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Mr Andrew Yelland
Consultant Breast Onco-plastic & Cosmetic Surgeon

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Chest Reconstruction Risk & Complications

The risks of chest reconstruction vary according to the procedure performed.

SURGICAL RISKS

The risks should be considered along with the usual risks of anykind of surgery such as thrombophlebitis (blood clot formation), problems with anaesthesia, blood loss, infection, and death.

The risk of these occurring is minimal and efforts are taken to reduce their likelihood such as getting you moving as soon as possible after FTM surgery, staying hydrated, monitoring your respiratory and cardiac function, and administering antibiotics as necessary.

To help reduce the risks further it is important to follow your pre and post-surgery guidance as instructed by your physician.

RISKS SPECIFIC TO THE DOUBLE INCISION TECHNIQUE

The double incision technique is often performed on transmen with a larger body mass and comes with the risk of the appearance of "dog ears" under the armpits after chest reconstruction.

This is where excess skin protrudes at the end of the incision and may require further surgery to remove the skin.

Puckering may occur along the scars and require surgery to minimise its appearance.

Numbness under the armpits can be a complication of liposuction used during tissue removal which may resolve as traumatized nerves heal or could be a permanent result of nerve damage.

Additionally, nipple grafts may be lost due to tissue death and require further surgery to remove the tissue followed by additional FTM surgery to tattoo a replacement "nipple" if desired.

You may find that you are unhappy with the placement of the nipples or that they are asymmetrical.

It is important to remember that your chest will be swollen and tender immediately after surgery and that it takes time for your new appearance to settle down.

If, after sufficient healing time, you are dissatisfied with the size or appearance of your nipples then you may be able to have further reconstructive FTM surgery to reposition or trim them.

FUTURE SURGERIES

Many transmen have one or more chest reconstruction surgeries as part of their FTM journey.

Imperfections such as "dog ears" or areas of bad scarring can be addressed along with nipple problems and surgeons usually wait eight to twelve weeks before assessing the desirability of further surgery.

Surgical revisions may be included in the cost of your initial chest reconstruction surgery, although you are likely to have to pay additional costs for the surgical facilities and anaesthesia.

It is, therefore, important to understand what is included in any costs quoted.

RISKS SPECIFIC TO THE KEYHOLE/PERI-AREOLAR TECHNIQUE

Those undergoing a keyhole or peri-areolar procedure may find that their chest does not look completely flat and that uneven fatty tissue and skin can give the appearance of a breast reduction rather than a chest reconstruction.

This may be an initial effect of the swelling and bruising common immediately after chest reconstruction and you should wait for the inflammation to subside before considering further surgery.

In some cases there may have been insufficient retraction or trimming of the remaining skin leaving areas of sagging or puckering.

Where the peri-areolar technique has been used the drawstring procedure may give an effect of puckering around the areola requiring revision.

As the nipple is not removed and grafted during the keyhole and areola procedures it may be that final nipple placement is not ideal and that you would like further surgery to move the nipple to a more aesthetically "male" position.

It is also possible that numbness or alterations in sensation of the nipple may occur due to trauma from liposuction.

PSYCHOLOGICAL EFFECTS

You may find that you feel exhilarated and liberated after your chest reconstruction but it is common for an initial wave of euphoria to be followed by general ups and downs in mood.

It is normal to experience some difficulty in adjusting to changes in your body's feel and look, especially when also experiencing post-surgical pain and possible complications.

The reaction of other people to your FTM surgery can also present problems as it may be that family and friends realise for the first time that your issues with gender are not superficial or temporary and are unable to provide the support they offered previously.

Taking care to have a support network available to you in your recovery period is very important and you may feel that delaying surgery is preferable until a time where you have sufficient emotional resilience to face the psychological challenges gender confirmation surgery involves.

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