DESCRIPTION Bilateral mastectomy and chest contouring, often referred to as “top surgery”, removes breast tissue and liposuctions the remaining tissue into a shape typically considered more masculine (flat and smooth contour) TERMINOLOGY Nipple refers to the central raised portion of pigmented tissue Areola refers to the circular shaped pigmented tissue immediately surrounding the nipple Nipple-ar. [...] KEYHOLE MASTECTOMIES (Recommended for people with an A cup-size and good skin elasticity) A small half-moon incision is made along the lower aspect of the areola The NAC is left attached to the body so sensation is possible and NAC grafting is not necessary Breast tissue is removed by liposuction and direct excision through the half-moon incision The incision is closed. [...] Drains (long thin tubing) are typically placed in the chest for this technique to allow blood/fluid to escape PERIAREOLAR MASTECTOMIES (Recommended for people with a B or less cup size and good - moderate skin elasticity) An incision is made all around the outside of the areola, skin excised circumferentially The NAC is left attached to the body so sensation is possible Breast tissue is removed by. [...] Asymmetry is common and may affect skin, chest contour, the size and position of the NAC and scarring. [...] ACKNOWLEDGEMENT This document was created by clinicians at Sherbourne Health and Women’s College Hospital, using up to date literature as well as information adapted from the Transgender Health Information Program of British Columbia, the GRS Montreal Clinic, and the Gender Identity Clinic at the Centre for Addiction and Mental Health.
Authors
- Pages
- 7
- Published in
- Canada
Table of Contents
- DESCRIPTION 2
- TERMINOLOGY 2
- INTENDED RESULTS 2
- ALTERNATIVE TREATMENT OPTIONS 2
- Align anatomy with gender identity Reduction in gender dysphoria andor gender incongruence Improve mental health and well being Flatter chest profile Eliminate need for binding 2
- Recommended for people with an A cup-size and good skin elasticity 3
- Recommended for people with a B or less cup size and good - moderate skin elasticity 3
- Top Surgery 3
- Summary for health care providers 3
- Recommended for people with a C-cup size or larger andor excess skin 3
- Top Surgery 4
- Summary for health care providers 4
- The procedure involves a significant degree of irreversibility to the chest and NAC of nipplesareolachest - higher risk of NAC numbness with double incision mastectomies because they are grafted 4
- . Body symmetry before and after surgery is imperfect. Asymmetry is common and may affect skin chest contour the size and position of the NAC and scarring. 4
- Masculine chest Flat chest Stop binding Nipple preservation 5
- Increase possibility of retaining sensation Minimize complications Resultant and desired scarring pattern 5
- Top Surgery 5
- Summary for health care providers 5
- Which medications to stop and when Anesthetic approach and risks Pain control measures Patients should ask their surgeon if there are any additional fees that are not OHIP covered 5
- Top Surgery 6
- Summary for health care providers 6
- Follow surgeons post-op instructions for drains dressings sutures and steri-strips 6
- Follow surgeons recommendations on restrictions to activities Some general guidelines include 6
- Have a support person during the post-op period to assist with IADLs cleaning cooking laundry groceries Avoid driving for one week or longer until safely able to move arms to drive 6
- Avoid straining lifting heavy objects max 10 lbs and exercise for four weeks Reduce activities and depending on type of work Gradual return to daily activities over four to six weeks 6
- Top Surgery 7
- Summary for health care providers 7
