Subcutaneous mastectomy is a specialized surgical procedure used to remove breast tissue while preserving the skin and, often, the nipple-areola complex. This technique is commonly used in gender-affirming surgeries, treatment of benign breast conditions like gynecomastia, or in select cases of breast cancer prevention and treatment. With various techniques available, understanding the types of subcutaneous mastectomy can help patients and their families make informed decisions.
This technique is widely used in gender-affirming top surgery for transmasculine and non-binary individuals who wish to achieve a more traditionally masculine chest. It is also a common treatment option for gynecomastia (a benign enlargement of male breast tissue), which can affect men of various ages due to hormonal imbalances, medications, or underlying health conditions. Additionally, subcutaneous mastectomy may be performed as a prophylactic (preventive) procedure in women at high genetic risk for breast cancer, such as those with BRCA1 or BRCA2 mutations, or in select early-stage cancer cases where preserving the skin and nipple is oncological safe.
What Is Subcutaneous Mastectomy?
A subcutaneous mastectomy (also called a nipple-sparing mastectomy in oncologic cases) involves the removal of glandular breast tissue while leaving most of the breast skin intact. The nipple-areola complex (NAC) may or may not be preserved depending on the type of surgery and the patient’s health condition or preference.
It’s important to distinguish it from a total (simple) mastectomy, where both the breast tissue and skin (including the nipple) are removed.
Who Needs a Subcutaneous Mastectomy?
This procedure is typically recommended for:
- Male patients with gynecomastia
- Transmasculine individuals undergoing gender-affirming top surgery
- Patients with benign breast tumors or fibrocystic breast disease
- Women at high risk of breast cancer, opting for prophylactic mastectomy
- Selected breast cancer patients, where tissue removal is needed but skin preservation is preferred
Main Types of Subcutaneous Mastectomy
There are several types of subcutaneous mastectomy, each suited to specific patient profiles and surgical goals. Below are the most common approaches:
- Periareolar Subcutaneous Mastectomy
Overview :-
This technique involves an incision around the edge of the areola. It is commonly used in cases of gynecomastia and for transmasculine individuals with smaller chest sizes (A to small B cup).
Ideal For :-
- Mild to moderate breast tissue
- Minimal skin excess
- Patients who want minimal scarring
Pros :-
- Less visible scar
- Preserves nipple sensation in many cases
- Quick recovery time
Cons :-
- Limited access for removing large volumes of tissue
- May need revision if excess skin remains
- Double Incision Subcutaneous Mastectomy with Free Nipple Grafts
Overview :-
This is one of the most common techniques used in gender-affirming surgery for patients with larger chest sizes. It involves two horizontal incisions across the chest and removal of both the breast tissue and nipples. The nipples are then resized and grafted back onto the chest in a more masculine position.
Ideal For :-
- Medium to large breasts (B cup and above)
- Patients with significant skin laxity
- Those who prioritize a flat, masculine chest contour
Pros :-
- Allows maximum tissue removal
- Provides excellent contouring
- Nipples can be resized and repositioned
Cons :-
- Longer healing time
- Risk of nipple graft failure
- Larger scars
- Inframammary Subcutaneous Mastectomy
Overview :-
The incision is made along the natural breast fold (inframammary fold), through which the surgeon removes the glandular tissue while preserving the nipple and areola.
Ideal For :-
- Patients seeking cosmetic procedures
- Women undergoing prophylactic mastectomy
- Patients desiring breast reconstruction with implants
Pros :-
- Hides the scar under the breast
- Excellent access to breast tissue
- Good for future implant placement
Cons :-
- Not ideal for significant sagging
- Limited nipple repositioning
- Keyhole or Circumareolar Subcutaneous Mastectomy
Overview :-
This technique uses a circular incision around the areola to remove breast tissue. It’s suitable for patients with small to moderate breast volume and good skin elasticity.
Ideal For :-
- Transmasculine individuals with smaller chest sizes
- Minimal to no ptosis (sagging)
- Patients who want to retain the nipple
Pros :-
- Small, concealed scar
- Minimal disruption of surrounding tissue
- Retains nipple sensation in some cases
Cons :-
- Limited tissue access
- Risk of leaving behind tissue in larger chests
- May need revision for contouring
- Endoscopic Subcutaneous Mastectomy
Overview :-
A newer and minimally invasive technique, this approach uses an endoscope (a tiny camera) inserted through small incisions to remove breast tissue.
Ideal For :-
- Patients with small to moderate breast volume
- Those prioritizing minimal scarring
- Selected prophylactic or cosmetic cases
Pros :-
- Minimal scarring
- Faster recovery
- Reduced risk of wound complications
Cons :-
- Limited availability and expertise
- Longer operative time
- May not be suitable for large or saggy breasts
Risks and Considerations
As with any surgery, subcutaneous mastectomy comes with potential risks, including:
- Bleeding or hematoma
- Infection
- Scarring
- Loss of nipple sensation or viability
- Asymmetry or contour irregularities
- Need for revision surgery
Always consult with a qualified plastic or breast surgeon to understand the best type for your body and goals.
Recovery After Subcutaneous Mastectomy
Recovery time can vary based on the technique used. In general:
- Hospital Stay :- Often same-day or 1-day admission
- Drain Removal :- Within 1–2 weeks (if placed)
- Back to Work :- 1–2 weeks depending on job type
- Exercise :- Light activity after 2 weeks, full recovery in 4–6 weeks
Choosing the Right Surgeon and Facility
When considering a subcutaneous mastectomy, it’s essential to choose:
- A board-certified plastic or breast surgeon
- A facility with experience in your specific type of surgery (especially gender-affirming procedures)
- A team that offers post-operative support and aesthetic follow-up
Conclusion
Subcutaneous mastectomy offers a safe and effective way to remove breast tissue while preserving skin and, in many cases, the appearance of the chest. With multiple types available from periareolar to endoscopic methods the choice of technique should be tailored to the patient’s anatomy, goals, and health condition.
Consult a qualified surgeon, understand your options, and choose the best surgical approach for your needs. Whether you’re considering surgery for medical, cosmetic, or gender-affirming reasons, a well-informed decision is the first step toward a confident and healthy future.
