Chest wall contouring in female-to-male gender affirming surgery: Algorithm, surgical techniques and outcomes

Chest masculinization is often the first operation requested by patients with female-to-male gender dysphoria. Despite increasing demand for this procedure, no recommendation of care is unanimous. We present our experience with the use of a simple and effective algorithm based on periareolar and subcutaneous mastectomy with free nipple graft techniques and compare complication rates between techniques.

The main objective of this study was to compare the postoperative complications associated with these two techniques.

Patients who underwent chest masculinization between January 2018 and February 2023 at Croix-Rousse University Hospital (Lyon, France) were retrospectively reviewed. Data of the 71 patients were collected from medical records.

Among the 71 patients, 32 (45%) were treated by periareolar mastectomy and 39 (55%) by double-incision mastectomy with free nipple graft. Twenty-one patients (30%) had minor postoperative complications, with no significant difference between the two groups. Five patients treated with the periareolar technique (16%) developed hematoma requiring emergency reoperation. In contrast, none of the patients treated by double-incision mastectomy had this complication (P=0.015).

The results of this study are in keeping with those in the literature, namely a higher rate of acute postoperative complications in patients treated by periareolar mastectomy. Hemostatic net has been used since March 2023 in these procedures to reduce the risk of postoperative bleeding complications. It is also a powerful procedure for better skin redraping.