Bilateral mastectomy

What is bilateral mastectomy?

A bilateral mastectomy is the surgical technique by which the tissue of the mammary glands is extirpated. This operation has the goal of attaining a flat, symmetrical chest that is anatomically and aesthetically male.

The operation

The patient will be admitted to the hospital centre on the same day as the operation. During that period, the pertinent controls will be performed and the patient prepared for the mastectomy.

To attain a flat, masculine chest, the team of surgeons at the Gender Unit of the Dr Ivan Mañero Platic Surgery Institute will perform a subcutaneous mastectomy that enables conservation of the mammary areolas (adapting them to the size of these in males) and the nipples. This technique is always performed under general anaesthesia and generally lasts from two to three hours. To perform the mastectomy, three distinct techniques may be used, mainly depending on the size of the mammaries:

Periareolar technique: When the breast is small this technique is often chosen. It consists of making an incision around the areola, through which the glandular tissue is extracted. This technique ensures minimal scarring.

Extended periareolar technique: This technique is often used for larger breasts. It basically consists of making a periareolar incision plus another one that extends towards the armpit region, through both of which the glandular tissue is extracted. In this case, the scars are more obvious than in the periareolar technique, though over time they may be concealed by body hair.

Free graft technique: when the mammaries are truly voluminous or when the patient is deemed a “heavy” smoker, the surgeon may opt for areola grafts during surgery.

All of these techniques can be performed both with reduction of the size of the areola and nipple, improving the end result in some cases, and with prior liposuction which would enable the size of scars to be reduced and improve the pectoral contour.

Recovery

During the operation, drainage catheters may be inserted in each breast to facilitate the exit of liquids retained in the area operated upon, thereby avoiding a haematoma. These drainage catheters are removed after 48 hours. Afterwards, the patient must use a compression belt, band or shirt for one or two weeks on the medical team’s criteria. This compression band avoids formation of haematoma and enables the skin to be modelled and adapted.

24 hours after the operation, the patient may return to their daily life, expressly avoiding expending physical effort or lifting weights.

Possible complications

The possible complications from this operation are:

  • Alterations in sensitivity in the nipple-areolar complex.
  • Loss of the nipple-areolar complex. This complication is not very common and tends to occur frequently in smokers with voluminous breasts. When this extreme occurs, it is possible to reconstruct the nipple-areolar complex using pigmentation methods or else by grafts of skin from the groin, which due to its darker pigmentation is similar to the areolar skin.

As well as the specific complications of this surgery, the following may also appear: haematoma, infection and anomalous scarring (keloids).