Chest reconstructive surgery is a
surgical removal of excess breast tissue and
reshaping of the chest to a male contour.
This surgical procedure is not
the same as a mastectomy. Mastectomy is a
medical term used to describe drastic excision
of skin, nipples, breast tissue, fat, and muscle
in cancer patients. A total removal of the
nipples, underlying muscle and fat is a radical
mastectomy. Removal of breast tissue, even in
men who develop breast cancer, does not result
in a masculine shaped chest. A mastectomy by
itself would result in a concave chest front, no
nipples, and more obtrusive scars.
A male chest reconstruction,
will result with incisions and reconstruction
intended to result in a male contoured chest.
The operation usually takes 3 to 4 hours and
requires a general anaesthetic.
Excess skin and mammary glands are removed
through incisions in the chest. Fat is also
removed, leaving the right amounts in the right
places for a male appearing chest. Depending on
the size and shape of your chest, your surgeon
may also remove the nipples. They are sometimes
sutured (sewn) back on individually. Drains are
placed on either side of the chest and left in
place for several days to a week to drain excess
fluid from the surgical site. The sutures (or
stitches) are removed about a week after the
surgery.
Usually a binder is worn for a time after the
surgery to keep fluid from collecting under the
skin. This post-surgical compression also
assists the skin to adhere to the new position
against the chest wall on the ribcage. It will
take your body 3-4 weeks or more to recover from
the anaesthetic as well as the surgery
itself.
The surgeon will usually advise you to not
lift anything for a number of weeks. Ask your
surgeon for advice. Scarring usually looks the
worst at about six weeks due to the formation of
scar tissue. This may also be itchy, due to
healing. From six weeks to six months, the scars
gradually flatten and pale.
Your surgeon may need to make further
modifications. Sometimes there are 'dog ears'
(excess skin at the end of the incision), or one
side of your chest may appear to have slightly
more remaining tissue than the other side.
It can take up to nine-twelve months for the
surgical results to settle down fully before you
can really tell how it’s going to be for
the rest of your life. This all depends on your
age and general state of health.
Types of Chest Surgery
Keyhole —
A half moon or 'keyhole' incision is made on
the underside of the areola to remove the excess
breast tissue. Leaves almost no scars. Usually
used for patients with small to minimal breast
development.
Purse-string or peri-areola —
Same as keyhole except an incision is made
all around the areola. Often used for patients
who have large development or where there is
excess skin or breast development. The nipple
might be or might not be removed. The surgeon
may reposition the nipple section and nerves
after removing all excess tissue from the breast
section.
Elliptical Incision —
Used on those with larger chests or droopy
breasts. Incisions are two large cuts across the
chest to remove tissue and skin. Sometimes they
meet in the centre of the chest. Nipples are
sometimes re-positioned (usually higher on the
chest); it is also common that nipples are
entirely removed or grafted back on or remain
attached to the nerves to facilitate the
likelihood of sensation.
Inverted T (simple mastectomy) —
This is the same method as used for breast
reduction or mastectomy in women with breast
cancer. Incision is an upside-down T shaped scar
running downwards from each nipple.
Note on Smoking
Smoking can significantly affect the outcome
of your surgery and reduces the amount of oxygen
available to the cells for healing.
Smoking shrinks small blood vessels
(vasoconstriction), which then reduces the
amount of haemoglobin (red blood cells)
available to your body and interferes with the
release of oxygen (fuel your cells need) to your
cells.
Smoking reduces the ability of your heart
and lungs to recover quickly from the effects of
surgery and it causes a further narrowing of
blood vessels which can cause a decrease or
obstruction in the blood supply (ischemia) of
the tissue, poor healing, bad scars, or actual
loss of tissue.
Nicotine gum and patches interferes with
healing in the same way as nicotine in
cigarettes.
Boost your outcome
- Aim to be in as fit condition as possible
leading up to surgery.
- Quit smoking.
- Workout up until your surgery - Getting
your chest as developed as possible will
assist your surgeon. It makes it easier for
your surgeon with contouring, nipple
placement, and scar placement.
- Plan to leave at least four to five
months before strenuous exercise such as
lifting weights or hard physical
exercise.
Chest Reconstructive Surgery — part 1
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