Archives of Plastic Surgery

  • 제46권5호
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  • Pages.433-440
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  • 2019
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  • 2234-6163(pISSN)
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  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
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Mastectomy in female-to-male transgender patients: A single-center 24-year retrospective analysis

  • Kuhn, Shafreena (Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital Frankfurt) ;
  • Keval, Seirah (Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital Frankfurt) ;
  • Sader, Robert (Rhein-Main Working Group on Transsexualism and Transidentity) ;
  • Kuenzlen, Lara (Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital Frankfurt) ;
  • Kiehlmann, Marcus (Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital Frankfurt) ;
  • Djedovic, Gabriel (Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital Frankfurt) ;
  • Bozkurt, Ahmet (Department of Plastic Surgery, Helios Clinic Wuppertal) ;
  • Rieger, Ulrich Michael (Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital Frankfurt)
  • 투고 : 2018.10.10
  • 심사 : 2019.07.31
  • 발행 : 2019.09.15
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초록

Background Mastectomy in male transgender patients is an important (and often the first) step toward physical manhood. At our department, mastectomies in transgender patients have been performed for several decades. Methods Recorded data were collected and analyzed for all male transgender patients undergoing mastectomy over a period of 24 years at our department. Results In total, 268 gender-reassigning mastectomies were performed. Several different mastectomy techniques (areolar incision, n=172; sub-mammary incision, n=96) were used according to patients' habitus and breast features. Corresponding to algorithms presented in the current literature, certain breast qualities were matched with a particular mastectomy technique. Overall, small breasts with marginal ptosis and good skin elasticity allowed small areolar incisions as a method of access for glandular removal. In contrast, large breasts and those with heavy ptosis or poor skin elasticity often required larger incisions for breast amputation. The secondary correction rate (38%) was high for gender reassignment mastectomy, as is also reflected by data in the current literature. Secondary correction frequently involved revision of chest wall recontouring, suggesting inadequate removal of the mammary tissue, as well as scar revision, which may reflect intense traction during wound healing (36%). Secondary corrections were performed more often after using small areolar incision techniques (48%) than after using large sub-mammary incisions (21%). Conclusions Choosing the suitable mastectomy technique for each patient requires careful individual evaluation of breast features such as size, degree of ptosis, and skin elasticity in order to maximize patient satisfaction and minimize secondary revisions.

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참고문헌

  1. Ahmed OA, Kolhe PS. Comparison of nipple and areolar sensation after breast reduction by free nipple graft and inferior pedicle techniques. Br J Plast Surg 2000;53:126-9. https://doi.org/10.1054/bjps.1999.3235
  2. Cregten-Escobar P, Bouman MB, Buncamper ME, et al. Subcutaneous mastectomy in female-to-male transsexuals: a retrospective cohort-analysis of 202 patients. J Sex Med 2012; 9:3148-53. https://doi.org/10.1111/j.1743-6109.2012.02939.x
  3. Wolter A, Diedrichson J, Scholz T, et al. Sexual reassignment surgery in female-to-male transsexuals: an algorithm for subcutaneous mastectomy. J Plast Reconstr Aesthet Surg 2015;68:184-91. https://doi.org/10.1016/j.bjps.2014.10.016
  4. Monstrey S, Selvaggi G, Ceulemans P, et al. Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm. Plast Reconstr Surg 2008;121:849-59. https://doi.org/10.1097/01.prs.0000299921.15447.b2
  5. Kaariainen M, Salonen K, Helminen M, et al. Chest-wall contouring surgery in female-to-male transgender patients: a one-center retrospective analysis of applied surgical techniques and results. Scand J Surg 2017;106:74-9. https://doi.org/10.1177/1457496916645964
  6. Monstrey SJ, Ceulemans P, Hoebeke P. Sex reassignment surgery in the female-to-male transsexual. Semin Plast Surg 2011;25:229-44. https://doi.org/10.1055/s-0031-1281493
  7. Kornstein AN, Cinelli PB. Inferior pedicle reduction technique for larger forms of gynecomastia. Aesthetic Plast Surg 1992;16:331-5. https://doi.org/10.1007/BF01570696
  8. Sutcliffe PA, Dixon S, Akehurst RL, et al. Evaluation of surgical procedures for sex reassignment: a systematic review. J Plast Reconstr Aesthet Surg 2009;62:294-308. https://doi.org/10.1016/j.bjps.2007.12.009
  9. Hage JJ, van Kesteren PJ. Chest-wall contouring in female-to-male transsexuals: basic considerations and review of the literature. Plast Reconstr Surg 1995;96:386-91. https://doi.org/10.1097/00006534-199508000-00019
  10. Hage JJ, Bloem JJ. Chest wall contouring for female-to-male transsexuals: Amsterdam experience. Ann Plast Surg 1995; 34:59-66. https://doi.org/10.1097/00000637-199501000-00012
  11. Webster JP. Mastectomy for gynecomastia through a semicircular intra-areolar incision. Ann Surg 1946;124:557-75. https://doi.org/10.1097/00000658-194609000-00011
  12. Davidson BA. Concentric circle operation for massive gynecomastia to excise the redundant skin. Plast Reconstr Surg 1979;63:350-4. https://doi.org/10.1097/00006534-197903000-00009
  13. Benelli L. A new periareolar mammaplasty: the "round block" technique. Aesthetic Plast Surg 1990;14:93-100. https://doi.org/10.1007/BF01578332
  14. Lindsay WR. Creation of a male chest in female transsexuals. Ann Plast Surg 1979;3:39-46. https://doi.org/10.1097/00000637-197907000-00007
  15. McGregor JC, Whallett EJ. Some personal suggestions on surgery in large or ptotic breasts for female to male transsexuals. J Plast Reconstr Aesthet Surg 2006;59:893-6. https://doi.org/10.1016/j.bjps.2005.12.001
  16. Nelson L, Whallett EJ, McGregor JC. Transgender patient satisfaction following reduction mammaplasty. J Plast Reconstr Aesthet Surg 2009;62:331-4. https://doi.org/10.1016/j.bjps.2007.10.049
  17. Kelahmetoglu O, Firinciogullari R, Yagmur C, et al. Combination of Wuringer's horizontal septum and inferior pedicle techniques to increase nipple-areolar complex viability during breast reduction surgery. Aesthetic Plast Surg 2017;41: 1311-7. https://doi.org/10.1007/s00266-017-0933-9
  18. Mistry RM, MacLennan SE, Hall-Findlay EJ. Principles of breast re-reduction: a reappraisal. Plast Reconstr Surg 2017; 139:1313-22. https://doi.org/10.1097/PRS.0000000000003383
  19. Muslu U, Demirez DS, Uslu A, et al. Comparison of sensory changes following superomedial and inferior pedicle breast reduction. Aesthetic Plast Surg 2018;42:38-46. https://doi.org/10.1007/s00266-017-0958-0
  20. Baslaim MM, Al-Amoudi SA, Hafiz M, et al. The safety, cosmetic outcome, and patient satisfaction after inferior pedicle reduction mammaplasty for significant macromastia. Plast Reconstr Surg Glob Open 2018;6:e1798. https://doi.org/10.1097/GOX.0000000000001798

피인용 문헌

  1. Effect of low‐thermal dissection device versus conventional electrocautery in mastectomy for female‐to‐male transgender patients vol.17, pp.5, 2019, https://doi.org/10.1111/iwj.13382
  2. The effect of early puberty suppression on treatment options and outcomes in transgender patients vol.17, pp.11, 2020, https://doi.org/10.1038/s41585-020-0372-2
  3. A review of gender affirmation surgery: What we know, and what we need to know vol.170, pp.1, 2021, https://doi.org/10.1016/j.surg.2021.02.013
  4. Leserbrief zur Arbeit: Patientenzufriedenheit nach geschlechtsangleichender Mastektomie in Frau-zu-Mann transidenten Patienten - eine Analyse unter Verwendung eines modifizierten Breast Q Fragebogens vol.53, pp.6, 2021, https://doi.org/10.1055/a-1628-2104