Transsexuality - NGS

Mastectomy

The anatomy of the female breast

Posted by Falk, restranslated by Selfmademan

The breast forms the largest gland in the body. It consists of the glandular body, fat and connective tissue, blood vessels, nerves and lymph vessels. The male breast is made up of exactly the same components, but while the man's breast no longer develops under the influence of male sex hormones during puberty, the woman's breast changes noticeably when the menstrual cycle begins.
Together with the uterus, the breast prepares for a possible pregnancy. The gland lobules grow and the milk duct tissue also increases in size. At the same time, the proportion of fat and mammary gland tissue increases steadily.

Responsible for these cyclical changes are the female sex hormones.
The adipose tissue and mammary glands give the female breast its shape (the proportion of fat and glandular tissue can vary over the course of life and thus lead to changes in the shape of the breast. The musculature lying under the mammary gland can also change the shape of the breast, albeit in to a lesser extent than the other factors mentioned). The tissue is held in shape by the elastic breast connective tissue.
The surrounding, breast tissue, extends from the collarbone to the lower ribs and from the breastbone to the outer edge of the armpits.

The nipples form the ends of the breasts.
The ducts of the glandular lobes open into the nipples, which can secrete milk and sebum. These are surrounded by a halo of more heavily pigmented skin. On the areola (areola mammae) there are small elevations, the Montgomery glands.

The basis for this site is an article that appeared in TNT (Transsexual News Telegraph) Issue #7 - Summer 1997 - with many thanks to Kris for translating it for us.

In the following, we would like to show all known incision variants that have been used for breast surgery (mastectomy/mamma reduction) in ngs-men with their possible advantages and disadvantages as well as possible risks. If you know any cutting techniques that are missing here, we ask for information about them so that we can add them here...

There are many different surgical techniques to remove a breast, but if you look closely, few of them are really useful.

For a successful operation one must take into account the size of the breast, the flexibility, thickness, elasticity and color of the skin, the percentage of fat, the size of the areola (areola) and the nipple itself.
One also has to consider the goals of e.g. having phalloplasty later or at the same time as breast surgery, as one could use the skin around the areola to replace the skin on the arm if both surgeries (mastectomy and phalloplasty ) can be carried out simultaneously.

It's up to you whether you want to reach the summit immediately - a dangerous choice - or whether you're willing to wait and make small corrections later to improve the results and reduce risk. This is something to think about seriously because the result of the surgery will probably be the key for you later to go topless or not.

It must also be realized that, depending on how well the individual knows the human body, it is always possible to tell that something has been done to the breast (e.g. by large scars, an indentation due to the removal of mammary gland tissue or similar physical abnormalities).

In principle, all interventions have one thing in common:
     

It is difficult for the surgeon to predict how much the skin will retract after the mammary gland tissue has been removed. Therefore, it is advisable not to remove too much, otherwise there could be a catastrophic result such as a deformed areola, ruptured and riddled with tissue tears and larger, white scars as the scars have spread widely. This effect can then usually only be reduced by repigmentation of the skin.
The surgeons are often responsible for these incidents, as they are more concerned with perfect surgery than with the dangers they inflict on their patients. Therefore, you should choose your surgeon carefully. Trust is very important here. You should always choose the surgeon who explains in detail what is being done and what the possible risks are.
It's your life, your freedom to go shirtless when the weather is warm or when you want to. You have the right to choose your surgeon and you should do so carefully.

Here are a few surgical techniques:

"Round Block"-technique

With the "round block" technique, the areola is completely separated from the skin and later reimplanted. Here, after removal of the mammary gland tissue and reduction and reimplantation of the areola, tissue death can occur, causing the areola to lose sensitivity. However, if the surgery is successful, the result can be flawless.
However, the nipple itself may be deformed and/or white scars may appear in the darker tissue of the areola. In order to avoid the excessive cavity created by the removal of breast tissue and fat tissue, it may be necessary to undergo liposuction (liposuction) to flatten the fat tissue.
When the skin is thin, it is more flexible and elastic, and is therefore more likely to retract. It retracts less when thicker, reducing indentation. More about the round block technique here: https://www.schoenheitsgebot.de/benelli-technik.php

Lateral-perimamillary incision

Bildquelle: www.link.springer.com

The least risky surgical technique is the lateral perimamillary incision, in which the surgeon cuts in a semicircle just outside the areola, which is the most common technique today.
This technique can be used in conjunction with liposuction (fat removal) and is possible for small to medium-sized breasts. A second operation usually takes place after about six months to a year, during which the remaining, unnecessary tissue (skin coat) is removed.

M-incision technique

The M-incision technique, albeit somewhat outdated, is still used in part today because it is intended to give the surgeon a slightly larger opening to work with as a result of a longer incision.
The scars are hardly visible later.
Remember: the longer the cut, the bigger the wound that has to heal later...
Corrective surgery is usually carried out after about 1/2 to 3/4 years, during which excess tissue (skin cover) is then removed.

 Anchor-Incision

Bildquelle: www.link.springer.com

The anchor-incision is outdated and is only rarely used for very large breasts. In order for the breast surgery to be visually successful, the surgeon must move the areola to a new location after removing the breast tissue, which means that it is completely removed through a circular incision.
The risks of this technique are similar to those of the "round block technique", although the large incisions also put a great strain on the immune system and the remaining scars cannot exactly be described as subtle.

Submammary incision

Bildquelle: www.link.springer.com

A variation on the anchor cut is the simple underbust cut. The "vertical ridge", the vertical upward scar, that is typical of the anchor cut, is missing here.

                                                  Horizontal incision

The horizontal cut to the right and left beyond the areola is also outdated and is actually no longer used today - the reasons are the same as for the anchor cut.

Round thread technique

The round-thread technique for reducing the areola (areola) is also outdated.
In this case, a non-self-dissolving, strong thread is knotted in the desired target size of the areola and sutured to the areola and the excess skin. This is intended to prevent the areola from being pulled by swelling and thus from unwanted enlargement after the procedure.
The disadvantage is, among other things, the danger that this thread can become detached again or that this thread can be overlooked and damaged/cut through during a second intervention and the areola thus assumes its original size again. There are many other surgical techniques.

Examples:

• The nipple itself is removed, the mammary gland tissue is sucked out, and the nipple is then sewn back on. With this method, the nipple rejection rate is high.
• In the case of very small breasts, the fatty tissue can also be suctioned out from under the armpits - but this can also cause problems. On the one hand, liposuction (comparable to poking around in the dark) is poorly suited to removing the mammary gland tissue, which is usually hardened by testosterone, so it can only minimize the fatty tissue. Since the performing surgeon does not see what he is doing, the risk of dents forming is relatively high. In addition, the entire chest area is often very swollen afterwards.

While some surgeons remove all of the breast tissue, others remove most of it, leaving a small portion in the body to avoid indentation and give the breast a "pectoral" (male) shape. However, this can lead to the remaining breast tissue collapsing or slipping, which can lead to complications. In addition, there is an increased risk of breast cancer in the preserved part of the mammary gland tissue when taking testosterone.

A visually satisfactory result can usually only be achieved through regular muscle training after the procedure. But be careful and don't jump on your weights right away - only when everything has healed is there no risk of the seams tearing open again, which can leave unsightly scars. Lifting weights before the operation is also not advisable, as otherwise the skin is already stretched before the operation - if you refrain from training before the operation, your muscles can "grow" into the skin afterwards.

How long you have to stay in the hospital depends on the surgical method. Four days is the average. The operation takes between one and three hours, depending on the method and the breast.

When it comes to bandages and showering, each surgeon has their own opinion. Some advise their patients to take hot baths to facilitate reabsorption of the hematoma, while others advise against showering.

The bruises disappear after a few days. They first turn yellow, then green. You shouldn't be a cause for concern; they are perfectly normal in cosmetic surgery. An ointment against bruises/hematoma brings support here. Ask your surgeon which ones they recommend for you.

Pulling the sutures when not using self-dissolving sutures should not be put off, otherwise they could leave marks/scars. It takes some time for the skin to recede. It depends on the size of the mammary gland tissue and the quality of the epidermis. Surgeons often do not advise their patients of a scar ointment, or they simply forget. You can decide for yourself whether you want to use them or not.

To clarify the principle of the mastectomy, here are a few cross-sectional drawings...

This is what a removed mammary gland looks like: