Treatment for Subcutaneous Mastectomy

Subcutaneous mastectomy also referred to as skin-sparing mastectomy is a surgical procedure that removes the majority or all breast tissue while protecting the skin that covers it and, in some cases, the complex nipple-areolar. This procedure is typically employed for women undergoing gender-neutral surgery, those who are at risk of developing breast cancer, and those suffering from benign breast problems.

Preserving the skin and nipple when safe to do so allows for better aesthetic results, especially when paired with immediate breast reconstruction using implants or autologous tissue. This approach not only improves physical recovery and thorax wall symmetry but also supports emotional and psychological healing, particularly for individuals undergoing gender transition or prophylactic surgery.

What Is a Subcutaneous Mastectomy?

Subcutaneous mastectomy subcutaneous mastectomy involves the removal of the breast glandular tissue, while leaving the skin and nipple and areola in good condition. Contrary to total mastectomy which involves the removal of the entire breast including the nipple, this method is designed to preserve the aesthetic appearance of the chest.

Common Indications:

1. Transgender affirming surgical procedure for transgender males and non-binary people

2. Gynecomastia (enlarged male breast tissue)

3. Breast cancers that are benign including fibrocystic disease, or adenomas

4. Risk-reduction for patients with a genetically high risk of breast cancer (e.g., BRCA mutation)

Goals of Treatment

The main goals of subcutaneous mastectomy is:

1. Removing tissu from the breast to decrease or eliminate risk of contracting disease, or for gender confirmation

2. The preservation of aesthetics on the chest which includes the skin as well as the nipple-areolar complex

3. Eliminating scarring and creating the appearance of a flat or masculine chest contour

4. Promoting psychological and physical well-being

Types of Subcutaneous Mastectomy Procedures

There are various surgical methods that are based on the anatomy of the patient and breast tissue, as well as desired results.

1. Periareolar Mastectomy :- Ideal for women with modest to small breasts. An incision is created around the area of areola. Access to breast tissue while also preserving the skin and nipple
2. Double Incision Mastectomy with Nipple Grafting :- Ideal for women who have larger breasts. It involves two horizontal incisions just below the muscle line of the chest. The nipples will be removed and resized and then grafted back to the natural chest position of a male
3. Keyhole or Circular Incision Mastectomy :- Ideal for breasts with small sizes.  Small cut made at the edges of the areola. The minimal scarring is often chosen by women for its privacy
4. Endoscopic-Assisted Subcutaneous Mastectomy :- Minimally invasive alternative. The procedure was performed with the aid of an endoscope that allows for precise measurements. Very small scars are left and speed up recovery

Pre-Surgical Evaluation

Prior to undergoing a subcutaneous mastectomy Patients are carefully evaluated by a multidisciplinary team usually comprising:

1. Reconstructive or plastic surgeons

2. Endocrinologists and primary physician of primary

3. Psychologists (especially for gender-affirming practices)

4. Radiologists to take images if required

Preoperative Considerations

1. Blood tests and health assessment

2. Breast imaging (mammogram or ultrasound MRI)

3. Hormone therapy for the continuation of (for transgender persons)

4. Stop smoking, if appropriate

5. Discussion of aesthetic goals and expectations for scars

The Surgical Procedure: What to Expect

Step-by-Step Overview:

1. Anesthesia :- General anesthesia is a method of ensuring that the patient is completely unconscious and pain free.

2. Incision :-  The method of incision is in conjunction with the preoperative plan.

3. Tissue Removing :-  The surgeon meticulously removes this glandular breast tissue keeping as as much skin and nipple strength as is feasible.

4. Hemostasis, and Drain Placement :- Bleeding is managed, and drains of a smaller size could be put in place to clear excess fluid.

5. The skin is closed :-  Incisions are closed by sutures that are absorbable or a skin adhesive.

6. Dressing, and Compression :-  Dressings made of sterile and a compression sock are used to reduce swelling and encourage healing.

Duration:

1. Typically, the time is about 2 hours

2. Same-day discharge or overnight stay depending on complexity

Recovery After Subcutaneous Mastectomy

Right away post-op (0-2 weeks)

1. The swelling, soreness and bruising are typical

2. It is generally manageable by prescribed medications.

3. Drains are usually removed within 7-10 days.

4. The garments for compression must be worn for a long time

A Short-Term Recover (2-6 weeks)

1. Gradual return to activities of daily living

2. Avoid stretching, lifting or performing strenuous exercise

3. Visits to follow-up on healing and the formation of scars

Lang-Term Healing (6 weeks or more)

1. The scar maturation process continues for 6 to 12 months

2. Final results of the chest contour become apparent

3. The sensation of the nipple can decrease, but it usually improves with time

Risks and Complications

While subcutaneous mastectomy is generally considered safe but it can be a risk as with any surgical procedure.

Common Risks

1. Hematoma and bleeding

2. Infection

3. Seroma (fluid buildup)

4. Nipple necrosis, or loss of the nipple sensation

5. Asymmetry or poor scarring

6. The need for revision surgery

How to Minimize Risks:

1. Choose a qualified, board-certified plastic or reconstructive surgeon

2. Follow all post-operative guidelines

3. Do not smoke and lead the healthy life style

Subcutaneous Mastectomy for Gender-Affirming Care

For transgender males or people who are not binary the procedure can be an significant, positive step towards their transformation. Also known by the name of the FTM Top Surgery It creates an appearance that is more masculine that can enhance:

1. Self-esteem and body image

2. Health outcomes for mental health

3. Confidence in the community and everyday comfort

WPATH Guidelines:

The World Professional Association for Transgender Health (WPATH) sets guidelines for gender-affirming procedures. Subcutaneous mastectomy is usually covered by these guidelines, and is often endorsed by insurance companies when it is documented.

Subcutaneous Mastectomy for Gynecomastia

Males who suffer from Gynecomastia or an excessive growth of breast tissue might consider subcutaneous mastectomy, if other methods (like hormonal therapy, or even weight reduction) do not work.

Cosmetic and Reconstructive Outcomes

The appearance of a subcutaneous mastectomy is contingent on a number of variables:

1. The anatomy of the patient and skin elastic

2. Surgical technique used

3. The experience from the doctor

In the majority of cases outcomes are very pleasing If needed, secondary revision procedures such as liposuction, scar revision or fat grafting could help to improve the look of the chest.

Conclusion

Subcutaneous mastectomy is a transformational and medically required procedure that can benefit many people. It can be performed to correct gender or gynecomastia, as well as benign breast problems The procedure can provide significant physical and mental benefits. When you choose the right surgeon and the right post-operative care the majority of patients will achieve positive and long-lasting outcomes.