Circumareolar mastectomy in female-to-male transsexuals and large gynecomastias: a personal approach.

Breast reduction or amputation in female-to-male surgery presents a specific surgical problem: obtaining a good breast shape of the masculine type. Over a 2-year period, 17 patients (12 female-to-male transsexuals and 5 extreme gynecomastias) were operated on using the circumareolar approach for subcutaneous mastectomy. The nipple-areola complex was left on a very wide deepithelialized dermal pedicle, and the final closure of the wound was performed using a round-block technique followed by numerous fine sutures to reduce wrinkling. This technique provides naturally flat masculine breasts, leaving sufficient dermal vascularization for the nipple-areola complex which is of the utmost importance. All the patients were very satisfied with the result because of the periareolar scar only. Two areolar necroses occurred due to perforation of the thin vascular dermal pedicle: one superficial which epithelialized spontaneously in a short period of time and one deeper which required skin grafting.