Chest wall contouring for female-to-male transsexuals: Amsterdam experience

Female transsexuals accepted for surgical reassignment usually choose breast removal to achieve a male chest configuration as their first operation, thus facilitating the adjustment to a male lifestyle. At the Academic Hospital of the Free University (Amsterdam, The Netherlands), usually one of three techniques is applied for a subcutaneous mastectomy. We describe and discuss our experience with 70 patients operated on before April 1993. For breasts with minimal to moderate skin redundancy, a concentric periareolar de-epithelialization technique, in combination with a subcutaneous mastectomy by a transareolar approach, is used. For larger breasts, or in cases of severe ptosis resulting from the use of breast-camouflaging devices, this method is extended by skin excision laterally and medially to the nipple-areolar complex. Sometimes, it is believed to be necessary to use a free transplantation of the nipple-areolar complex graft in combination with fusiform skin excisions, resulting in a scar passing under the grafted areola. In case of doubt, the simplest technique should be applied. Secondary corrections are often needed.