Out of , we performed 52 bilateral subcutaneous mastectomies in the Agencies off Plastic material, Reconstructive and you can Aesthetic Functions, Trakya College or university Health, Edirne, Chicken ( Desk 1 ). The common patient ages was 28.dos (age groups, 18-47). Brand new weights out of patients had been between forty and you may 100 kilogram and you can mediocre bmi (BMI) try 23.4 (Body mass index assortment, fifteen.6-36.7). 30 customers had a history of finding testosterone hormones procedures just before procedure. Hormonal therapy is actually left behind 4 weeks prior to medical intervention. And, each diligent undergone an entire psychological, endocrinological, urologic and gynecological research, which desired the brand new diagnosis out of “FtM transsexualism” is generated. A keen ultrasound examination are performed to evaluate the clear presence of glandular tissue and also to prohibit people pathologic bulk throughout instances. ‘Diligent Informed Agree Form’ try extracted from all of the some one.
Dining table step 1
Preoperatively, the option of techniques is based on nipple proportions and you can degree from surface too much, body suppleness, NAC proportions and you will condition. A four values nipple classification is performed predicated on breast proportions and you will epidermis continuously:
Most of the people was indeed advised towards compatible techniques regarding slices and you may you’ll be able to postoperative marks. For these customers that would not deal with postoperative markings beyond the subpectoral shade, this problem is indexed. Then, particular subcutaneous mastectomy try chose according to research by the formula displayed inside Contour 1 . Suitable antibiotics was indeed applied 1 hour through to the procedure as well as the five months shortly after. Someone fulfillment survey is actually did 1 year adopting the operations to check the general visual outcome of subcutaneous mastectomy. Diligent pleasure try rated since “very good” (5), “good” (4), “satisfactory” (3), “less satisfactory” (2) and you may “unsatisfactory” (1).
Surgical techniques
All of the subcutaneous mastectomies was in fact performed less than standard anesthesia. Into patient within the vulnerable status, specific surface cuts were made based on preoperative scars. When you look at the elevation out of flaps, really careful dissection was performed to preserve every subcutaneous lbs more than the brand new mammary gland. Thus, enough occurrence surface provides a great looking tits wall structure looks in the place of strictly adhered and depressed components within surface and you may boobs wall structure.
From the cases of bust with minimal dimensions and body excessively, the newest Webster strategy was used ( Contour 2 ). The new cut begins from ‘three’ status in the areola-body conjunction and you may stops at the ‘nine’ status. It could be lengthened laterally and you will medially from the about step 1 cm, to own top visibility of the subcutaneous dissection town. Throughout the level away from NAC state-of-the-art, a little bit of mammary cells will likely be provided lower than which flap to get rid of anxiety deformity. Following, subcutaneous mastectomy is carried out. At the end of this technique, to make an aesthetically pleasing male breasts contour, the mandatory number of subcutaneous body weight muscle is going to be excised off above the quantity of the newest submammary bend, if necessary. As the method is much harder, because of the quick publicity window by which dissection and you may hemostasis are executed, this short incision leads to a well-undetectable infra-areolar mark. On top of that, breast reduction can be performed, if needed. A suction drain is placed on subcutaneous dissection area. not, in the event your diligent provides the fascination with an inferior areola, this procedure are going to be revised so you’re able to a beneficial concentric periareolar means.
The fresh new concentric periareolar techniques are used for boobs with modest body excessive and you will a great facial skin suppleness (B cup) or tits with just minimal epidermis extreme however, which have a beneficial large NAC state-of-the-art ( Contour step 3 ). One or two concentric incisions are produced. The foremost is placed in brand new areola towards the need diameter which will make a different sort of NAC, while the larger one is designed with the ideal diameter, permitting the latest excision from enough continuously mammary facial skin. Then your area anywhere between several sectors is actually deepithelialized to end limiting the blood supply with the NAC. Subcutaneous mastectomy is performed as a result of a beneficial semicircular cut placed in the latest deepithelialized urban area. A sufficient amount of mammary structure should be leftover in NAC flap; this flap was carefully dissected having a broad-mainly based dermal pedicle. If necessary, the fresh new submamount off subcutaneous weight tissue away from above the number of which fold. A sucking sink is placed when you look at the dissection hole. Brand new exterior circle will then be sutured so you’re able to reduced you to because of the purse-sequence styles. The process brings a beneficial exposure windows to possess dissection and you will hemostasis. And it allows for the fresh new decrease in highest areola and you can excessive body. And additionally, when the breast 
avoidance becomes necessary, you can accomplish it in identical training because the vascular source of it flap strategy is generally legitimate.