Mastectomy in female-to-male transgender patients: A single-center 24-year retrospective analysis

BACKGROUND: Mastectomy in male transgender patients is an important (and often the first) step toward physical manhood. At our department, mastectomies in transgender patients have been performed for several decades. METHODS: Recorded data were collected and analyzed for all male transgender patients undergoing mastectomy over a period of 24 years at our department. RESULTS: In total, 268 gender-reassigning mastectomies were performed. Several different mastectomy techniques (areolar incision, n=172; sub-mammary incision, n=96) were used according to patients’ habitus and breast features. Corresponding to algorithms presented in the current literature, certain breast qualities were matched with a particular mastectomy technique. Overall, small breasts with marginal ptosis and good skin elasticity allowed small areolar incisions as a method of access for glandular removal. In contrast, large breasts and those with heavy ptosis or poor skin elasticity often required larger incisions for breast amputation. The secondary correction rate (38%) was high for gender reassignment mastectomy, as is also reflected by data in the current literature. Secondary correction frequently involved revision of chest wall recontouring, suggesting inadequate removal of the mammary tissue, as well as scar revision, which may reflect intense traction during wound healing (36%). Secondary corrections were performed more often after using small areolar incision techniques (48%) than after using large sub-mammary incisions (21%). CONCLUSIONS: Choosing the suitable mastectomy technique for each patient requires careful individual evaluation of breast features such as size, degree of ptosis, and skin elasticity in order to maximize patient satisfaction and minimize secondary revisions.

Six years clinical experience with the dorsally pedicled buccal musculomucosal flap.

A dorsal pedicled buccal musculomucosal flap was developed to reconstruct medium-sized intraoral defects, too large for primary closure if major functional and esthetic impairment is to be avoided. Although free flaps, axial, or perforator flaps are excellent in large defects, they may not provide mucosal sensitivity, motility, volume, and texture to replace lost structures with similar tissue. Twenty-five flaps were performed in 24 patients, 1(bilateral) up to a flap-size of 60 x 35 mm, in average 45 x 34 mm. Reconstructed became the lateral mouth floor, lateral oral vestibule, lateral tongue margin, the oropharynx, hard and soft palate. Partial necrosis occurred in 1 flap, 22 (92%) patients recovered with good objective as subjective speech and swallowing, esthetics, and if necessary prosthetic rehabilitation. The donor site was closed primarily, mimics and mouth opening resolved after less than 3 months. The parotid duct had to be marsupialized in large flap preparations, never provoking stasis or infection. The 2-point sensitivity of the flaps was in average equal to the nonoperated mucosa in intraindividual correlation and the flaps lost in average 10% of their original size; 5 (21%) had weakness inflating their cheeks postoperatively. The results indicate dorsal pedicled buccal musculomucosal flap to be reliable and technically easy for reconstructing lateral intraoral, medium-sized defect that yields sensitivity, merely risking occasional buccal muscle weakness but facilitating the rehabilitation of oral function.

[The Er:YAG laser in dentoalveolar surgery]. / Der Er:YAG-Laser in der dentoalveolären Knochenchirurgie.

In contrast to many currently employed osteotomy techniques like saws or drills the use of short-pulsed laser light offers the possibility of non-contact and vibration-free bone cutting. With a wavelength of 2.94 microm the Er:YAG laser displays a consummate absorption in water and thus is particularly suitable for bone ablation. To examine the benefits of laser osteotomy in oral surgery a short-pulsed Er:YAG laser was used for different surgical procedures in 30 patients. Preliminary clinical findings revealed satisfactory cut efficiency and no carbonisation. No serious complications were encountered in the postoperative wound healing process. However, the surgical procedures were time-consuming.