Posters
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Abstract
Background: Many female to male (FTM) individuals that desire to live as male experience persistent psychological discomfort (e.g. gender dysphoria) related to anatomical sex. One method to change anatomical sex characteristics is top surgery. Top surgery, consisting of bilateral mastectomy and nipple-areola complex (NAC) placement, has been found to help alleviate gender dysphoria and improve quality of life. However, many techniques have been used to perform top surgery and standardized methods/recommendations are not currently available. Our goal was to analyze research on bilateral mastectomy and NAC to provide more optimal surgical gender-affirming care.
Methods: An electronic literature review was performed using PubMed and search included a combination of keywords “nipple areolar complex”, "transgender”, and “top surgery". Articles were included if the patients were FTM, published from 2017 onward, and mentioned mastectomy techniques and/or NAC surgical techniques. Reviews, surveys, and non-English publications were excluded. PRISMA guidelines were followed.
Results: The search yielded 147 unique articles; 24 met inclusion criteria. The articles explored various aspects of chest surgery for FTM individuals, especially mastectomy and considerations for NAC placements. Articles meeting criteria were synthesized to identify mastectomy techniques associated with patient satisfaction and successful NAC measurements.
Discussion: For bilateral mastectomies, surgical incision procedures vary. Surgeons consider grade of skin excess, breast cup size, skin elasticity, and BMI. Techniques consist of transareolar, semicircular, concentric, extended concentric circular, double incision with free nipple graft, and inferior pedicle. These techniques differ in incision size, glandular tissue removal, and scarring. Complications are minimal but can include hematoma, graft necrosis, hypertrophic scars, or keloids. NAC placement lacks a precise protocol but follows general guidelines relative to anatomical landmarks.
Conclusion: Given the growing rate of top surgeries and its importance, surgeons need to understand current knowledge on chest masculinization procedures. Future considerations should explore outcomes in racially diverse populations.
Recommended Citation
Bhatia, Sonya A.; Paz, Julia; Mourao, Nina; Baker, Kelsey; and Gadad, Bharathi Shrikanth, "Systematic Review of Literature on Gender Affirming Surgical Procedures for Female to Male Transgender Patients" (2025). Research Symposium. 154.
https://scholarworks.utrgv.edu/somrs/2025/posters/154
Included in
Systematic Review of Literature on Gender Affirming Surgical Procedures for Female to Male Transgender Patients
Background: Many female to male (FTM) individuals that desire to live as male experience persistent psychological discomfort (e.g. gender dysphoria) related to anatomical sex. One method to change anatomical sex characteristics is top surgery. Top surgery, consisting of bilateral mastectomy and nipple-areola complex (NAC) placement, has been found to help alleviate gender dysphoria and improve quality of life. However, many techniques have been used to perform top surgery and standardized methods/recommendations are not currently available. Our goal was to analyze research on bilateral mastectomy and NAC to provide more optimal surgical gender-affirming care.
Methods: An electronic literature review was performed using PubMed and search included a combination of keywords “nipple areolar complex”, "transgender”, and “top surgery". Articles were included if the patients were FTM, published from 2017 onward, and mentioned mastectomy techniques and/or NAC surgical techniques. Reviews, surveys, and non-English publications were excluded. PRISMA guidelines were followed.
Results: The search yielded 147 unique articles; 24 met inclusion criteria. The articles explored various aspects of chest surgery for FTM individuals, especially mastectomy and considerations for NAC placements. Articles meeting criteria were synthesized to identify mastectomy techniques associated with patient satisfaction and successful NAC measurements.
Discussion: For bilateral mastectomies, surgical incision procedures vary. Surgeons consider grade of skin excess, breast cup size, skin elasticity, and BMI. Techniques consist of transareolar, semicircular, concentric, extended concentric circular, double incision with free nipple graft, and inferior pedicle. These techniques differ in incision size, glandular tissue removal, and scarring. Complications are minimal but can include hematoma, graft necrosis, hypertrophic scars, or keloids. NAC placement lacks a precise protocol but follows general guidelines relative to anatomical landmarks.
Conclusion: Given the growing rate of top surgeries and its importance, surgeons need to understand current knowledge on chest masculinization procedures. Future considerations should explore outcomes in racially diverse populations.
