Gender Reassignment Surgery – Female to Male Breast Surgery

  • Reference Number: HEY-434/2016
  • Departments: Breast Services

Introduction

You will have been given an appropriate referral from the Gender Identity Service, supported by a second specialist confirming your diagnosis. The referral confirms that funding is now in place for your surgery. This leaflet has been produced to reinforce the information that has been given to you about your surgery. Most of your questions should have been answered by this leaflet. It is not intended to replace the discussion between you and your doctor, but If, after reading it you have any concerns or require any further   explanation, please discuss this with a member of the healthcare team caring for you.

What is this type of Breast Surgery?

This surgery is an operation to remove most of the breast tissue in order to help create a flatter chest shape and masculine appearance.

Your initial consultation

You will be seen by the consultant and asked various questions about your general health, as well as being given a physical examination, which will include several measurements of the breast being taken and recorded.  Consent will be required for clinical photography, involving before and after surgery pictures, to complete an accurate visual record.  Each option of surgery will be discussed with you including the risks, advantages and disadvantages of each, as relevant to you.

This consultation provides an opportunity to see pictures of previous pre and postoperative surgery results. You are encouraged to ask questions and discuss any concerns fully with your consultant and understand the potential issues of your surgery. It is important that you have realistic expectations of the final appearance of your chest.

Can there be any complications or risks?

As with all surgery, there can be complications or risks. Your consultant will go through these in detail with you as part of your consultation; however we have listed some of these below for your reference.  If you have additional concerns regarding risks or complications, please do not hesitate to discuss these with your consultant.

General complications and risks could include:

General surgery risks –   bleeding, infection, bruising, scars. Steps are taken to reduce risks, such as injections to help prevent adverse blood clotting; use of compression stockings to help prevent deep vein thrombosis and antibiotic cover.

Bruising – this may cause the breast area to become a little discoloured and may spread down towards the abdomen. Your body will absorb this bruising and rarely needs any intervention but if worried, contact your surgeon.

Seroma – this is a build-up of serous fluid between the tissues and the skin. This fluid is usually absorbed by the body but if it is present in large amounts, it can be uncomfortable. The fluid can be removed by inserting a fine needle and removing the fluid.  This is quite a common procedure undertaken in the breast clinic outpatient department.

Skin necrosis – occasionally the blood supply to the flaps of skin on either side of the surgical incision is inadequate.  This is significantly more common in people who smoke. The skin involved dies (necrotic) and gradually heals by scarring. If this area is quite extensive, surgical removal may be required, although this is not common.

Nipple necrosis –  if the nipple is retained, there is a small possibility that the nipple may lose its blood supply and become necrotic. This means that a poor blood supply to this area may result in the loss of some colour and the nipple may not survive. If this happens, it is possible to have a nipple reconstruction at a later date.

Infection – this may occur despite the routine administration of antibiotics. Any signs of redness, heat, discharge or raised temperature needs to be reported to the doctor, consultant or the surgical ward. An earlier follow-up appointment can then be made to attend the ward or the breast clinic outpatient department.

Fat necrosis – this is a condition that can occur under the skin post-operatively. It results in hard lumps forming within the breast area which can be a concern for the patient. The condition is benign (harmless) and does not carry any risk of cancer, however all lumps should be investigated appropriately.

 Scarring – there will be scarring that will gradually fade, varying with each individual. If you do suffer from an infection, this can affect scarring; the scar can become thicker than expected and take longer to fade. Even without any infection, some scarring can become thicker and overgrown due to a condition called Keloid (excessive tissue growth in the wound area). This may require a special silicone dressing in order to help treat the scar.

Nipple sensation – this may be lost completely or there may be some small loss or even increased feeling in the cases of surgery retaining the nipple area. There can be no guarantee regarding this.

Skin sensation – it is quite normal for the skin sensation to change with areas of numbness, tingling, small sharp feelings after surgery due to the normal healing process. Again, this can vary greatly from one individual to another.

What will happen after your initial consultation?

After your initial consultation, you will be placed onto a waiting list. When a suitable date becomes available for your surgery, you will receive a letter with appropriate details including:

  • A date for your pre-assessment appointment.
  • A date for your surgery, times and where to attend.

 Pre-operative admission to the ward – you will be seen by the doctor, anaesthetist and surgeon. After routine medical checks and obtaining consent, the breasts are marked with several measurements for the operation.

Your operation

The operation is performed under general anaesthesia and involves the removal of most of the breast tissue with the preservation of the nipple and areola (coloured) area, if possible. The particular surgical technique used is dependant on the breast size of the individual patient and initial assessment:

  • Liposuction may be used to remove breast tissue via small incisions.
  • An Inframammary Fold Mastectomy (removal of the breast from the fold underneath the breast) results in a scar along the crease of the skin directly under the breast. The nipples may be completely removed and repositioned. If the nipples are not preserved, both nipple and areola tattoos can be done at a later date.
  • A Benelli Procedure (surgical name) may be used by making a circular cut around the outer edge of the areola, leaving the nipple partially attached. Breast tissue is removed and the excess skin is trimmed. The nipple is then repositioned and a ‘purse-string’ (type of stitch) technique is used to pull the skin around the areola tighter together to close the reduced area.

All of these surgical options will be discussed fully as to which will be the most appropriate for you.

Post-operatively

Recovery – when your operation has been completed, you will spend some time in the recovery room, where you will be monitored until you are considered well enough to return to the ward.

Post operative pain management – if you are experiencing pain, please speak to a nurse who will ensure you are given appropriate pain relief.

Antibiotics – are given before the procedure and may be given for a few days afterwards. It is important that you complete the full course of antibiotics given.

You will have an infusion (drip) in your hand until you are able to eat and drink. There may be two drainage tubes to drain away excess fluid from the wounds, one in each side, which normally stay in place for about 1-3 days, dependant on the amount of fluid loss. You will be encouraged by the physiotherapist, to move your arms in order to prevent stiffness. Dissolvable sutures are used and the dressings should stay in place for approximately 2 weeks and will be removed when attending the breast clinic outpatient appointment.

You can expect to go home 1-3 days later, once your surgery allows you to be mobile and self caring. Continue to wear the chest binder (compression vest) for 6 weeks, as this will help protect and support the chest throughout the healing period.

On Discharge

On discharge you will be given an information leaflet with advice about post operative care, pain relief and exercises as relevant to your breast surgery.

Bruising and a swollen appearance can be expected, which may take several weeks to settle before the final effect is apparent. Sometimes, small adjustments may be required at a later date but it normally takes a few months for everything to settle.

Follow up and further treatments

Follow up – initially, 2 weeks after surgery and then again in 3 months to check everything has settled properly or sooner, if any problems arise. Further appointments are arranged if subsequent surgery or treatment is required.

Liposuction – this involves the removal of extra fatty/glandular tissue from the breast/armpit area to help create a flatter contour. This procedure may sometimes be undertaken at the same time as the mastectomy (removal of the breast) or at a later date, when post-operative swelling has subsided, allowing particular areas of concern to be identified and discussed.

 Dog-ear – this refers to the possible, puckered appearance of the skin at the end of the scar line, looking like a little flap. This can be removed by a minor operation at a later date.

 Nipple reconstruction – a procedure can be undertaken to replace the lost nipple, if not retained, by creating a small lump projecting from the skin on the breast. This could be done at a later date, once the original wound area has healed properly.

 Nipple/areola tattoo – the area around the nipple can be tattooed with colour onto the skin, either around an existing nipple or colour shading applied to provide definition of nipple and areola. This procedure can produce extremely realistic results.

Contact Information:

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the  Breast Care Unit on telephone number (01482) 622679 or email hyp-tr.tgsinfo@nhs.net

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.