How is transgender mastectomy done?

Transgender mastectomy, technically called bilateral subcutaneous mastectomy, is a surgical procedure performed to remove both breasts in transgender men or non-binary individuals who wish to transition and eliminate secondary sex characteristics that do not align with their gender identity. For many trans men and non-binary individuals who do not want to have feminine breasts, this procedure can be an essential part of their gender affirmation process. If present, this surgery may provide significant relief from gender dysphoria. In this article, we will discuss how a bilateral subcutaneous mastectomy is performed and what to expect during the recovery process.

“The goal of bilateral mastectomy is not just to remove the breasts, but primarily to masculinize the chest of a trans man or a non-binary person seeking a flatter, more masculine torso,” explains Dr. Ivan Mañero, director of IM GENDER, the Gender Unit of IM CLINIC.

Bilateral subcutaneous mastectomy is performed under general anesthesia. During the surgery, the surgeon makes an incision either at the lower part of the breast or around the areola to remove glandular and fatty breast tissue. The skin is preserved to minimize visible scarring and maintain sensation in the area. “It is crucial to minimize scarring as much as possible to avoid any stigma that may make the patient uncomfortable,” states Dr. Mañero.

Additionally, to achieve better aesthetic results, the areolas and nipples are resized and repositioned higher on the chest for a more masculine appearance.

Depending on breast size, shape, skin quality, and individual needs, different surgical techniques can be used for transgender mastectomy.

The periareolar incision technique for bilateral mastectomy involves making a circular incision around the areola to remove breast tissue. The remaining skin is stretched and sutured in place. This technique is typically used for individuals with small breasts and elastic skin, as it results in minimal scarring.

This technique is generally used for patients with larger breasts. It involves the periareolar incision along with an additional incision extending toward the armpit, through which glandular tissue is removed. While scarring is more visible than in the periareolar technique, it may become less noticeable over time due to body hair growth.

For individuals with very large breasts or those considered heavy smokers, surgeons often use this technique, which involves removing and grafting the areola during surgery.

All of these techniques can be combined with preoperative liposuction to reduce scar size and improve chest contour.
During transgender mastectomy, the surgeon may place surgical drains to prevent fluid buildup in the area. At IM GENDER, these drains are typically removed 48 hours after surgery.

The procedure can take several hours, depending on the complexity of the mastectomy and the breast size. Additionally, it can be combined with other masculinizing surgeries, which may extend the time in the operating room.

It is important to remember that the goal of transgender mastectomy is to achieve a flat, symmetrical chest, resulting in a masculinized torso.

Within 24 hours after surgery, you will be able to return home, following all medical recommendations. Your surgeon may recommend wearing compression garments (such as a binder, compression band, or vest) for several days to reduce swelling, prevent bruising, and help the skin adjust to the new chest shape. These garments can also contribute to a faster recovery.

During the first few weeks after surgery, heavy lifting and strenuous activities should be avoided. In general, full recovery from bilateral subcutaneous mastectomy takes six to eight weeks. It is advisable to rest and sleep on your back for the first four weeks post-surgery.

If you are considering bilateral subcutaneous mastectomy, it is important to consult with a specialist in gender-affirming surgery, such as the team at IM GENDER, to answer any questions you may have about the procedure and recovery process. For many trans men, transgender mastectomy is a significant step in their gender affirmation journey.