Top Surgery (Double Mastectomy)
General information
Breast amputation in a patient diagnosed with trans-gender female → male and non-binary individuals
Conditions necessary for the procedure before legal change of birth certificate:
- Completed 18 years of age;
- Two independent opinions: sexologist and psychologist with a diagnosis of transsexualism (psychiatric-psychological opinion);
- Started hormone therapy (does not apply to non-binary individuals);
- Correct BMI (slight overweight is acceptable)
- Between the last dose of testosterone and the date of surgery, there should be a break slightly longer than the interval between testosterone doses (does not apply to individuals not receiving hormone replacement therapy).
Type of anesthesia
general (anesthesia);
Procedure duration
4 h (sometimes longer);
Stay in clinic:
1 day;
Follow-up examinations:
- The day after the procedure: local condition check, drain removal (if placed);
- after one week (necessary): local condition check, partial suture removal;
- after 2 weeks (not essential): local condition check, removal of all sutures;
- after one year: final evaluation of the surgery result;
Medications:
Over-the-counter painkillers;
Recovery period:
- Return to mental work and driving after 2 weeks;
- Return to light physical work after one month;
- Return to sports (cycling, swimming pool) after 6 weeks;
Scar care:
- Until suture removal – do not apply anything to the scar;
- After all sutures are removed, moisturize the scar twice a day until all scabs fall off the scar;
- Then silicone patches (almost 24 h/d non-stop, minimum 2 months);
- Areas of palpable thickenings along the scar should be massaged;
Unavoidable consequences of surgery
discomfort/pain (usually mild), swelling, bruising, scarring, skin sensation disturbances in the scar area, THE PROCEDURE IS IRREVERSIBLE
Complications may occur:
Excessive bleeding into the wound/hematoma – (requires another procedure); fluid accumulation in the wound (requires puncture and evacuation); infection (requires antibiotics); exposure of internal sutures; prolonged wound healing; hypertrophic scar/keloid; necrosis of the nipple/areola complex; insufficient correction (necessity of another procedure); asymmetry always occurs before the procedure – asymmetry may also be present after the procedure; dissatisfaction with the aesthetic result of the procedure.
Photo gallery
Preparation for double mastectomy for transgender individuals
Patients' general health must be good. Chronic diseases may coexist, but they must be well-controlled, and an opinion from the treating physician is necessary stating that the disease does not contraindicate the surgery. Test results and consultations should be delivered to the clinic 3 weeks before the planned procedure date; A consultation with an anesthesiologist should take place 2 weeks before the surgery.
A necessary condition for qualification for mastectomy is a state after a court-ordered change of birth certificate or two independent psychiatric and psychological opinions with an F64 diagnosis.
Required tests:
- Blood type (every procedure carries the risk of needing a blood transfusion)
- Complete blood count;
- ESR or CRP (can detect inflammation in the human body that has no symptoms);
- APTT, INR (blood clotting system)
- Sodium, Potassium
- Glucose (to detect possible hidden diabetes)
- Creatinine (assessment of kidney function)
- HBS-Ab, HCV-Ab, HIV: to identify patients who may be infectious to others;
- General urine test (important for breast implant surgery);
- ECG (important for patients over 40 years of age, as cardiovascular diseases begin to appear at this time);
- Breast ultrasound only before breast surgery;
Other tests depending on the patient's health condition (most often TSH in case of thyroid diseases);
- For a procedure under general anesthesia, you must report 6 hours fasting;
- Take a shower before arriving at the clinic;
- Metal piercings must be removed. Metal ones can be replaced with plastic ones. There must be no piercings in the tongue or lips.
- The procedure must not be performed during an infection (e.g., common cold, herpes);
- Before the procedure, discontinue:
- Dietary supplements 1 month before (they have an unpredictable effect on blood clotting and anesthesia);
- Blood thinners (drugs with acetylsalicylic acid, e.g., Aspirin, 2 weeks before);
- Discontinue blood clotting-enhancing drugs before major procedures lasting longer than 2 hours and after the age of 40 (most often these are contraceptives or hormone replacement therapy);
- Testosterone should be taken so that the last dose is as far as possible from the date of the procedure (if the injection is once every 3 weeks, the last dose 3 weeks before the procedure; return to testosterone 2-3 days after the procedure);
- Chronically used medications for co-existing diseases (e.g., arterial hypertension, hypothyroidism) should be taken continuously and brought to the hospital (they must not be discontinued even on the day of surgery);
- Leaving the clinic in the presence of an accompanying person;
- To reduce the risk of swelling and bruising, it is recommended to take arnica preparations up to 2 weeks before the procedure (Boiron Arnica montana 9CH 4g – 3x/day 5 granules sublingually) and rutin with vitamin C (Rutinoskorbin 3x2 tablets per day);