Masculinisation: Mastectomie
The procedure
The medical term for this procedure is subcutaneous mastectomy. The procedure aims to achieve a flat chest and a more masculine aesthetic while minimising scarring. A mastectomy removes your breasts and creates a more masculine chest contour. It also resizes the nipples and areola (the area of dark-coloured skin around your nipples) and, in many cases, repositions them.
Referral criteria
You may only have a mastectomy if you have been referred by one of our partners
What happens during a mastectomy?
- Most of the breast tissue is removed;
- Excess skin is removed;
- The breast fold is removed;
- Your nipples and areola are resized and repositioned.
What are the different types of mastectomy?
- Keyhole surgery
- Periareolar (donut) surgery
- Batwing procedure
- Double incision
- Inverted-T top surgery
Keyhole surgery
Keyhole surgery is ideal if you have a smaller chest and elastic skin. A small incision (cut) is made along the bottom of your areola to remove your breast tissue. Liposuction (fat removal) may be used to flatten the area around the areola. The nipple stalk is left intact, so that the nipple retains sensation. The areola is not resized. You will be under general anaesthetic.
Periareolar (donut) surgery
This surgery is known as the periareolar or concentric-circle technique. It is ideal if you have a smaller chest or have a B-cup and good skin elasticity. An incision (cut) is made around the border of the areola. A second, larger concentric-circle incision is then made around it. The ring of skin – the donut – is then removed. Once the breast tissue is removed, a ‘drawstring’ technique is used to draw the skin together and connect it to the edges of the areola, which may first be resized or repositioned. The nipple stalk is left intact. The nipple is usually not made smaller due to complications with vascularisation (blood vessel formation). You will often retain some sensation in your nipples. Additional liposuction (fat removal) may be carried out to flatten the area around the areola. As the inner circle has a smaller diameter than the outer circle, some creasing may occur around the circular scar. You will be under general anaesthetic.
Batwing procedure
The Batwing procedure (also known as Fishmouth incision) is ideal if you have a B-cup chest, less skin elasticity and mild ptosis (sagging). An incision (cut) is made around the border of the areola, along with a second, larger concentric-circle incision. Extra skin on the medial (central) and lateral side of this circle is removed in the shape of a triangle. The resulting ring featuring lateral, triangular extensions of the skin – the ‘batwing’ – is removed. The horizontal scar is aligned with the areola. The nipple stalk is left intact. The nipple is usually not made smaller due to complications with vascularisation (blood vessel formation). You will often retain some sensation in your nipples. Additional liposuction may be carried out. You will be under general anaesthetic.
Double incision
Double incision is the most commonly used technique and is ideal if you have an average to larger chest size. The skin on your chest is opened along two horizontal incisions to the left and right of the areola and in the chest fold. The skin is held open, and the breast tissue is removed. Additional liposuction may be carried out to shape the chest contour. The resulting scar will be located in the breast fold. Your nipples will be removed, resized and relocated higher on the chest at a tailored location. The free nipple grafts (FNG) are reattached and bandaged to the skin to promote the growth of new blood vessels into the graft. The bandages will be removed at the outpatient clinic five to seven days post-operation. Following the nipple transplant, you will have limited sensation in your nipples and areola. Very occasionally, you may retain the original nipple stalk and nerves. In such cases, the nipple retains its blood flow and all or part of its original sensation. You will be under general anaesthetic.
Inverted-T top surgery
Inverted-T top surgery is ideal if you have a larger chest and somewhat inelastic skin. The procedure is comparable to the double incision technique, but includes an additional vertical excision (tissue removal). This enables the surgeon to redrape the skin on your chest without causing too much skin folding. Your nipples will be removed, resized and relocated higher on the chest at a tailored location. The free nipple grafts (FNG) are reattached and bandaged to the skin to promote the growth of new blood vessels into the graft. The bandages will be removed at the outpatient clinic five to seven days post-operation. Following the nipple transplant, you will have limited sensation in your nipples and areola. Very occasionally, you may retain the original nipple stalk and nerves. In such cases, the nipple retains its blood flow and all or part of its original sensation. Additional liposuction may be carried out to shape the chest contour. You will be under general anaesthetic.