Surgeries & Procedures-FtM
This procedure is based on the following:
|1) Size and shape of breast
|2) Elasticity of skin
|3) Patient's needs and preferences
In general, patients who have smaller breasts can have the entire surgery performed
through an incision in the lower half of areola (the pigmented portion of the nipple)
using liposuction in combination with surgical removal. It is also possible to
remove larger breasts using this technique, if the skin of the breast is thicker, more
elastic, and not damaged or stretched out. In these patients with good skin tone, the
excess skin and the areola will shrink a remarkable amount. If the skin does not
shrink enough, it may be necessary to have a small amount of skin removed (in a
keyhole pattern or in an incision around the areola). If the patient is willing to
return for an additional procedure if necessary, I think this is a very reasonable
approach. In those patients with a large amount of breast tissue with excessive skin
of poor quality and droop, I usually recommend removing the excess skin and
breast tissue in the crease of the pectoralis muscles and put the nipples back on as
grafts. However, this surgery leaves larger scars on the chest.
Some small breasted patients have a strong preference for liposuction alone in order
to preserve sensation or to stretch out the costs. You can have the liposuction done
first, and if necessary, the residual breast tissue can be removed in a second
operation. Having this done in two stages probably doesn't alter the final result, but
does increase the number of operations required and time off work. In a majority of
patients who have liposuction alone, Dr. Meltzer thinks he could improve the result
with surgical excision of the remainder of the breast tissue. Nevertheless, this is his
opinion, and some people are quite content with just liposuction.
Chest surgery is routinely done as an outpatient. The patient will need to stay in the
area from three to six days following the surgery depending on the type of
procedure done. However, if you live in the Scottsdale area you can be discharged
home. Patients may also stay in nearby hotels. If a patient chooses to stay in a hotel
they should have a friend or family member stay with them to help with their care.
RISKS AND COMPLICATIONS
Obviously, procedures such as this are not without risks or complications and Dr.
Meltzer wants to review these with you.
Bleeding is a risk of any operation, but the need for transfusion is very
unlikely. However, when using minimal incisions to surgically excise most
of the breast tissue the risk of blood loss is greater. Although a transfusion
has not been required to date using this combined approach, it is
recommended that you consider donating a unit of your own blood in
advance of surgery to assure that if a transfusion is necessary, the blood
would be your own.
Infections are rare complications.
The blood supply of the nipple might be damaged with the more limited
surgery, and the nipple could die. If the nipples are used as grafts, then it is
possible that they might not survive.
These complications are exceedingly rare in my experience.
The scars of the areola usually heal very well. The scars below the pectoral
muscles will take longer to fade out and will widen as mentioned above;
however, a raised or excessively wide scar is possible and might need
further treatment. It is possible that there may be residual tissue left, which
appears as a contour deformity. This would need to be removed at a second
DEPRESSION OF THE SKIN
Where the breast tissue was removed is a risk and possible complication.
The possibility of this complication can be reduced or avoided by leaving
some breast tissue on the skin. Since not all the breast tissue is removed,
you are still at risk for developing breast cancer, and therefore, you should
still be vigilant in routine self-exam and screening for breast cancer.
WHO IS A CANDIDATE?
The chosen procedure is largely dependent upon the patient's preference and need, the
size and shape of the breasts, and the elasticity of the skin. The type of procedure can
only be determined after Dr. Meltzer performs a physical examination of the patient.
It is critical that the patient understand the limitations and risks involved
with each type of procedure.
Patients with small breasts, good skin tone and minimal ptosis (droop).
Very few patients will be in this category.
LIPOSUCTION WITH EXCISION
Small to medium breasted patients with skin that is thick, more elastic and not damaged
EXCESION AND FREE NIPPLE GRAFTS
Large breasted patients with poor skin tone, excess skin and droop.
LIPOSUCTION ONLY OR LIPOSUCTION WITH EXCISION
A male-appearing chest with some contour and a smaller areolar complex. Liposuction
only or liposuction with excision will leave a small scar around the nipple areolar
complex that normally heals well.
EXCISION AND FREE NIPPLE GRAFTS
A male-appearing chest with some contour and a smaller areolar complex. This
procedure leaves larger scars on the chest which will fade over time, but the scars will
be particularly conspicuous for the first six months after surgery.
A small incision is made in the areola. Breast tissue is removed using either traditional
or ultrasonic-assisted liposuction.
LIPOSUCTION WITH EXCISION
A small incision is made in the areola complex. Breast tissue is removed using a
combination of liposuction and surgical excision of the breast tissue.
EXCISION AND FREE NIPPLE GRAFTS
An incision is made in the crease of the pectoralis muscle, and the excess tissue and
skin is removed. The nipples are excised.
RECUPERATION AND HEALING
WHERE IS THE PROCEDURE PERFORMED?
The procedure is routinely performed at the Greenbaum Surgery Center Scottsdale
HOW LONG DO I NEED TO STAY IN SCOTTSDALE?
Following the procedure you will stay in the Recovery Care Center of the hospital for one
night. You will need to stay in Scottsdale an additional four to six nights. You may stay
in a hotel (after one night in RCC) if a friend or family member accompanies you that
can help with your care.
WITH ADDITIONAL PROCEDURES
Patients having liposuction with excision are required to stay in town five to seven
nights. Patients having excision with free nipple grafts are required to stay in town six
to eight nights. You may stay in a hotel after the first night if a friend or family member
accompanies you that can help with your care.
LIPOSUCTION WITH EXCISION FOR LARGER BREASTED PATIENTS
You must be willing to allow time for the excess skin to shrink and also be willing to
return for possible additional procedures. If necessary, excess skin can be removed
at a second stage.
Prepayment for this procedure is required.
Dr. Meltzer neither participates nor bills for any insurance companies.
Please read the INSURANCE section of the FINANCIAL POLICY for more detailed
WPATH (formerly the Harry Benjamin International Gender Dysphoria Association).
Dr. Meltzer is a member of WPATH and follows the Standards of Care (SOC). Prior to surgery, the prospective patient must fulfill the criteria established by WPATH.
If you need a copy of the SOC, please contact the office.
POSSIBLE NEED FOR SECOND STAGE OR REVISION
In patients with good skin tone, the excess skin and the nipple areola complex will
shrink markedly. If the skin does not shrink enough (especially in patients with larger
breasts), a return trip to Scottsdale to have a small amount of skin removed (in a
keyhole pattern or in an incision around the areola) may be necessary. Sometimes this
procedure can be performed in our clinic under local anesthesia (not to be confused with
I.V. sedation) and this will keep the revision fee to a minimal charge. If it is performed
in the hospital and requires I.V. sedation, the fee will be greater and will depend on the
length of time. In addition, patients that are traveling alone and receive any type of
sedation cannot be discharged to a hotel. If an overnight hospital stay is required, there
is an additional fee. If you have someone with you, you can be discharged to a hotel.
The specific risks and suitability of this procedure for a given individual can be
determined only at the time of consultation. All surgical procedures have some degree
of risk. Minor complications that do not affect the outcome occur occasionally.
Major complications occur rarely.
Please e-mail us at firstname.lastname@example.org for more information,
or call our office at 1-480-657-7006 or toll-free at 1-866-876-6329.