I am an FTM transgendered person and I had a terribly botched surgery. My surgeon opted for a small incision around the nipple and Mayo scissor dissection of tissue. The breast tissue removed was 450 grams on one side and 475 on the other. I wanted a double incision mastectomy but he decided at the last minute to give me this type. I need multiple revisions, lost a nipple, and had many infections. Can anyone tell me if that was a good type of surgery for me based on my chest size?
April 9, 2020
Answer: I am a female to male transgender person who had a botched surgery. Can you tell me what type of surgery I should of had? I generally dislike terms like "botched" surgery, but your surgeon is NOT experienced in transgender top surgery if (s)he truly believed keyhole surgery would leave you with a reasonable result that even would be close to a masculine chest. Especially with the amount of tissue removed! This should have been a star-pattern nipple reduction, areola reduction, and after biconvex elliptical skin-reducing total mastectomies (not an anchor pattern), reconstruction of the nipple/areola complexes as full thickness skin grafts in masculine position (lateral and inferior, at the edge of the pec muscle). For examples of this (proper) operation, and a few examples of (proper) keyhole top surgeries, click on the web reference link below. All examples are my patients over a nearly 3 decade experience with transgender surgery. Sorry you had this (lack of) experience. This is truly one operation that even ABPS-certified plastic surgeons have no business doing unless they have experience with this specific procedure, and can show photographic evidence they know how to choose and do the proper procedure for each transman's anatomy. Revision can correct this pretty effectively. Best wishes! Dr. Tholen
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April 9, 2020
Answer: I am a female to male transgender person who had a botched surgery. Can you tell me what type of surgery I should of had? I generally dislike terms like "botched" surgery, but your surgeon is NOT experienced in transgender top surgery if (s)he truly believed keyhole surgery would leave you with a reasonable result that even would be close to a masculine chest. Especially with the amount of tissue removed! This should have been a star-pattern nipple reduction, areola reduction, and after biconvex elliptical skin-reducing total mastectomies (not an anchor pattern), reconstruction of the nipple/areola complexes as full thickness skin grafts in masculine position (lateral and inferior, at the edge of the pec muscle). For examples of this (proper) operation, and a few examples of (proper) keyhole top surgeries, click on the web reference link below. All examples are my patients over a nearly 3 decade experience with transgender surgery. Sorry you had this (lack of) experience. This is truly one operation that even ABPS-certified plastic surgeons have no business doing unless they have experience with this specific procedure, and can show photographic evidence they know how to choose and do the proper procedure for each transman's anatomy. Revision can correct this pretty effectively. Best wishes! Dr. Tholen
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May 19, 2016
Answer: FTM Top Surgery - Double incision with free nipple grafts Sorry to see that you have had such an unfavorable outcome. Based on the volume removed from each breast, you were likely a better candidate for a double incision approach with free nipple grafts. It appears that you still have a moderate amount of excess skin inferiorly as well as some residual breast tissue that can be removed with a revision of your surgery to the double incision approach. With the standard double incision top surgery with free nipple grafts, the contour will be superior, scar placement can be optimized into the inframammary crease and nipple placement can be achieved into a more masculine position further lateral on the pectoralis muscle. We have also had patients that have opted to not have the nipple grafts placed at the time of surgery and will then seek nipple tattooing postoperatively to place the nipples into the location of their choice. This is a decision you will have to make since you lost one of your nipples - you will either have to sacrifice the remaining nipple and have them both tattooed postoperatively or replace the surviving nipple as a nipple graft and do a nipple reconstruction on the one you originally lost. By all means place yourself into the care of a board certified plastic surgeon comfortable with FTM top surgery and more specifically top surgery revisions. I hope this helps and best of luck with your continued transition!!
Helpful
May 19, 2016
Answer: FTM Top Surgery - Double incision with free nipple grafts Sorry to see that you have had such an unfavorable outcome. Based on the volume removed from each breast, you were likely a better candidate for a double incision approach with free nipple grafts. It appears that you still have a moderate amount of excess skin inferiorly as well as some residual breast tissue that can be removed with a revision of your surgery to the double incision approach. With the standard double incision top surgery with free nipple grafts, the contour will be superior, scar placement can be optimized into the inframammary crease and nipple placement can be achieved into a more masculine position further lateral on the pectoralis muscle. We have also had patients that have opted to not have the nipple grafts placed at the time of surgery and will then seek nipple tattooing postoperatively to place the nipples into the location of their choice. This is a decision you will have to make since you lost one of your nipples - you will either have to sacrifice the remaining nipple and have them both tattooed postoperatively or replace the surviving nipple as a nipple graft and do a nipple reconstruction on the one you originally lost. By all means place yourself into the care of a board certified plastic surgeon comfortable with FTM top surgery and more specifically top surgery revisions. I hope this helps and best of luck with your continued transition!!
Helpful