Mastectomy in San Francisco Bay Area, Oakland, and Walnut Creek

Gender (Sexual) Reassignment Surgery (GRS/SRS) : Female to Male Breast

The female-to-male (FTM) gender reassignment surgery involves removing both breasts: termed mastectomy, with preservation of the nipple areola complex and with the creation of a contoured, male-looking chest.

People undergoing gender reassignment surgery, desire to make his or her body as congruent as possible with their preferred sex through surgery and/or hormone treatment. Sex reassignment surgery, along with hormone therapy and real-life experience, has been proven to be effective in persons with transsexualism or profound Gender Identity Disorder (GID). Persons seeking this procedure should have received a letter from their current psychologist and or psychiatrist, in support of their proposed surgery.

Mastectomy Procedures:

There are several FTM techniques for breast surgery. Typically, surgery is performed under general anesthesia, with or without overnight observation at the surgical facility and usually the surgery takes 3 hours or less to complete.

Inframammary Horizontal Wedge Excision with Free Nipple Graft

This procedure is performed if the breasts exhibit significant sagging: called ptosis and / or medium to large sized breasts (full B or greater cup size). A wedge shaped Incision is made horizontally – across each breast, one at the infra-mammary crease and another above the areola. Skin, mammary gland and fatty tissue are removed. Liposuction may be used to remove fatty tissue near the armpits and to create the desired contour. Once the excess tissue has been removed, the excess skin is trimmed and the incision is closed, leaving a single scar at the infra-mammary crease. Usually the original nipples are completely removed, trimmed to a smaller size, and then are replaced as a free nipple graft in position to give a more masculine appearance. Alternately, using a pedicle technique, the nipples are left partially attached to the body via a pedicle of tissue. This pedicle is then repositioned in a higher location. This option is sometimes chosen in the hope that nipple sensation will be maintained. In a less common procedure, the nipples are not preserved and a new nipple areola tattoo is placed on the chest wall.

Keyhole Incision

The keyhole procedure usually reserved for FTM patients with a smaller breast (cup size B ) who has less breast tissue, and less ptotic breast skin. In the keyhole method, the nipple is left attached to the body via a stalk of tissue in order to preserve sensation.  Once the breast tissue is removed, the incision is closed in the form of an anchor incision and the nipple can be resized and repositioned if necessary.

Periareolar Incision

The periareolar (purse string) method, utilizes a circumferential incision around the areola.  The nipple is left attached via a central pedicle in order to preserve sensation and blood supply. The breast tissue is removed by scalpel and liposuction is used to provide gentle contour around the remaining breast mound.  The areola may be trimmed to reduce its size.  Excess skin on the chest may also be trimmed away along the circumference of the incision.  The skin is the pulled toward the center of the opening and the nipple is reattached.  The nipple may be repositioned slightly, depending on the original breast size.  Because a purse string closure is used, there may be some puckering, depending on the diameter of the skin defect of the chest wall. The scar puckering may resolve over several months after surgery.