Chest Masculinization

For some people, chest incongruity, in which the appearance of the chest does not match a person’s identified gender, results in marked gender dysphoria symptoms.  Surgery seeks to create a better identity alignment and can allow our patients to feel much more comfortable in their daily lives.  The two main types of surgery offered are mastectomy with free nipple grafts and a keyhole surgery with lateral scar.

For the majority of patients, mastectomy is necessary to adequately remove all of the excess skin and breast tissue.  The scar is aligned at the lower border of the pectoralis muscles and the nipple is completely removed and placed in a more masculine position as a skin graft.  Tacking stitches are placed which closes off the space where the breast tissue used to be.  This allows us to avoid placement of a drain almost all the time.  The dressings are removed after 5-7 days, once the skin graft has time to heal.

The keyhole surgery is appropriate for some patients who have a smaller amount of extra skin and breast tissue.  In this case, the areola is left attached to the chest, and a skin incision is made around the areola.  This incision is used to access and remove the breast tissue underneath.  Sometimes a lateral extension of the scar is placed extending from the areola to remove some of the extra skin along the outer quadrant of the chest.

The typical healing for returning to work is 3 weeks, and patients or instructed to wear a binder for about 4 weeks.  Because this procedure is a gender affirming surgery, rather than a cancer procedure, there is some residual breast tissue left to prevent a concavity deformity and such that the chest looks masculine, rather than surgical.  This does mean that you would need to continue breast cancer screening as recommended by your primary care doctor as you age.

Discover what we can do for you. Call us at 503-400-6622 or submit this form to schedule a consultation.