Part of the
sex reassignment surgery options open to
female-to-male transsexuals. This is the most common surgery for such individuals as a)
genital surgery for FTMs is in a pretty poor state, and b) while
estrogen usually increases breast size in
MTFs, and testosterone may cause
some amount of breast shrinkage, there is no non-surgical way to be totally rid of them and breasts are a very important
gender signifier.
Many people believe that
breast removal is either a matter of
breast reduction surgery or traditional
mastectomy (as performed for breast cancer patients,) but neither are accurate, and the surgical techniques vary in very important ways. The purpose of male chest reconstruction is, as one might figure from the name, to create a chest that appears masculine and naturally so.
There are two primary surgical options for this:
1. "Keyhole" technique - This is a
surgery only suitable for FTMs with naturally small breasts (usually only those who would be sized as an "a cup" would qualify.) It is performed by making
periareolar incisions from which the tissue is removed, which is sometimes facilitated by liposuction, after which some degree of areolar resizing may take place (depending on the surgeon - in any case only a limited amount of this may be done while insuring the viability of the areolar and nipple tissue.)
Pros: Little-to-no scaring (this is a big deal for most), lack of need for skin grafts.
Cons: Nipples and areolae may remain the same size (or larger than desired even if they are resized) and position and skin shrinkage may not occur entirely as desired, higher probability of needing revision.
2. Traditional technique - The more commonly used procedure, and basically the only option for those with average or large breasts, is a bilateral mastectomy (I said earlier that this isn't like a traditional mastectomy but is technically a removal of the
mammary glands and tissues nonetheless) with
nipple and areolar reconstruction.
This is a 3-4 hour
operation which involves incisions made horizontally under the breasts, breast tissue being removed from these incisions, removal of the nipples and areolae which are resized, removal of much of the skin covering the breasts and repositioning of nipples higher (and usually more
laterally) on the chest for a more masculine appearance. The skin is manipulated so it goes smoothly across the chest and the incision is sutured, usually with drains being left coming out of the edge of each incision to allow excess fluid to escape. The nipples are generally packed to prevent damage. The nipple packing and drains are removed approximately one week after surgery and sutures removed shortly thereafter (the patient must not shower in the meantime.)
With both surgeries, a
surgical binder is worn for 2-3 weeks following surgery to prevent
fluid accumulation, and if applicable
surgical tape is used on the incisions to keep them in place. They are both done under
general anesthesia, so the general
risks of such kinds of surgery accompany these; blood collecting under skin,
infection, failure of skin grafts to take if used, etc. Death is also possible, as it is with all surgeries performed under general anesthesia, but is extremely uncommon (I have never heard of a case of it, myself.) Usually a recovery period of about two weeks is needed, though one generally won't be "
100%", and able to return to things like heavy exercise, for about a month.
Revisions are often needed to correct things such as the "dog ears" that occur at the ends of incisions, which some surgeons offer free of cost, and is performed under local anesthesia, eliminating the cost of an
anesthesiologist. They are usually performed 6-12 months after the initial procedure.
Like other
sex reassignment surgery procedures, almost all surgeons will require a letter or two of referral from
psychologists, and some require that you have been on
hormones for a period of time. Unlike for MTFs the "
real life test" is almost never used with regard to FTMs because there is much more of a grey area for MTFs about when one is "dressing as a man", etc. due to differences in acceptable behavior for people perceived as men versus people perceived as women.
Much of this information is based on the techniques Dr. Michael Brownstein uses; he is considered one of, if not the, best surgeon for this procedure, so techniques, results, etc. vary quite a bit. Dr. Brownstein's website is http://www.brownsteinmd.com, and has photos of surgical results.