Free nipple graft mammoplasty
With thoracic masculinization we seek on the one hand to eliminate an element as feminine as the breast but at the same time we must achieve a masculine appearance of the thorax.
There are two techniques to achieve a male thoracic contour: subcutaneous masculinization mammoplasty and masculinization mammoplasty with free nipple graft. Depending on each case, the doctor together with the patient will decide the most appropriate technique.
The masculinization mammoplasty consists not only of removing the mammary gland and excess skin but also of making the chest appearance, masculine. Hence it’s very important to take into account the differences between men and women, for example the male nipple is smaller than the female one, it’s located more lateral and a little lower than the female is, just where the pectoralis major muscle rotates from the armpit to the chest.
To achieve a masculine thoracic aspect, we must bear in mind that the final objective of the transsexual boy is precisely to have the most masculine aspect, therefore, in addition to removing the gland, we will have to shape the nipple, place it in place and correct and shape the chest. This is achieved through a precise and laborious work and long operating room time that allows us to reach the final shape.
There are only two thoracic masculinization surgeries for transsexual men, the subcutaneous masculinization mammoplasty and the nipple free graft masculinization mammoplasty. The rest of the techniques are female breast reduction techniques that have been shown to be unsuccessful in the results, by not offering the transsexual man a male thoracic contour.
Depending on the size of the breast and the excess skin, we will choose one technique or another.
The one that is used more frequently is the masculinization mammoplasty with free nipple graft since in most of the trans boys a drooping breast has already occurred, due to the use of binders, or in other cases it is simply very large.
It depends of course on the type of technique performed. If the chosen technique is a masculinization mammoplasty with free nipple graft, it is very important to keep an absolute rest during the first week, since the graft will be nourished only by diffusion and if there is friction between the graft and the recipient bed, necrosis and loss may occur.
Graft loss is not a major complication from a health point of view, but it does leave a morphological sequel. Once the graft loss has been objectified, an early or late long-term re-graft can be done. Skin from a donor area is used, specifically the inner side of the thigh, which is pigmented skin to simulate the appearance of the nipple. The other option is to micropigment the nipple, but there will be no relief of it.
It depends on the technique. When a periareolar mammoplasty can be performed, the scar is practically imperceptible since it is located around the areola where the color of the nipple pigment changes with respect to the rest of the skin. In the case of masculinization mammoplasty with free nipple graft, the scars are placed just on the edge of the pectoral, in the pectoral groove, so they are hidden over time, not only by using cosmetic surgery techniques but also generally by the appearance of hair secondary to hormonation.