst technique is more difficult, of the quick publicity screen whereby dissection and you can hemostasis are carried out, that it quick incision leads to a highly-undetectable infra-areolar scar. Concurrently, nipple reduction can be executed, if needed. A sucking drain is put on the subcutaneous dissection town. Although not, in case the patient gets the interest in an inferior areola, this process will likely be changed to an effective concentric periareolar method.
The newest concentric periareolar techniques can be used for tits which have average skin way too much and you may an excellent facial skin flexibility (B glass) or tits with reduced epidermis excess but having a high NAC state-of-the-art ( Profile 3 ). One or two concentric incisions are created. The very first is placed in the latest areola into the wanted diameter which will make a separate NAC, therefore the larger one is constructed with an appropriate diameter, helping the fresh new excision out-of enough extreme mammary facial skin. Then your urban area ranging from a couple groups was deepithelialized to cease decreasing brand new blood flow towards NAC. Subcutaneous mastectomy is performed using good semicircular cut placed in this new deepithelialized area. Enough mammary muscle is going to be kept within the NAC flap; this flap was carefully dissected with a wide-based dermal pedicle. If necessary, the brand new submamount away from subcutaneous body weight tissue from over the amount of this fold. A sucking drain is positioned from inside the dissection hole. The brand new outside community will then be sutured so you’re able to less that because of the purse-string manner. The strategy offers an excellent exposure window for dissection and you will hemostasis. Also it enables the reduction of high areola and excessively surface. Plus, if breast prevention is required, you can accomplish it in identical lesson as the vascular way to obtain this flap strategy is generally credible.