CHEST-WALL CONTOURING FOR FEMALE-TO-MALE TRANSSEXUALS - AMSTERDAM EXPERIENCE

Female transsexuals accepted for surgical reassignment usually choose breast removal to achieve a male chest configuration es their first op eration, thus facilitating the adjustment to a male lifestyle. At the Academic Hospital of the Free University (Amsterdam, The Netherlands), usually one of three techniques is applied for a Subcutaneous mastect omy. We describe and discuss our experience with 70 patients operated on before April 1993. For breasts with minimal to moderate skin redund ancy, a concentric periareolar de-epithelialization technique, in comb ination with a subcutaneous mastectomy by a transareolar approach, is used. For larger breasts, or in cases of severe ptosis resulting from the use of breast-camouflaging devices, this method is extended by ski n excision laterally and medially to the nipple-areolar complex. Somet imes, it is believed to be necessary to use a free transplantation of the nipple-areolar complex graft in combination with fusiform skin exc isions, resulting in a scar passing under the grafted areola. In case of doubt, the simplest technique should be applied, Secondary correcti ons are often needed.