Chest masculinisation is carried out as part of gender reassignment surgery from female to male. The procedure consists of breast removal and reshaping of the chest to make it more masculine.
Chest masculinisation is a procedure for permanently reshaping the upper body into a more masculine form. People seeking this kind of surgery are transgender or non-binary, with an experience of their own body that does not match their identity. Although anyone can request the procedure, in practice it is required that the person be involved in a gender identity-affirming clinic’s assessment process.
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The result of masculinisation is permanent
Masculinisation is an irreversible procedure, which is why access to it is highly restricted. Often, the person seeking gender-affirming surgical treatment will have a diagnosis (F64.0 or F64.8) as a result of the gender identity research clinic process. In this case, the procedure may be performed as a medical rather than an aesthetic treatment. However, a diagnosis is not mandatory, and the person is welcome to discuss matters with a plastic surgeon during the research process.
The decision to proceed will be made by the operating surgeon, and typically patients are quite far along in the investigation process. Masculinisation is often the first and for some the only surgical procedure in gender-affirming surgical treatment.
Chest masculinisation starts with a consultation
The treatment process starts with a consultation with a plastic surgeon to discuss the person’s circumstances and their expectations of the results. The procedure, including the risks, recovery time and expected results, are thoroughly discussed and the most suitable surgical technique is then chosen. At the end of the consultation, a suitable surgery date is agreed.
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Masculinisation involves breast removal and chest reshaping
The procedure consists of breast removal followed by chest reshaping. The difference between masculinisation and a conventional mastectomy is that the breast tissue is not completely removed – instead, it is used to make the chest area more masculine.
An ultrasound scan or mammogram of the breast area may be performed before the masculinisation if necessary. This is done to ensure that there is nothing of particular concern in the breast area and that the procedure can be performed safely.
There are two general techniques. With the double curve technique, the scars are located around the lower edge of the pectoral muscle and in the areola. Another option is the technique of making an opening around the areola, in which case the scars will be left around the areola.
This is a fairly extensive operation, and is always performed under general anaesthetic. It takes about two to three hours, depending on the individual situation and the technique chosen. The person can usually be discharged the same day.
Aftercare at the Skin Hospital
Recovery from chest masculinisation takes about four weeks. During this time, the person must wear a supportive textile to help shape the chest and must avoid intensive exercise, sauna bathing and swimming. Depending on the person’s job or studies, two to four weeks of sick leave are usually needed. There should not be significant pain in the operated area, so over-the-counter anti-inflammatory drugs should be sufficient for pain relief.
There are always risks involved, the most common of which are infection or other problems with the healing of the surgical wound. In addition, chest masculinisation is associated with a roughly one-in-ten risk of postoperative bleeding, which may require a repeat operation in the emergency room. Typically, any such leakage occurs within 24 hours of the procedure. The clinical pathway at the Skin Hospital includes post-procedure emergency care, which will be agreed during the consultation. This means that any need for aftercare is considered, and the patient is not left alone.
Visible results of masculinisation after several months
The aesthetic outcome of chest masculinisation is usually good and what the person hoped for. The final result of the operation can be assessed only after six to twelve months, when the chest area has softened and shaped and the scars have matured.
The final result will depend most of all on the scar treatment, which the plastic surgeon will individually advise the person on. This process requires commitment, as the scars take months to mature. The scars are treated by regularly applying ointment, massaging and applying silicone tape. The aim is to ensure that the scars are as inconspicuous as possible at the end of the healing process.
A small number of people may sometimes have a corrective procedure carried out about six to twelve months after the initial surgery, once the final result of the chest masculinisation is visible. This is usually a scar revision or a minor operation to achieve greater symmetry across the chest.
