Regarding , we did 52 bilateral subcutaneous mastectomies during the Agencies regarding Synthetic, Reconstructive and you may Artistic Operations, Trakya School Hospital, Edirne, Poultry ( Table 1 ). The average diligent age try 28.2 (a long time tinder, 18-47). This new weights of customers was indeed ranging from forty and you will 100 kilogram and you may mediocre body mass index (BMI) are 23.cuatro (Body mass index range, fifteen.6-36.7). 30 people got a track record of acquiring testosterone hormonal cures ahead of operation. Hormones treatment try deserted 4 weeks before medical intervention. Also, each diligent underwent an entire psychiatric, endocrinological, urologic and you may gynecological assessment, which desired this new medical diagnosis off “FtM transsexualism” to be made. An ultrasound examination is actually did to evaluate the current presence of glandular structure also to exclude one pathologic size in every times. ‘Diligent Informed Concur Form’ is taken from every some body.
Dining table 1
Preoperatively, the option of approach was according to breast size and training off surface excess, facial skin suppleness, NAC dimensions and status. A several grade breast classification was did considering breast size and facial skin excess:
The customers was basically told in regards to the appropriate techniques regarding slices and you may you are able to postoperative markings. Of these clients who perhaps not deal with postoperative scars beyond the subpectoral trace, this disorder is listed. Up coming, certain subcutaneous mastectomy is actually chose in accordance with the algorithm displayed within the Figure step 1 . Compatible antibiotics was in fact applied 60 minutes till the procedure and also for the 5 weeks once. Someone fulfillment questionnaire is did 12 months adopting the operations to test the overall visual outcome of subcutaneous mastectomy. Patient pleasure is rated because the “decent” (5), “good” (4), “satisfactory” (3), “reduced satisfactory” (2) and you will “unsatisfactory” (1).
All subcutaneous mastectomies was performed around general anesthesia. For the patient when you look at the susceptible updates, particular facial skin cuts were made according to preoperative scars. Within the elevation out of flaps, really cautious dissection is did to preserve every subcutaneous body weight a lot more than the fresh mammary gland. Ergo, enough thickness surface produces a great looking tits wall surface looks versus purely followed and you may depressed parts between the epidermis and bust wall structure.
Throughout the instances of breasts with minimal size and you can facial skin way too much, the brand new Webster strategy was applied ( Figure 2 ). This new incision initiate of ‘three’ position in the areola-epidermis conjunction and you may finishes during the ‘nine’ position. It can be offered sideways and medially by the at the very least 1 cm, to own best publicity of the subcutaneous dissection city. During elevation regarding NAC complex, a little bit of mammary muscle should be provided lower than that it flap to get rid of depression deformity. Following, subcutaneous mastectomy is carried out. After this procedure, to form an aesthetically pleasing masculine breasts figure, the required amount of subcutaneous weight muscle can be excised out of over the amount of the brand new submammary flex, if necessary. Whilst the technique is more difficult, by the short visibility window through which dissection and you will hemostasis are performed, that it short cut causes a properly-concealed infra-areolar scar. At exactly the same time, nipple protection can be performed, if needed. A suction drain is placed on subcutaneous dissection city. Yet not, when your patient contains the interest in an inferior areola, this technique can be modified so you can a concentric periareolar strategy.
The newest concentric periareolar technique are used for chest having moderate facial skin an excessive amount of and you can a beneficial body flexibility (B cup) and for bust with reduced skin an excessive amount of but that have a highest NAC cutting-edge ( Figure step 3 ). Two concentric cuts were created. The first is placed in the new areola towards wished diameter to create a different NAC, additionally the larger a person is constructed with the right diameter, enabling the fresh new excision out-of an adequate amount of too-much mammary epidermis. Then your town between one or two groups is actually deepithelialized to stop reducing the brand new blood circulation to your NAC. Subcutaneous mastectomy is completed using good semicircular incision listed in brand new deepithelialized area. Enough mammary structure will be kept in NAC flap; that it flap was very carefully dissected with a broad-mainly based dermal pedicle. If necessary, new submamount away from subcutaneous pounds muscle regarding over the amount of so it bend. A sucking drain is placed in the dissection hole. The fresh new external network will then be sutured to help you less one to from the purse-sequence fashion. The strategy offers a publicity windows to possess dissection and you may hemostasis. Also it enables the new reduced amount of highest areola and too much facial skin. In addition to, if the nipple avoidance is needed, it can be done in the same concept while the vascular way to obtain so it flap technique is mostly credible.