Out-of , i performed 52 bilateral subcutaneous mastectomies at Agency away from Synthetic, 
Reconstructive and Artistic Functions, Trakya College Healthcare, Edirne, Poultry ( Dining table step 1 ). The typical diligent decades are twenty-eight.2 (a long time, 18-47). This new weights from clients was between forty and a hundred kg and average bmi (BMI) is actually 23.4 (Body mass index variety, fifteen.6-thirty six.7). Thirty clients got a history of choosing testosterone hormone medication in advance of operation. Hormonal cures is actually abandoned four weeks before surgical input. Along with, for each and every patient underwent a whole psychiatric, endocrinological, urologic and you may gynecological assessment, and therefore greeting the latest medical diagnosis off “FtM transsexualism” to be made. An ultrasound examination are did to check the presence of glandular structure also to exclude any pathologic bulk in most circumstances. ‘Diligent Advised Consent Form’ was taken from every anybody.
Dining table 1
Preoperatively, the option of approach is actually based on breast proportions and studies out of epidermis excessively, epidermis flexibility, NAC dimensions and you may status. A four level nipple group is actually performed centered on breast dimensions and facial skin extreme:
Most of the customers was in fact informed concerning the compatible techniques out of incisions and you can postoperative marks. Of these patients who does maybe not deal with postoperative marks outside of the subpectoral shadow, this condition was listed. Next, specific subcutaneous mastectomy was selected in accordance with the algorithm demonstrated during the Shape 1 . Compatible antibiotics were given an hour up until the procedure and for the 5 months after. A patient satisfaction questionnaire is actually did 12 months following the businesses to check on the general aesthetic results of subcutaneous mastectomy. Diligent pleasure are rated while the “decent” (5), “good” (4), “satisfactory” (3), “smaller high enough” (2) and you will “unsatisfactory” (1).
Operative process
All of the subcutaneous mastectomies have been performed less than standard anesthesia. Towards the diligent in the vulnerable reputation, certain facial skin slices have been made considering preoperative marks. Within the elevation off flaps, very cautious dissection is actually did to preserve all subcutaneous fat above the newest mammary gland. Thus, adequate thickness epidermis supplies a great looking bust wall surface physical appearance instead strictly followed and you will disheartened areas between the skin and breasts wall.
On instances of breasts with reduced proportions and you will body too much, brand new Webster strategy was utilized ( Figure dos ). This new cut starts out of ‘three’ updates inside areola-epidermis conjunction and you may ends at ‘nine’ standing. It could be longer laterally and you will medially from the at the least 1 cm, to have ideal publicity of your subcutaneous dissection town. Through the elevation out of NAC advanced, a small amount of mammary structure are included not as much as this flap to eliminate depression deformity. Upcoming, subcutaneous mastectomy is accomplished. At the end of this method, to create an aesthetically pleasing masculine boobs profile, the required quantity of subcutaneous pounds tissues are excised of above the number of the fresh new submammary fold, if necessary. Whilst technique is more complicated, of the brief coverage window whereby dissection and you will hemostasis are executed, that it small cut results in a properly-concealed infra-areolar scar. As well, breast reduction can be carried out, if needed. A suction sink is placed from the subcutaneous dissection town. Although not, should your patient has got the desire for a smaller areola, this technique are changed to a good concentric periareolar approach.
New concentric periareolar approach are used for bust with moderate skin too-much and you can a beneficial skin suppleness (B mug) and for bust with just minimal body extreme but having a beneficial higher NAC advanced ( Profile 3 ). A few concentric incisions are produced. The first is placed in the areola to your wanted diameter to create yet another NAC, in addition to big a person is constructed with a suitable diameter, enabling the fresh new excision from a sufficient amount of a lot of mammary body. Then town anywhere between a couple circles is deepithelialized to cease diminishing the newest blood flow into NAC. Subcutaneous mastectomy is done courtesy an excellent semicircular incision placed in the deepithelialized city. A sufficient amount of mammary tissues are left in NAC flap; that it flap are cautiously dissected which have a broad-oriented dermal pedicle. If required, the newest submamount out-of subcutaneous weight cells away from above the level of that it flex. A sucking drain is put when you look at the dissection hole. The brand new outside network is then sutured in order to reduced one to of the purse-string trend. The process gets good exposure window to own dissection and hemostasis. Plus it enables this new reduction of highest areola and you can way too much facial skin. As well as, in the event the breast avoidance is necessary, it can be done in identical example because the vascular way to obtain this flap strategy is mainly reliable.