Subcutaneous Mastectomy with Chest Reconstruction

Chest masculinization surgery involves the removal of the glandular, fatty tissue of the chest (aka breast tissue), also called a mastectomy.

Different surgical techniques are used to remove tissue from the chest. The determination of surgical technique mostly depends on patent’s anatomy. The two most common techniques are:

• Double incision: This method is used for individuals with more tissue and may require two horizontal or one horizontal line across the chest at the pectoral muscle line. The areola and nipples are repositioned (by grafting) and reshaped to create a masculine appearance to the chest.
• Periareolar incision, or “Keyhole”: This method can be performed on individuals with less chest tissue; it is a smaller incision in the areolar area and liposuction is used to remove fat tissue. Nipple reshaping and repositioning are not typically performed.

Your peer navigator can help you prepare for a successful consultation with a surgeon and discuss your desired goals and outcomes prior to consult.

SURGICAL PLAN

Surgical techniques used are based on chest shape and size, skin elasticity, as well as patient’s needs and preferences. During your consultation, you and the surgeon will work together to discuss your preferences and determine a surgical plan based on your needs.

NIPPLE SIZE AND SENSATION

Patients will want to discuss nipple size, reshaping, as well as impact on sensation, including erotic sensation, with surgeon during consultation. Patients can choose to completely remove the nipples.

SCARRING

Scarring is a part of surgery. It is important to discuss where incisions will be made and potential impact of scarring on the chest area.

Your PCP, surgeon, and Gender Health Navigator can help you achieve optimal surgical outcomes by actively preparing for your surgery and making sure expectations are surgically possible.

PHYSICAL HEALTH

• Maintain a healthy body weight, high body weight can increase complications and interfere with wound healing.
• Although there is not a strict Body Mass Index (BMI) requirement, your surgeon may discuss specific anesthesia risks or considerations, depending on your BMI. It is beneficial to reach your own personal sustainable goal weight prior to surgery

MENTAL HEALTH/WELLNESS

• Having surgery takes both physical and mental preparation.  Surgery is stressful, some people feel an increase in depression or anxiety after surgery. 
• If you notice any changes in your mood or sleep, especially with anesthesia, please discuss with your care team.
• If you struggle with mental health, reach out to your mental health provider or navigator for support.

SMOKING

• Nicotine intake by smoking, patches, chewing gum, or vaping may interfere with wound healing. If you use nicotine, you should discuss a quit date with your PCP and surgeon. Surgeons require patients to stop nicotine prior to surgery and may test for confirmation.
• If you inhale cannabis, it’s important to find another way to use it, for example, topical, edibles, and tinctures, or to stop altogether.

SUPPORT

Build your network of support with providers, family, and community to help you plan and organize your recovery prior to and after surgery

• Transportation to and from appointments 
• Meal planning and preparation
• Providing a calm and supportive healing space

Everyone heals differently. Patients will experience— pain, bruising, swelling, and fluid or blood drainage. You will leave the hospital wrapped in a bandage garment on your chest area, it is recommended you keep this on until 1-week post-op visit. You may need to sleep in specific positions, on your back and slightly elevated for a couple of weeks after surgery

MOBILITY

After your surgery, you will have less mobility/ability to move and lift your arms. It is important to rearrange your recovery area so that you won’t lift or reach for anything above your shoulders during your recovery.

PAIN MANAGEMENT

Ask the doctor what will be provided for pain management. If you have a history of substance use, you may want to talk to your doctor about the safest ways to control pain after surgery.

Aftercare can differ by a patient and depends on the post-op care plan you discuss with your surgeon. For optimal results and to help avoid complications, it is essential to follow all post-op care instructions from your surgeon.

Make sure to review the instructions with your navigator and surgeon. The following questions can guide your conversation with your surgeon:

• What will post-op recovery look like over the course of 3 months?
• What are recommendations for limiting physical or sexual activity?
• When can I start to lift or carry heavier items?
• When can I lift my arms above my shoulders?
• What impact to my sleeping positions should I expect?
• How long should I expect to take off from work/school?

• Medicare A&B
• Full Scope Medi-cal
• San Francisco Health Plan (Medi-cal, Healthy Workers and Healthy Families)
• Anthem (Medi-cal)
• Healthy San Francisco (Health Access Program)