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.