Chest surgery for gender affirmation is usually the first surgical procedure performed as a transgender person achieves an appearance congruent with the gender with which they identify. In the female to male transition, the goal is to remove chest tissue to allow the chest to take on a more masculine appearance. In its simplest form, this is done through liposuction alone. Most patients, however, require surgery to also reduce the breast skin envelope and nipple diameter and/or projection. The goal is to achieve a more masculine chest while performing the least invasive procedure possible and thus minimizing scarring. The most common approach to the male to female transition is to place a breast implant beneath the breast tissue, similar to a breast augmentation procedure. Less often, a temporary implant called a tissue expander is placed and then used to stretch the skin of the chest over time before returning to the operating room at a later date to exchange it for a permanent implant. This technique is very similar to a common approach to breast reconstruction in patients who have had a mastectomy due to breast cancer.
The nuances of these procedures can be discussed during your consultation. Dr. Lien specializes in this type of surgery, which is performed under anesthesia in the operating room. Most patients are able to go home after surgery without spending a night in the hospital. Surgical drains are rarely needed. Recovery takes roughly 3-6 weeks, depending on the magnitude of the change the patient desires. Complications are rare with this type of surgery, but can include infection, fluid collections, poor wound healing, scarring, numbness of the skin or nipple, and asymmetry. With breast implants, there are potential long-term complications such as implant rupture or capsular contracture that could necessitate further surgery down the road. Please see the “breast revision” section for more information about this. A more complete discussion of the risks and benefits of the surgery is always included at your visit. Many insurance companies cover this type of surgery, and we recommend that you contact your insurance company about gender affirmation surgery prior to your consultation so that we can work with you to ensure coverage of your surgery.