2, 3, 10, 11, 12 It consists of harvesting the NAC as a full-thickness skin graft amputating the breast and grafting the NAC onto its new location on the chest wall. 7) has been proposed by several authors for patients with large and ptotic breasts. (A) Incisions and scar (B) preoperative preoperative (C) postoperative. 2, 3, 4, 5 Recently, the importance of the skin elasticity has also been demonstrated and it is important to realize that in this patient population, poor skin quality can be exacerbated when the patient has engaged in years of “breast binding” (Fig. 4, 5 Many different techniques have been described to achieve these goals and most authors agree that skin excess, not breast volume, is the factor that should determine the appropriate SCM technique. The goal of the SCM in a FTM transsexual patient is to create an aesthetically pleasing male chest, which includes removal of breast tissue and excess skin, reduction and proper positioning of the nipple and areola, obliteration of the inframammary fold, and minimization of chest-wall scars. This procedure allows the patient to live more easily in the male role 2, 3, 4, 5 and thereby facilitates the “real-life experience,” a prerequisite for genital surgery. At a later stage, a testicular prostheses and/or erection prosthesis can be inserted.īecause hormonal treatment has little influence on breast size, the first (and, arguably, most important) surgery performed in the female-to-male (FTM) transsexual is the creation of a male chest by means of a SCM. The two major sex reassignment surgery (SRS) interventions in the female-to-male transsexual patients that will be addressed here are (1) the subcutaneous mastectomy (SCM), often combined with a hysterectomy/ ovariectomy and (2) the actual genital transformation consisting of vaginectomy, reconstruction of the fixed part of the urethra (if isolated, metoidioplasty), scrotoplasty and phalloplasty. It is usually advised to stop all hormonal therapy 2 to 3 weeks preoperatively. Gender reassignment usually consists of a diagnostic phase (mostly supported by a mental health professional), followed by hormonal therapy (through an endocrinologist), a real-life experience, and at the end the gender reassignment surgery itself.Īs to the criteria of readiness and eligibility for these surgical interventions, it is universally recommended to adhere to the Standards of Care (SOC) of the WPATH (World Professional association of Transgender Health) 1. As to the treatment, it is universally agreed that the only real therapeutic option consists of “adjusting the body to the mind” (or gender reassignment) because trying to “adjust the mind to the body” with psychotherapy has been shown to alleviate the severe suffering of these patients. Although the exact etiology of transsexualism is still not fully understood, it is most probably a result of a combination of various biological and psychological factors. Transsexual patients have the absolute conviction of being born in the wrong body and this severe identity problem results in a lot of suffering from early childhood on.
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