Chest Wall Masculinization in Female-to-Male Transsexuals: Our Treatment Algorithm and Life Satisfaction...

Area of Science:

• Plastic Surgery
• Gender Affirming Surgery
• Chest Wall Reconstruction

Background:

• Female-to-male (FTM) chest masculinization is a crucial step in gender reassignment surgery.
• The procedure requires breast tissue removal, nipple-areola complex repositioning, and scar minimization for esthetic male chest appearance.

Purpose of the Study:

• To present a surgical algorithm for female-to-male chest masculinization.
• To evaluate the outcomes of different surgical techniques based on patient chest wall characteristics.

Main Methods:

• A series of 68 female-to-male transsexual (FTMTS) patients underwent 136 bilateral mastectomies between 2010 and 2017.
• Four operative procedures were utilized: subcutaneous (pull-through, concentric circular) and skin-extended (ultrathin vertical bipedicle, free nipple graft).
• A treatment algorithm was applied based on breast volume, ptosis, and skin elasticity.

Main Results:

• A total complication rate of 6.6% was achieved, which is lower than reported in existing literature.
• Additional esthetic improvement procedures were needed in 14.7% of cases.
• Mean patient satisfaction was rated as excellent at 4.57 out of 5.

Conclusions:

• The proposed algorithm aids surgeons in selecting appropriate FTMTS surgical techniques.
• This approach helps reduce unfavorable outcomes and improve esthetic results in chest masculinization.
• High patient satisfaction and low complication rates were achieved using the algorithm-guided approach.