OBJECTIVE

To develop the algorithm of masculinizing mammoplasty in patients with male-to-female transsexualism depending on the patient’s anatomical data and risk factors.

MATERIAL AND METHODS

The first author performed 208 mastectomies in 104 patients with male-to-female transsexualism for the period from August 11, 2012 to February 27, 2018. The choice of surgical technique was based on breast size, ptosis degree, body mass index and risk factors. Inclusion criteria were age of patients over 18 years old, previously established diagnosis of F64.0 transsexualism and no previous surgeries of anterior chest wall. One year after discharge, an anonymous social survey was conducted among patients about satisfaction with postoperative result and changes in the quality of life.

RESULTS

The following postoperative complications were observed: hematoma (n=20; 9.6%), seroma (n=40; 20.2%), partial necrosis (n=25; 12.0%), wound dehiscence (n=1; 0.4%), folliculitis (n=12; 5.7%), ligature-associated abscess (n=2; 0.9%), hypertrophic scars (n=14; 6.7%), areola hypersensitivity (n=2; 0.9%). Four patients (3.5%) required redo surgery for hematoma in early postoperative period. Scar correction with simultaneous lipofilling in long-term postoperative period was required in 16 (15.3%) patients. One patient (0.9%) required tertiary correction with reduction of areola. One year after surgery, patients assessed postoperative outcome as 4.3 out of 5 scores.

CONCLUSION

The proposed selection system for masculinizing mammoplasty is effective. This method ensures favorable aesthetic result within one procedure with minimum complication rate and incidence of redo corrections. Masculinizing mammoplasty with areola autotransplantation reduces the incidence of complications associated with seromas and hematomas. However, higher risk of hypertrophic scars is observed.