Chest reconstructive surgery

Men (identified female at birth) require the surgical procedure of ‘male chest reconstruction’. This is not the same as a mastectomy.Mastectomy is a medical term used to describe the excision of skin, nipples, breast tissue, fat, and muscle in cancer patients. A total removal of the nipples, underlying muscle and fat is a radical mastectomy. A mastectomy by itself usually results in a concave appearance, no nipples and more obtrusive scars. Removal of breast tissue, even in men who develop breast cancer, does not result in a masculine shaped chest.

A male chest reconstruction will result with incisions and reconstruction intended to result in a contoured, male looking chest. The operation usually takes 3 to 4 hours and requires a general anaesthetic. Excess skin and mammary glands are removed through incisions in the chest. Fat is also removed, leaving the right amounts in the right places for a male appearing chest.

Depending on the size and shape of your chest, your surgeon might also remove the nipples. They are sometimes sutured (sewn) back on individually. Drains are placed on either side of the chest and left in place for several days to a week to drain excess fluid from the surgical site. The sutures (stitches) are removed about a week after your surgery.

Ideally, you’ll wear a binder for a short time after the surgery to keep fluid from collecting under the skin. This post-surgical compression also assists the skin to adhere to the new position against your chest wall. It will take your body 3-4 weeks or more to recover from the anaesthetic as well as the surgery itself.

Your surgeon will usually advise you to not lift anything or work out for a number of weeks after the surgery. Ask your surgeon for advice when you can get back to your normal lifting or working out. Scarring usually looks the worst at about six weeks due to the formation of scar tissue. Scars are often itchy, due to healing. From six weeks to six months, the scars gradually flatten and pale.

Your surgeon may need to make further modifications. Sometimes there are ‘dog ears’ (excess skin at the end of the incision), or one side of your chest may appear to have slightly more remaining tissue than the other side. Most men will have at least one revision (sometimes more).

It can take up to 9-12 months for the surgical results to settle down before you can really tell how things will look for the rest of your life. This all depends on your age and general state of health.

Types of Top Surgery

Depending on a number of factors, your surgeon will decide on the best technique to achieve the best outcome of chest reconstruction for you.

Keyhole

  • A half moon or ‘keyhole’ incision is made on the underside of the areola to remove excess breast tissue.
  • Leaves almost no scars.
  • Usually used for patients with small to minimal breast development.

Purse-string or peri-areola

  • Same as keyhole except an incision is made all around the areola.
  • Often used for patients who have large development or where there is excess skin or breast development.
  • The nipple might be or might not be removed.
  • The surgeon should be able to reposition the nipple section and nerves after removing all excess tissue from the breast.

Elliptical Incision

  • Used on patients with larger chests or ‘droopy’ breasts.
  • Incisions are two large cuts across the chest to remove tissue and skin. Sometimes they meet in the centre of the chest.
  • Nipples are sometimes re-positioned (usually higher on the chest); it is also common that nipples are entirely removed or grafted back on or remain attached to the nerves to facilitate the likelihood of sensation.

Inverted T (simple mastectomy)

  • This is the same method as used for mastectomy in women with breast cancer or breast reduction.
  • Incision is an upside-down T shaped scar running downwards from each nipple.

Questions to ask your surgeon –

  • Ask questions about scars, pleating, skin thickness, skin elasticity, and final shape.
  • Look for fine detail work in the suturing at the areola.
  • Look for consistency and some kind of artistry or pride in the work.
  • also see Questions to Ask your Surgeon

Boost your outcome –

  • Aim to be as fit and healthy as you can leading up to surgery.
  • Quit smoking.
  • Work-out before your surgery.
  • Getting your chest as developed as possible will help your surgeon. It makes it easier for your surgeon with contouring, nipple placement, and scar placement.
  • Plan to rest at least four to five months after surgery, before you return to working out, lifting weights or hard physical exercise.

Note on Smoking –

  • Smoking can significantly affect the outcome of your surgery. Smoking reduces the amount of oxygen available to your cells when healing.
  • Smoking shrinks small blood vessels (vasoconstriction), which then reduces the amount of red blood cells (haemoglobin) available to your body and interferes with the release of oxygen (fuel your cells need) to your cells.
  • The use of nicotine gum and patches interferes with healing in the same way as nicotine in cigarettes.
  • Smoking also reduces the ability of your heart and lungs to recover quickly from the effects of surgery and it causes a further narrowing of blood vessels which can cause a decrease or obstruction in the blood supply (ischemia) of the tissue, poor healing, bad scars, or actual loss of tissue.

Australian Society of Plastic Surgeons – phone the information hotline on 1300 367 446 or visit their website to make sure your surgeon is accredited.

Written with Dr Megan Hassell, reconstructive surgeon, Sydney NSW in 2004.